Is twilight sedation safe? Looking into neck/lower face lift.

Question

I had a consultation with a plastic surgeon for a neck/lower face lift. He explained that the twilight is safer but I am concerned as there is only a nurse to administer it. Would you recommend having this done without an anesthesiologist present. It is not a nurse anesthetist either.

David Hansen, MD · Answer

Never undergo general anesthesia if you can help it.  Local with a little iv sedation for complete comfort is so much safer and you can get better results since the doc can sit you up and fine tune the results which you can't undrer general. Since you are awake and comfortable, the RN or doc is always supervising you , and monitering you so don't be hesitant since you don't need the anesthesiologist at all.

Alejandro J. Quiroz, MD · Answer

Thank you for your questions. I perform the majority of my face lift under sedation and local anesthesia. Safety should no be different than general anesthesia. A preoperative evaluation is imperative and the surgical facility should be accredited preferable AAASF to assure that everything is is order if any condition is present.

Miguel Delgado, MD · Answer

Different surgeons have different preferences for anesthesia. For my practice I perform face lift surgery under general anesthesia administered by a board certified anesthesiologist for patient safety and comfort. For such delicate surgery, I do not want the patient to be moving. Be sure that your surgeon is Board Certified in Plastic Surgery. Good luck.

Arnold Almonte, DO · Answer

There are basically 3 levels of anesthesia available to patients undergoing cosmetic surgery: 1) general anesthesia, where you are unconscious and a machine breathes for you, 2) IV sedation, where you are unconscious but breathing on your own, then 3) local anesthesia where you are conscious abscess breathing on your own, but sedated with an oral medication. The choice of anesthesia is often decided by the surgeon, depending on the type of procedure. So discuss this with him or her. In our practice, facial operations are done under local anesthesia, but this is our preference. Practices will vary. I wish you the best!

Wayne F. Larrabee, MD · Answer

Each surgeon must make his or her own decision as to anesthesia. I have been through all stages from using a nurse for some sedation early in my career, to using a nurse anesthetist, to my current situation where we use only physician anesthesiologists. Although we never had a problem under any system it gives both myself and the patient reassurance that there is an expert present should there be an anesthesia or serious medical problem. I am especially fortunate in that the high quality anesthesia group at Swedish hospital supports my surgical center. I have a small group of superb anesthesiologists plus the back up expertise of a group of over 100. Anesthesia is so safe these days that I see no reason not to do general on all of my facelift patients. The vast majority are done this way. We will occasionally do monitored anesthesia care (MAC) at a patient request.  Some smaller "tuck-ups" are done under straight local with no IV sedation.

Robert Singer, MD · Answer

Intravenous
(IV) sedation is a reasonable option for many aesthetic procedures, including a neck and face lift . Most plastic surgeons prefer general anesthesia for breast
implants placed under the muscle. With either IV sedation or general
anesthesia, it is important that it be administered by an appropriate provider,
either a CRNA or ideally a Board Certified Anesthesiologist. Although some
surgeons administer their own anesthesia or have a nurse administer the medications, this is not optimal for safety, which
should be the primary concern. 
With
any cosmetic procedure that requires either type of anesthesia, it should be
performed only in a facility licensed or accredited by one of the national
accrediting organizations like the American Association for Accreditation of
Ambulatory Surgery Facilities (AAAASF) and the surgery should be performed only
by a fully trained plastic surgeon certified by the American Board of Plastic
Surgery and ideally, a member of the American Society for Aesthetic Plastic
Surgery (ASAPS). Accreditation assures that the facility has yearly
inspections, appropriate equipment, adequate safety protocols, appropriately
trained personnel, a full complement of resuscitation medications, and a
hospital transfer agreement. You need to be also aware that many states do not
require inspection or accreditation of office based surgical facilities and
that not everyone who calls himself or herself a cosmetic surgeon is
in fact a fully trained plastic surgeon.
 
IV
sedation is a reasonable option in the appropriate patient and in the proper
setting. 
 
Robert
Singer, MD  FACS
La Jolla, California

Kimberly Lee, MD · Answer

In general, when a facelift/necklift is performed a patient has a few options for anesthesia, including general anesthesia and sedation (e.g. twilight).  In my practice, I have my anesthesia performed by a board certified anesthesiologist for patient safety.  Patient safety is the most important consideration when undergoing an elective procedure.  Please consult with your plastic surgeon to convey your concerns.

William Portuese, MD · Answer

In our practice, we perform all lower face and neck lift procedures under general anesthesia by a board certified physician anesthesiologist for patient safety and comfort.  Having the surgeon and his nurse perform a twilight procedure  would not be advisable

Michael Elam, MD (retired) · Answer

Dear Rebecca, A licensed anesthesia provider such as an anesthesiologist or a CRNA should administer any medications in an office. I would check and see if the facility is a fully accredited operating facility. Generally for accreditation you must follow the standards of care for anesthesia. I personally have a fully accredited private operating facility and always use an anesthesiologist for any type of anesthesia. Best regards, Michael V. Elam, M.D.

David Alessi, MD - Account Suspended · Answer

The lower neck lift can be done under local, twilight or general.  All are safe.  We use an anesthesiologist but a nurse anesthetist is fine.  Best wishes.

Is twilight sedation safe? Looking into neck/lower face lift.

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