Blepharoplasty/Facelift Anesthesia?

Hello Doctors, I want an upper and lower blepharoplasty AND a face and neck lift. I've read on RealSelf that doctors think patients should get both procedures down at the same time. I assume this surgery would call for general anesthesia. However, I also understand that it is preferable for a patient to be under local anesthesia during a blepharoplasty, as the patient is supposed to look upward during the procedure. Cost and downtime are less important than outcome. Thanks for your input.

Doctor Answers 19

Facelift and blepharoplasty under local anesthesia

Thanks for posting your question. I have performed thousands of facelifts, neck lifts, mini lifts, blephs, lasers and chin implants all under local anesthesia including (tumescent anesthesia) and oral sedation (valium). Done properly, patients are comfortable and have an easier recovery both mentally and physically.

Facelifts and eyelid lifts are very commonly and easily performed together. They can all be done under local anesthesia.  There is an art and science to this local anesthesia technique to acquire a high level of patient comfort. My patients do not even require a narcotic prior or during their their procedures thus reducing nausea caused by narcotics. The risks, both short term and long term, of general anesthesia are eliminated. Please consult with several board certified surgeons experienced in facelifting and also in local anesthesia techniques.

Orange County Facial Plastic Surgeon
5.0 out of 5 stars 86 reviews

Anesthesia for Blepharoplasty, Facelift

Your plastic surgeon and anesthesia provider will recommend type of anesthesia for your procedure.  The choices are local, intravenous sedation or general anesthesia.  The pros and cons should be considered and discussed with your surgeon.  Blepharoplasty can be safely performed with any of the options.  Ptosis repair which is a separate and distinct procedure as compared to blepharoplasty is one that some surgeons prefer to perform under local or mild sedation anesthesia so that the patient can open their eyes in adjusting eyelid position.

Craig Mezrow, MS, MD, FACS
Philadelphia Plastic Surgeon
5.0 out of 5 stars 17 reviews

Anesthesia for blepharoplasty and facelift

  Patients do not need to be awake for the blepharoplasty procedure.  Most patients are placed under general anesthesia, however IV sedation is also a possibility if the patient desires to be  sedated. The incisions are marked out on the eyelids prior to the surgery and patients are placed under anesthesia  for the eyelids and face lift procedures. Expect 3-4 hours of surgery to complete both procedures. Also important to have a board certified physician anesthesiologist present who can perform either general anesthesia or deep sedation. In addition it's also important to have the procedure performed in a certified  and licensed ambulatory surgery Center

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 143 reviews

Anesthesia for Eyelid Lift, Facelift and Neck Lift

Thank you for the great question. There are many options for anesthesia and the key is making sure that each patient has a safe and comfortable experience. In most cases, a sedation-type anesthetic can be used. This means that some supplemental oxygen is give through the nose and medications for relaxation are given through an IV.  This is the most common regimen that I use, and is appropriate for eyelid lifts as well as facelift and neck lift. In terms of being awake or waking up for a part of the eyelid surgery, this is only needed for dynamic repairs such as ptosis surgery, and is not required for a regular upper eyelid lift. Best of luck! 

Evan Ransom, MD
Bay Area Facial Plastic Surgeon
4.9 out of 5 stars 110 reviews

General anesthesia not necessary...

Upper and lower eyelid blepharoplasty can be done safely and effectively under local anesthesia, with light sedation, deep sedation or general anesthesia. An experienced surgeon would not need to have you look up during the surgery.

Though, I've heard of some surgeons do facelifts under local anesthesia with oral sedation, and although this costs the patient some money on the anesthesia front,  this is not the ideal scenario for the patient.

In our practice, we have excellent anesthesia providers that can provide both deep sedation without intubation, or general anesthesia depending on the patients neck anatomy and other variables [such as sleep apnea], and we treat each patient individually in deciding which option to go.

Ideally, I would recommend picking an experienced/talented surgeon that ALSO is affiliated with an experienced and versatile anesthesia provider that is comfortable in providing both general anesthesia [some doctors do not have this capability in their offices] AND deep IV sedation.

A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 37 reviews

Anesthesia for Facelift and Blepharoplasty

There are various opinions about the best anesthesia for facelift and blepharoplasty. I have used both local and general for each separately and together over the years. Presently I am using general anesthesia for both, either separately or together, and would not consider going back to local for either. My patients do better during the procedure and even recover faster now (the gases dissipate faster than the body excretes the sedation for the local). Also, lower blepharoplasty has changed and become more complicated in order to get maximum results safely. Because of this, I do more to the lower lid than I used to do. Patients definitely do not enjoy local for this procedure. To compensate for the patient looking up there are a number of things I now do to obtain the same result.

Robert T. Buchanan, MD
Highlands Plastic Surgeon
5.0 out of 5 stars 6 reviews

Blepharoplasty/Facelift Anesthesia?

        I think there is an easy compromise on this.  The eyelids can be performed under local anesthesia with or without light sedation.  General anesthesia can then be used for the rest of the facial procedures.  Find a plastic surgeon with ELITE credentials who performs hundreds of facial and eyelid surgeries each year.  Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results.  Kenneth Hughes, MD Los Angeles, CA

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 492 reviews

Eyes and face surgery

It is certainly possible to combine eyes and facial surgery together. I do them all the time.  I offer deep sedation or general for the procedure as well.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 28 reviews

Both Procedures Okay with General Anesthesia

It is very appropriate to have both procedures performed at the same time.  It is not necessary during a blepharoplasty to have the patient perform specific eye movements if appropriate planning is done prior to surgery. 

Dr. ES

Combination blepharoplasty and facelift

There are definite advantages not just financially to doing both procedures at the same time. The main advantage is one recovery time since a facelift can take up to two or three weeks to heal from depending upon the bruising. As far as looking upward during the procedure, that should not be an issue unless your physician is planning on removing a large amount of lower eyelid skin which I personally think looks unnatural and should be avoided. I prefer a more natural lower blepharoplasty using the transconjunctival approach or behind the eyelid that does not rely on the position of the mouth.

To answer the other part of your question, the choice of anesthesia should be up to you an your surgeon depending upon the overall comfort level of your provider. I prefer laryngeal mask anesthesia which is a light type of general anesthesia where patients go to sleep and wake up quickly but other types of anesthesia are also possible. Good luck.

Scott Trimas, MD
Jacksonville Facial Plastic Surgeon
5.0 out of 5 stars 20 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.