Local Anesthesia Toxicity?

Question

I am scheduled to have a face/neck lift with local anesthesia and just some oral sedation (Xanax). I had another surgeon tell me this week that it was impossible to do this without giving a toxic dosage of local, and that it was also dangerous because no one would be monitoring my blood pressure or vital signs. He said he had seen many things go wrong this way. Can someone please enlighten me as to how true this is?

Carey Nease, MD · Answer

First of all, it it absolutely possible to do this procedure under local anesthesia safely. The tumescent technique has been done for over 30 years and is very safe, including for liposuction, mini tummy tucks, neck lifts, etc. However, you should still expect to be monitored by a nurse during the procedure for safety and the center should have what we call life safety equipment just in case of emergency, which should be rare but still possible. The question you should ask is, "can I handle being awake for the procedure?" as there will be some mild pain and discomfort while getting the areas numb (shots). If you are an anxious person or have a low pain tolerance then don't do it without IV sedation, which is what I prefer. Hope that helps!

Ryan Rebowe, MD · Answer

What you are describing is a way to perform a facelift more or less "awake" but under heavy sedation, meaning there is no general anesthetic utilized. There are many surgeons, especially older surgeons, that have done this in the office for many years without any issues and with patients extremely comfortable (and, might I add, with excellent results). The surgeon that is warning you is correct that when performed incorrectly, or by an inexperienced or poorly trained surgeon, local anesthetic toxicity is a major concern. In the end, if this is the option you choose to pursue, I would ensure that your surgeon is well trained and has extensive experience performing these types of procedures in this manner.

John Michael Thomassen, MD · Answer

Facelift under local anesthesia is a safe procedure; however, your surgeon should carefully monitor the amount of local anesthesia used.  Your vital signs should also be monitored during the procedure.  If done properly, it is a safe way to undergo this procedure without the risk of general anesthesia.

Lucian Ion, FRCS · Answer

Hello,

Thank you for your question regarding the safety of having a facelift and neck lift under local anaesthesia with a small amount of oral sedation.

Safety Considerations:

Facelift and neck lift surgeries can vary significantly in their extent and complexity. Here are some important points to consider:

1.	Limited Interventions: Under local anaesthesia, it is usually possible to perform more limited procedures. These can still produce adequate results, depending on the specific characteristics and needs of the patient. For example, a mini-facelift or a less invasive neck lift might be suitable.
	2.	Complexity of Deep Plane Procedures: A deep plane neck lift, which involves accessing deeper layers of tissue and muscle, is more complex and typically requires a higher level of anaesthesia. Performing this procedure under local anaesthesia with mild sedation is unlikely to be successful due to the difficulty in accessing deeper planes and the increased risk of complications.

Recommendation:

For more extensive procedures, such as a deep plane facelift or neck lift, it is generally recommended to use general anaesthesia or a higher level of sedation to ensure both safety and optimal results. However, for less invasive or more limited interventions, local anaesthesia with mild sedation can be a safe and effective option.

Selcuk Inanli, MD · Answer

Hello! Thank you for your question.
As far as I can understand from your question I recommend that you have all surgical operations under general anesthesia, both psychologically and the right thing is to have this surgery under general anesthesia.
It would be better face to face consultation.
Best Regards!

Michal Brichacek, MD · Answer

This is not true. It is possible to safely perform a facelift with local anesthetic with oral sedation, and I do many facelifts in this manner. The local anesthesia is diluted to a safe level to ensure that local anesthetic toxicity is not a concern.

Stephen Prendiville, MD · Answer

This is a question that I have encountered many times in my years as a Surgeon. First of all, it's important to recognize a few things in this question: 1) Local anesthesia is better for straight forward limited cases, 2) Local anesthesia toxicity is a rare but real consideration (and very serious for Bupivicaine), 3) Most people won't sit in a lounge chair for longer than 30 minutes, so don't discount the impatience factor, 4) Most people are far more anxious about procedures under local anesthesia than they initially realize, 5) Local anesthesia cases are often marketed as a "benefit", when there is far more to the picture than described. 
Because of all of these factors, it is my opinion that local anesthesia facelifts aren't a bad idea........ they are a horrible idea for most patients.  If you need significant facial rejuvenation, it's not going to be a "simple" case, especially in the neck.  You don't want the Surgeon racing the clock for your Facelift, you want it performed correctly.  And the answer to your question is that local anesthesia does carry the risk of toxicity.  Rare, but significant if it occurs.

Jeffrey M. Darrow, MD · Answer

It is easy to calculate the maximum dose of local anesthesia that a patient should receive.  If the dosing is kept under this, it should be safe.  If you were only having a mini facelift, only a relatively small area of skin needs to be numbed, and you would easily be within the safe range, and this could easily be accomplished with local anesthesia and sedation. As the extent of the facelift expands, more local anesthesia would be required, and it would be prudent to have someone monitoring you.  Having said that, there are people who perform full facelift in their office. I would check with your plastic surgeon to see if they have extensive experience with this. Best wishes.

Robert M. Wald, Jr., MD · Answer

Yes, you can have a facelift under local anesthesia. The mixture of lidocaine will be very dilute and will not be toxic. There should be a nurse present taking your vital signs during this procedure. Please realize, this procedure under local can be difficult in patients with low pain thresholds.

Ajaya Kashyap, MD · Answer

Thank you for your query. I have done several facelifts under local anesthesia. The dose of local anaesthetics, for simple face and neck lifts, can be kept well within safety limits. However, if you need a more extensive face and neck lift ,general anesthesia may be preferable. It all depends on the experience and comfort of your surgeon. Please discuss all your concerns with the surgeon you have chosen, who can even have you talk to some other patients that he has operated on using local anesthesia. All the best!

Local Anesthesia Toxicity?

Answers (19)

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