Does every facelift need to be done under general anesthesia?

This is a very common question for patients seeking facelift surgery. The level of anesthesia that is necessary is enough that you are compliant enough to allow the steps of surgery to proceed while not in pain or anxious, while still breathing for yourself. When more extensive neck work needs to be performed, it is best to have an airway placed, necessitating a deeper form of sedation. I prefer to have he least amount of sedation necessary to perform the task at hand, but sometimes general anesthesia is a better and safer option.

This is a common question that many of my facelift patients have. I favor deep sedation to general anesthesia for facelift surgery as it gives the patient the most comfort to allow me to execute surgery and give a perfect result. I understand the allure of avoiding general anesthesia, however, with a deeper understanding of the spectrum of anesthesia, I find patients prefer this approach over other types when weighing risks and benefits.

Anesthesia is best understood in the context of a spectrum of sedation. There are four levels of sedation: 1. Minimal, 2. Moderate, 3. Deep and 4. General anesthesia. The same types of anesthetic medications are used with each level of sedation---just varying amounts and combinations. Think of minimal sedation as taking a xanax prior to a minor procedure. This is common in dentistry and other fields. The patient can follow verbal commands, but may have some cognitive and functional impairment (i.e., don't drive yourself home!). With minimal sedation, you still feel pain, so your surgeon would inject numbing medication in your face while you are awake so that you don't feel surgery.
At times you may still feel pressure or uncomfortable sensations similar to having a cavity drilled and filled while you are awake. Moderate sedation is the next level of sedation where consciousness may be impaired, but you are still able to make purposeful responses to verbal and tactile stimulus. Similar to minimal sedation, the surgeon is relying on injecting local anesthesia to avoid you feeling the surgery. The next level, deep sedation, is where an anesthesiologist uses medications (usually through an IV) to decrease consciousness to the point where you may not respond to limited painful stimuli, but may still be able to breathe on your own. This is a common level of sedation used in colonoscopies and other similar procedures. In general anesthesia you do not feel painful stimuli. You may still be able to breathe on their own but often requires assistance from the anesthesiologist.

My preference for facelift surgery is the spectrum between deep sedation and general anesthesia. Once asleep, I comfortably inject local anesthesia into the surgical field so that you don't feel painful stimuli and the anesthesiologist may limit the amount of anesthetic medication (and therefore the level of sedation) is required. This not allows you to be comfortable during your procedure without experiencing pain, but also minimizes the untoward effects of anesthesia such as nausea and vomiting and speeds recovery.

I typically perform all of my face and neck lifts under local anesthesia (no general / no sedation). My Trl-Harmony lift is a mini deep plane, lower face and neck lift that uses advanced techniques to naturally lift the skin and deeper tissue of the face and neck (SMAS and platysma) - correcting the effects of aging and weight loss. This results in natural looking refresh of the face with minimal downtime and no anesthesia issues. This is often combined with CO2 skin resurfacing, neck liposuction, and fat grafting in the same procedure.

Check out the link below for more info on the Tr-Harmony Lift.

A detailed examination will help delineate the best surgical option and provide you a custom plan for your face and goals. Check out our "Instant" Consults at the link below.