Deep plane facelift under local anaesthetic

Question

I am truly perplexed. 52yr, healthy, non-smoker, but NO plastic surgeons here will consider a facelift procedure without GA considering anything else unsafe while in US and Europe it is the norm. The scientific literature supports the increased safety of LA and better recovery. Im curious as to the driver of this decision as all surgeons have got patient safety as the core concern, yet so polar opposite views. Thanks.

Mitchell Hagen, MD · Answer

Hello and thank you for this question! This is a very interesting topic with answers that can vary dramatically. The vast majority of facelifts are currently being performed under general anesthesia and this has historically been the case for some time. Some surgeons will not deviate from this. A small percentage of facelifts are being performed with local anesthetic (numbing injections) plus deep sedation with an anesthesiologist. This means the patient is breathing on their own and can respond to painful stimuli, but is unconscious and not aware of what is going on around them. An even smaller percentage of facelifts are being performed with only local anesthetic only. There is a balance between being able to perform surgery safely for several hours with the patient's ability to remain comfortable during a lengthy surgery. I cannot speak for every surgeon, but the tendency appears to be much shorter surgeries with these local only procedures. The only way to shorten a surgery is to do less dissection and hence is why some of these patients can have less of a result. I would caution you to weigh the pros and cons of the surgical result as well as the specific anesthesia protocol. In my practice, most of my patients get either general anesthesia or a deep sedation and I find this allows me to give them consistent results that meet their aesthetic goals. It is also typical for most of my patients receiving a facelift to have additional procedures at the same time (blepharoplasty, lip lift, etc) and this is another reason for anesthesia. That being said, there are always exceptions and I encourage you to have this discussion with several surgeons before deciding what is right for you. I hope this helps and gives some perspective from the surgeon's point of view. Good luck with your decision!

Kevin Sadati, DO · Answer

For the past 20 years, I have specialized in performing facelift surgeries using local anesthesia and twilight sedation, ensuring a safe and comfortable experience for my patients. More recently, I have adopted the advanced Preservation Deep Plane Facelift technique, which I also perform under local anesthesia with twilight sedation, eliminating the need for general anesthesia. This approach has consistently proven to be well-tolerated by patients, offering effective results while minimizing the risks associated with deeper sedation methods.

Lucian Ion, FRCS · Answer

Although a deep plane facelift with intravenous sedation is very common in the US, it is practiced less frequently in Europe. The available statistics do not show a clear safety advantage for local anesthesia with intravenous sedation compared to general anesthesia, despite this being a common belief.

Post-operative recovery with intravenous sedation may be easier in some cases because there is a lower risk of nausea and a reduced risk of deep vein thrombosis (although this risk is not entirely eliminated). However, pure local anesthesia for a deep plane facelift presents significant challenges. The potential for patient movement during dissection around the facial nerves is a significant concern, as it increases the risk of nerve injuries.

With modern general anesthesia, the difference in recovery is relatively minimal, provided that bleeding during and after the operation is well controlled. This ensures a smoother overall process regardless of the type of anesthesia used.

David K. Isaacs, MD, FACS · Answer

I typically perform the deep-plane facelift with IV sedation and not with general anesthesia or just local anesthetic. Patients are much more comfortable this way both during and after surgery.

Gerald Minniti, MD, FACS · Answer

I've watched many a colleague perform facial rejuvenation surgery with an anesthesiologist who doesn't use a dedicated airway (endotracheal tube or laryngeal mask), and only administers intravenous medications. This is the most common scenario that a marketing savvy surgeon and the lay public would call 'sedation' anesthesia. However, I can assure you that it is not. It is general anesthesia. What you and the public don't understand is that these names for anesthesia actually are tied to levels of consciousness, not whether someone was intubated or not. In the case of true sedation, a patient can react to auditory stimuli, like calling out their name, and certainly to painful stimuli in an area that has not also gotten local anesthetic. As I mentioned already, this not the case for patients having facelifts; they are not responsive to painful stimuli and will not respond to loud auditory commands, so they are under general anesthesia regardless of how it appears.  Further, there is NO STUDY showing that 'sedation' anesthesia is safer than general anesthesia, and in fact the opposite has been shown: sedation has a bad track record for deaths. Do you remember the famous comedian Joan Rivers? Finally, you are incorrect about the US. Facelifts performed by board certified plastic and facial plastic surgeons are done using general anesthesia. It's safe and just as quick to recover from as 'sedation' anesthesia.

Ronald J. Edelson, MD · Answer

A facelift can be done under either local or general anesthesia. The place surgeons get into trouble is with local anesthesia along with heavy sedation but without an anesthesiologist in attendance to properly monitor the vitals signs and most importantly the airway.  This is true with facelifts as well as any other surgery.  Most of the disasters you hear about are because of over sedation without an anesthesiologist or nurse anesthetist present to properly monitor vital signs.  Although it rarely occurs, over sedation with l loss of the airway can be a catastrophe.  And it only has to happen once in a surgeons career

Reza Nassab, FRCS (Plast) · Answer

The deep plane facelift is an invasive procedure and often performed under general anaesthetic. It can be done under local and sedation but not commonly done just under local. The reasons are many and mainly due to the fact the it can be uncomfortable for the patient under pure local. In the UK most surgeons would do this under general.

Berat Cigdem, MD - Account Suspended · Answer

The decision often boils down to the surgeon’s personal training, comfort level with either technique, and the specific regulatory and healthcare guidelines of the country. It might be worth exploring more options or consulting with a surgeon who specializes in LA for deep plane facelifts, if available in your area.
PS - In my practice I preffered to do in a fully equipped hospital under general anesthesia, because I am trained to do so