Deep plane facelift under local anaesthetic

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!

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.

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.