Deep-plane facelift using using tumescent anesthesia - safe?

Thank you for your thoughtful question. Tumescent anesthesia (TA) is commonly used for less invasive procedures and can be appealing for patients who wish to avoid general anesthesia. However, when it comes to a deep plane facelift, my recommendation is to proceed with caution.
The deep plane technique involves working at a much more profound level — releasing ligaments and repositioning the SMAS layer and deeper facial structures. This requires meticulous dissection and hemostasis, particularly in areas like the neck and jawline, where bleeding can occur and needs to be controlled promptly and efficiently.
While it is technically possible to perform a deep plane facelift under tumescent anesthesia, I do not believe it offers the safest or most comfortable experience for the patient. In my practice, I perform all deep plane facelifts under IV sedation or general anesthesia, and always in a fully equipped hospital setting. This ensures the highest level of safety, comfort, and surgical control — both for the patient and the surgical team.
Regarding your second question, a brow lift can be performed as a separate surgery. Whether it should be done before or after the facelift depends on your anatomy and aesthetic priorities. In some cases, both procedures can be combined. I would recommend discussing this in consultation with your surgeon, who can assess your facial dynamics and recommend the ideal sequencing.

Hello, hope you are doing well. Thank you for posting your questions! Tumescent (local) anesthesia is safe, but it may not be very comfortable for you. It's sometimes done for cost savings because there is no anesthesia fee or no facility available to the surgeon to provide anesthesia. I perform all facelifts with general anesthesia or deep sedation and have no complaints from patients about that. On the other hand, I occasionally meet prospective patients for revision facelifts who have had their prior surgery performed under local anesthesia and it's not uncommon that they express some regrets about that. When I have an anesthesia provider present to manage the GA/sedation it allows me to focus entirely on the deep plane surgery and not need to be concerned with a conscious patient's experience. I would recommend undergoing brow lift and facelift surgery concurrently, if possible--otherwise, sequence does not really matter.

Cheers,
Dr. Tower

Dear PeakDog,

It's not unusual for plastic surgeons to provide surgical surfaces in their office using the local anesthetic/tumescent anesthetic plus either IV sedation or oral sedation. Every practitioner is different in the amount of surgery that he has she will perform in the cirmumstances. In my opinion, performing a deep plane facelift , in my hands, under these conditions would be more challenging. I prefer that the patient have general anesthetic so that I can move more efficiently and safely. This doesn't mean that this practitioner cannot perform a deep facelift under these conditions. You will have to trust his or her judgment if you decide to move forward.

Best wishes,

Earl Stephenson, Jr, MD, DDS, MBA
ESJ Aesthetics