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.

Is tumescent anesthesia inherently safe when appropriate doses of local anesthetic are used? Yes. The real question lies in your preference to avoid having sedation. Is this the best way to achieve the best result possible? In my practice, I ask patients how long they are comfortable sitting in a beach or pool chair? My deep plane facelift takes about 3 hours, an endoscopic browlift about 20-30 minutes; I usually perform both together during the same procedure event. In my opinion, this exceed the patience level and sometimes duration of feeling aware and anxious about the procedure. Therefore, I perform all of my facelifts under sedation. However, it's not wrong to pursue the avenue that you are seeking.

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

A facelift can be done under local anesthesia although it is not my preference. Make sure you are clear regarding any sedation that is given as well as how you will be monitored the procedure. .

In our practice, we do not recommend TA anesthesia for a variety of reasons. When performing the deep neck lift procedure, it's important to be able to see the anatomical structures that we are removing rather than having being completely obliterated by too much fluid. For patient safety and comfort, we also perform all face neck lifts, and brow lifts under general anesthesia. You could also undergo the forehead lift and facelift simultaneously under one anesthesia with one recovery.. Choose your surgeon very wisely based on studying their before and after facelift and forehead lift photo gallery to make sure that there it is extensive with natural results that you like.