I visited a PS the other day and he said I can get a local & be awake for a SMAS & fat transfer. Is this reasonable?

He said it would take approx. 5.5 hours as he is going to do fat transfer too. Is this reasonable or should I be concerned. He has been in practice for 15 years and I was referred by a friend who has SMAS done by him.

Doctor Answers 10


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Yes, you can preform this under Local however, I prefer not too. Why would you want to be awake during this? 

Toronto Plastic Surgeon
4.9 out of 5 stars 521 reviews

Facelift under local anaesthetic

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Thank you for your question.
Yes this is possible, I have pioneered my Concept Facelift, which targets the SMAS muscle and skin, therefore giving the same longevity as a traditional facelift, however is performed under local anaesthetic.  This ensures a significantly reduced recovery period, with minimum swelling and bruising, therefore patients returning to their daily routines within 5-7 days. My reasons for pioneering this were because patients did not want the health risk of going under general anaesthetic (especially as is it not a necessity procedure), local anaesthetic or twilight sedation would be a great alternative, not only for health reasons but your recovery period will be shorter.  My patients will experience slight discomfort when injecting the local anaesthetic, then will feel very relaxed and calm throughout the procedure (please watch video).
Please make sure you find a reputable and qualified plastic surgeon who can assess you properly to give you a realistic idea of what outcome you can achieve. 
All The Best 

Facelift with fat transfer under local anesthesia alone

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A facelift with fat transfer can be accomplished under local anesthesia alone in very calm individuals. The longer I practice, the more I realize that getting beautiful, natural facelift results requires "thorough" surgery - shortcuts create suboptimal results. I consider myself an expert facelift surgeon, and it takes me 4 hours to do my best work of a facelift with fat transfer. For patients who are able to stay relaxed, and lie on their back for that length of time, local anesthesia is an option.

Laxmeesh Mike Nayak, MD
Saint Louis Facial Plastic Surgeon
5.0 out of 5 stars 230 reviews

Facelift without general anesthesia

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While you can have a face lift of any kind with local anesthesia, it is not what I recommend to my patients.  Even with local, the procedure can be quite uncomfortable and a patient's movement during the procedure can create a dangerous situation.  

SMAS Facelift and Fat Grafting under Local Anesthesia

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Dear pjs333:

The simple answer is yes. It is an option to undergo multi-hour procedures under local anesthetic but there are many considerations.

Local anesthesia, a combination of short acting lidocaine and longer acting bupivicaine with a vasoconstrictor epinepherine are tried and true medications to numb the skin. Too much of any of them and they can affect your sensorium or breathing or heart rhythm. Consider whether the surgical center is accredited and the physician is Board Certified with your best interests in mind. How will you be monitored? Are there other nurses or staff available to help the surgeon particularly if there is a adverse concern? You will feel the many needles use to numb the skin and maybe hear all that is going on (depending on the use of oral medications to allow sleep and pain control). Is this the type of experience you want?

The use of IV sedation anesthesia allows for a MD or CRNA (certified anesthetist) to provide the proper medications required to provide a wonderful sedative with amnesia and lack of pain or awareness while monitoring your vital signs. Current IV sedation techniques have a minimum of nausea and vomiting compared to general inhalant anesthesia. It is a great experience and one that I recommend to my patients.

The history in the increased use of local anesthesia for longer skin type procedures grew from good experience with the use of the medications but also from increased regulation with the use of IV anesthesia to be performed in regulated and accredited settings for the safety of the patient. 

You should receive a medical clearance for anesthesia and surgery whether or not you proceed with local only or local with IV sedation to be assured that you are at your optimum to proceed with a elective surgical procedure. 

I hope this has been helpful. Please consult with and review your desires with a well experienced Board Certified Plastic Surgeon or Facial ENT to provide you your best and safest results. 

All the best!

Dean P. Kane, MD, FACS
Baltimore Plastic Surgeon
4.9 out of 5 stars 103 reviews

Facial Rejuvenation Under Local Anesthetic

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This is a very reasonable approach as long as your surgeon is very experienced with this setting.  I have performed hundreds under this very scenario and it goes very smoothly.  A lift and fat transfer should only take about 3-4 hours at the most.  I agree that anything longer can be associated with some discomfort mainly from positioning.  Multiple injections are not the issue as was mentioned earlier.  If local anesthesia is delivered properly, then you only feel the initial few injections.  Every injection afterwards should be almost painless.  It's a technique that requires significant surgeon experience and awareness.  Come see me and I'll walk you through the whole procedure.  Adding an anesthesiologist for light IV sedation is also a reasonable luxury that doesn't really add to the risk or recovery.  I'll tell you what I think is the best approach for you depending on your medical history and personality.  

Justin Yovino, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 103 reviews

SMAS & Fat Transfer Under Local Anesthesia

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It is definitely possible to perform a SMAS face lift with fat transfer under a straight local anesthetic.  The question is why would you want to?  You will first require multiple injections into your abdomen or thighs to numb up the areas to harvest the fat for the fat transfer.  You will then need multiple facial injections to adequately anesthetize the face for the fat transfer and the procedure.  You would have a much better experience with the addition of sedation or even a light general anesthetic (which I prefer).

Michael Sundine, MD
Orange County Plastic Surgeon

Face lift under local anesthesia

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While it is possible to undergo a SMAS   face lift under local anesthesia, 5-1/2 hours is a long time to sit still  while  the procedure is being performed.  Most patients cannot tolerate that length of time for the procedure. In our practice, we place the majority of patients under a general anesthetic for patient safety and comfort. For many examples of a SMAS  facelift, please see the link and video below

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews

Anesthesia for SMAS facelift and fat transfer

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Most cosmetic procedures on the face and neck can be performed under a variety of anesthesia types.  The decision as to which type to use can be based on the specific procedure, the cost, and the preferences of the surgeon and patient.  It technically would be possible to perform a SMAS facelift and fat transfer under local anesthesia, but I would check with your surgeon to get more details.  Most likely, your surgeon was discussing local anesthesia with IV sedation, which would be more comfortable than just using local anesthesia alone.  There are deeper types of anesthesia that could be used as well.   

Michael I. Echavez, MD
San Francisco Facial Plastic Surgeon
4.5 out of 5 stars 18 reviews

I visited a PS the other day and he said I can get a local & be awake for a SMAS & fat transfer. Is this reasonable?

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While many procedures can be performed under local anesthesia, the vast majority of fully trained plastic surgeons who are board certified by the American Board of Plastic Surgery would tell you that performing a comprehensive SMAS lfacelift and fat transfer could be done under just local anesthesia and sounds appealing to a patient, but it is not a good idea.

Excellent artistic facelift surgery requires precision and a relaxed comfortable patient. In many offices that perform facelift surgery under just local anesthesia, the emphasis is on marketing, speed and cost cutting for the facility rather that the best outcome for the patient. The physician performing the procedure may not even be a board certified plastic surgeon. In addition, many of these facilities are not accredited nor routinely inspected by a national accrediting organization like the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF), AAAHC, or JCAHO. In fact, many would lack the basic requirements of sterility, personnel staffing, monitoring and safety equipment to even qualify for accreditation. Monitoring throughout the procedure is most safely performed by an appropriately trained anesthesia provider rather than by the operating surgeon, especially if any medication is given for anxiety or sedation.

Patient comfort, safety and an overall positive experience should be primary concerns. Just because something can be done doesn’t mean that it should be done that way.

Robert Singer, MD FACS

La Jolla, California

Robert Singer, MD
La Jolla Plastic Surgeon
4.6 out of 5 stars 22 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.