I am considering a facelift, age 56. Excellent health. Two of the four consults I have had prefer IV sedation, the other two, general. The estimated time for the surgery is 4.5 hours. This is consistent among all surgeons. The costs is approximately $3000 difference for general. I have been reading pros and cons to both. What factors should I consider in making my decision?
Factors to Consider when Deciding for a Facelift?
Doctor Answers 24
Face Lift factors
The factors to consider when deciding on a facelift should be centered on your needs, the surgeons experence,their training and case volume. Your surgeon should be able to show you similar patients that demonstrate the agging face changes you see in the mirror. I would not use the type of anesthesia or place of the procedure as primary decision point.
General anesthesia allows the surgeon to focus only on achieving the best facelift
The most important factor if facelift is the skill and experience of your surgeon.
The advantage of local anesthesia is that you are less likely to have nausea post op and you will "bounce back" quicker.
However, I prefer general anesthesia because it allows me to focus entirely on achieving the best possible facelift result.
Often, the most important technical details of the facelift occur near the end of the operation, and often after the time taken for dissection and preparation, local begins to wear off and the surgeon is distracted having to re inject more local for the patients comfort-which distracts attention from the actual facelift operation.
However, you are correct in seeing multiple surgeons. Choose the doctor you are most comfortable with, the one you fell confident about and trust to take good care of you. Trust your "gut feelings' about ythe doctor, and follow that doctors advice.
Facelift anesthesia types
Modern superlight anesthetics are quite safe, especially if performed by an anesthesiologist with hospital credentials who has specialized in outpatient cosmetic surgery anesthesia.
IV sedation, when performed for a long case, is best performed with an anesthesiologist, not by the doctor himself in my opinion. The reasons for this are many. When local anesthesia is administered, the pulse and blood pressure can rise. The patient can have an unexpected allergic reaction. The patient can have increased airway resistance if they are or were asthmatic. They can experience low blood pressure requiring careful calculations of the fluid administereds, the medical history and the medications the patient takes.
Who will identify and definitively treat these problems if they arise?
I hope it is not the doctor who is busy doing surgery.
The price differential you have cited leads me to believe that IV sedation with no anesthesiologist is being proposed for a facelift taking 4 1/2 hours. I would not have surgery under those conditions, nor would I allow a relative to (if they listened to me).
It is usually not wise to cut corners when buying a parachute, or when having plastic surgery.
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Anesthesia considerations for facelift
There is no single correct answer to this. I use a CRNA (nurse anesthetist) and would be very comfortable having her give me anesthesia. It is more a matter of preference than any demonstrable safety issue. Recovery after anesthesia may be a little bit faster with IV sedation than general. In either case the experience should be a comfortable one for you so go with the surgeon you think will do the best job.
Anesthesia for facelift.
1) The most important point about anesthesia for facelifts is that it be given by a board certified anesthesiologist (an MD) experienced in cosmetic surgery anesthesia. The blood pressure has to be maintained low and stable, and you have to wake up very smoothly.
2) In our office surgical suite in New York, I prefer deep intravenous sedation and local anesthesia. But general anesthesia is fine too.
3) If general anesthesia is used, then you need an endotracheal tube. An LMA (laryngeal mask airway) cannot be used because it distorts the neck.
Decision making for a facelift
It sounds as though you've done your homework! As long as you're comfortable with your surgeon, you like his/her before and after pictures, and you're comfortable with how your post-operative care will go you should be in good hands. Don't let price dictate your surgeon choice as you may be disappointed in the end. Good luck!
This is a good questions that there may not be a perfect answer for. First you should decide on the surgeon not the anesthesia. But having said that, you need to make sure that there is an anesthesiologist and that they are board certified as well. Then I would say take it from there.
The issue I have with IV sedation for such a long procedure is that the risks increase for problems because the anesthesiologist is leaving the breathing up to you, who is going to be sedated. So there is a fine line between good anesthesia where you wont feel anything and you stopping breathing. That is why I prefer general anesthesia, as do most plastic surgeons for longer procedures.
IV Sedation vs. General Anesthesia for Facelift
Nowadays there is a fine line between IV sedation. IV sedation means that no tube is in your throat and you breath on your own. In addition local anesthetic is infiltrated into the tissues to help with pain control and bleeding. Many surgeons have an nurse anesthetist do the sedation as they perform the surgery. The surgeon is then the physician responsible for both the surgery and the anesthesia.
General anesthesia for cases like this is different then it used to be. In the past an endotracheal tube was inserted through the vocal cords into the trachea and the ventilator breathed for the patient. However, today instead of this kind of tube an LMA tube is used. This tube sits in the back of the throat. So instead of the machine breathing for you, you breath on your own.
The difference is that should you need deeper sedation during the surgery your airway is protected and deeper sedation is possible. With IV sedation the airway is not protected. Therefore, it's less safe.
I perform all of my surgeries with this LMA general anesthesia in a hospital with a Board Certified Anesthesiologist. It's safe and patients aren't subjected to remembering being in an uncomfortable operating room.
The type of anaesthesia is usually surgeon preference. They have similar risk and the same potential for nausea- the most dredded aspect. There are arguments for both and in the end the surgeonhas to be happy to do your surgery and you have to like your surgeon.
With Warm Regards,
Trevor M Born MD
IV or general anesthesis for facelift
My personal preference is general anesthesia but I am willing to perform the procedure under IV sedation. My general recommendations are that if a procedure is less than 2 hours then either is acceptable. However, it is difficult for anyone to remain still for more than this and therefore I recommend general anesthesia for longer cases.