IV Sedation and Local Anesthesia Safe Option for Facelift?

We do all of our regular facelifts under general anesthesia combined with local. In that way the depth of anesthesia needs to be much less. We also like to be able to control the airway.
For mini lifts in some patients, I will do them strictly under local after they have taken oral valium. If I use IV anesthesia I ALWAYS have it done by an anesthetist since I only want to focus on my job, not two.

I have performedwell over 2,500 facelifts under local anesthesia with oral sedation for thepast ten years. Without doubt it is safe and well tolerated by patients.Compare to the traditional facelift procedures that are performed under generalanesthesia, the post operative complications associated with local anesthesiacases are lower and risk of bleeding is minimized. I do not ask my patients tostop their HRT while undergoing facelift with local anesthesia that normallytakes less than two hours. The key to a successful facelift procedure usinglocal anesthesia is selection of the right patient by the surgeon and his orher comfort doing these cases.

Thanks for posting your question. I have performed thousands of facelifts, neck lifts, mini lifts, blephs, lasers and chin implants all under local anesthesia and oral sedation (valium). Done properly, patients are comfortable and have an easier recovery both mentally and physically. There is an art and science to this local anesthesia technique to acquire a high level of patient comfort. My patients do not even require a narcotic prior or during their their procedures thus reducing nausea caused by narcotics. The risks, both short term and long term, of general anesthesia are eliminated. Please consult with several board certified surgeons experienced in facelifting and also in local anesthesia techniques.

Facelift can generally be performed using 3 anesthesia options mainly 1) Local anesthesia with some oral sedation, 2) IV sedation with local anesthesia, 3) General anesthesia. It is best to discuss these options with your plastic surgeon. Not all plastic surgeons will be comfortable with all these options. The options available to you will depend on you and the experience of your plastic surgeon with that anesthesia option and the type of procedure. We have performed facelifts with all the options. Most of our patients prefer local with oral sedation, then IV sedation with local anesthesia, lastly general anesthesia.

 


Anesthesia Choices for Facial Aesthetic Surgery such as a mini-lift depend on several factors.
First off, I do not think the type of anesthesia influences either the recovery time or the amount of bruising. Although it is possible to do all of these procedures under local anesthesia - your comfort is the most important concern. You will have to lie still for hours and you will be aware in many cases of injections. For procedures more than 3-4 hours I would recommend IV sedation or a general anesthesia. The IV sedation for most means that you will remember little of most of the procedure and sleep for the majority of it. It is a good choice with less risks than a general anesthetic For local anesthesia cases I usually give Ativan or Valium before hand and most sleep for most of the cases without the need for an IV in healthy patients.

There are several good options for anesthesia during a facelift depending on what a patient desires.  


Local anesthesia with a minimal sedation (mostly awake) can be a good option for some patients who want to avoid general anesthesia.  Seek consultation with a surgeon who can perform this.

IV sedation is another good option.  Here an experienced anesthesiologist is very important.

General anesthesia is also a good option, in particular for patients who want to be knocked out.  


An experienced surgeon can guide you through the options of which anesthetic approach is best for you.

In our experience, I.V. sedation is a fine anesthesia option for facial aesthetic surgery. Personally, I avoid general anesthesia for facelift surgery. Waking up and restlessness can be avoided when the anesthesia service is provided by an experienced anesthesiologist.
At the end, listen to your intuition.

Dear Jacqui
It is certainly possible to perform a facelift under IV sedation. It is also possible to perform a facelift under just local anesthetic. The choice of anesthetic usually is determined by what the surgeon and anesthesiologist are comfortable with rather than any scientifically mandated requirement.
Surgeons often prefer general anesthesia because it eliminates subjective concerns of the patient. The surgeon is free to do whatever they need to during surgery because patient discomfort is largely out of the equation.
Anesthesiologists prefer general anesthesia because the airway is secure and the anesthesia machine can be used to significantly control and reduce the potential for human errors.
A facelift performed under IV sedation, for the most part, is considered a general anesthesia by the anesthesiologists. They have to work much harder to maintain the appropriate level of anesthesia. Too deep, and they need to step in and ventilate the patient; too light and the patient will begin to shift around.
To my thinking there are advantages to run a case this way but it is an art and it requires a willing artist. Many anesthesiologists seem to ADD and lack the attentiveness to run a case this way. In my experience, nurse anesthetists are much better at this skill.
I perform a number of facelifts in my office under local anesthetic and an oral valium. I have carefully screened these people ahead of time. Generally I have performed prior eyelid surgery on them in the office so I know they will be OK hearing things and can hold still the time it takes to perform surgery. The great advantage of this is minimal drugs in the system so you are not hung over by the anesthesia.
I encourage you to discuss these issues with your doctor. If nothing else, it is a test for how flexible and open your doctor is, which is a good trait to have in a surgeon.

I believe my patients are best served by having an anesthesiologist at ther bedside throughout surgery. It is what I would want for my family or myself. From my perspective as the surgeon, the most important issue is not the form of anesthesia but the credentials and experience of the person who is providing the anesthesia. The options that are available are the following: An anesthesiologist (board-certified MD)A certified registered nurse anesthetist (CRNA)An office nurse (RN) who is responsible for delivering and monitoring IV sedation Your plastic surgeon (believe it or not) administering sedation themselves or directing another person to do so In my practice II use experienced, board-certified anesthesiologists (MDs) for the anesthesia care of my patients. One of the many advantages operating in my own Dually accredited surgical suite is that the anesthesiologist is caring for my patient exclusively. The anesthesiologist remains at the bedside of my patient throughout the procedure.Beyond the issue of the person who is administering your anesthesia, the type of anesthesia really depends on what ‘facelift’ you are talking about, and what risk factors you may have for different forms of anesthesia. A mini-facelift generally takes one to two hours and can be performed in many patients under relatively light IV sedation. The only unpleasant portion of the procedure in terms of pain is the injection of local anesthesia at the very beginning. So the IV sedation is deeper initially for local anesthetic injection, and then once the entire surgical area is numb then the IV sedation can be lightened.A full facial rejuvenation surgical procedure (structural fat grafting, High-SMAS face and necklift, browlift, blepharoplasties, etc) may take six hours or more. These procedures can also be performed in many patients under prolonged IV sedation, which is referred to by anesthesiologists as MAC (monitored anesthesia care) anesthesia. To have a long surgery under IV sedation, you ideally should be under the care of an experienced anesthesiologist.By far the most important consideration from an anesthesia perspective is management (i.e. control of) a patient’s airway. If you can’t reliably provide oxygen delivery and carbon dioxide elimination, then you cannot conduct surgery safely. So experienced, board-certified anesthesiologists insist on some adequate and appropriate means of airway protection. For long IV sedation cases it is customary to pass a nasal airway (once a patient is sedated, of course) which goes in one side of the nose and into the back of the throat and helps to keep a sedated patient’s nasal airway open. It is removed before you wake up.Some patients will experience airway obstruction when sedated and laying in supine (on your back) position. If your snore heavily, and especially if you have sleep apnea, you are likely to be one of these patients. This in one of the reasons that a good anesthesiologist asks you so many questions before they perform your anesthesia: aspects of your history provide the anesthesia MD significant insight into what to expect and what to be particularly concerned about while you are under anesthesia.This is important to know: general anesthesia for elective cosmetic surgery, particularly longer cases, is an absolutely reasonable choice. In some patients it is the safest form of anesthesia – as your airway is completely. This is deeper level of anesthesia than IV sedation, and it requires a flexible, soft plastic tiube (either an endotracheal tube or laryngeal mask airway) to keep your airway open as the muscles that keep the airway open when you are awake will be relaxed. If you snore heavily or have sleep apnea, the safest form of anesthesia for you is general anesthesia with an ET tube or LMA.

I always do my facelifts under general anesthesia but use local anesthesia in addition to allow the anesthesiologist to keep the amount of general anesthesia to a minimum. Pts are less likely to feel woosey for an extended period of time. In my opinion, the patient is comfortable and I can focus on the surgery and the outcome.