My doctor said he could perform my facelift under local anesthetic and just give me some sedation. I am 42, would general anesthesia be safe for me? I don’t know what is worse – the general anesthesia, or not being fully knocked out.
Anesthesia Used During a Facelift?
Doctor Answers 103
Anesthesia Used During a Facelift
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.
Facelift anesthesia depends on your tolerance for discomfort
Almost all modern facelifts are performed with local anesthesia. The question then is only what sedation you administer in addition to the local anesthetic, and who administers it. The options are no sedation, oral sedation alone (i.e. valium), deep intravenous sedation, or a light general anesthetic.
When the airway may be compromised, for example by bleeding during surgery, or in a patient with reflux disease, it is usually better to have the patient asleep with a tube protecting their airway.
In our practice, when a deep intravenous sedation or light general anesthetic are administered, these are performed by a board certified anesthesiologist (not the surgeon pushing drugs on his own) in an accredited outpatient surgery center or hospital.
For mini-lift type procedures in a compliant patient, a local anesthetic may be fine. For a patient having a full facelift with many ancillary procedures, deep sedation or a light general anesthetic may be preferable. Your doctor should be able to discuss with you all the options above. And remember, safety first!
Local anesthesia is best and you are still "knocked out" with deep sedation
I perform all facelifts under deep sedation with local anesthesia even though our office surgical facility is also accredited to perform general anesthesia. With local and sedation, you are completely unconscious and it is safer. I don't have to work around a tube in your throat and you wake up more smoothly.
For example, a large recent study showed that the only facelift patients who developed pulmonary emboli (very, very few) were those who were done under general anesthesia.So, for facelfts, I think local with sedation is better. I use general anesthesia for most breast and body operations.
But note that I am talking about DEEP sedation. Mild sedation does not work well for me. I don't want you uncomfortable or moving around while I am working on you. So the kind of sedation matters a lot. For deep sedation, you need a specially trained, board certified anesthesiologist. It is not any kind of a short cut.
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Depends on your health, type of facelift, anxiety level of patient.
Having used both techniques for more than 30 years I only use local anesthesia for the following patient: 1. patients who only require a" minilift " and the idea of surgery does not make them anxious. 2. Patients who medically cannot have general anesthesia, but can have local anesthesia. In these patients I always have an anesthetist to give IV medication to make the injections totally without pain. 3. Someone who absolutely refuses general anesthesia because of fear.
For all other patients, I use intubation or LMA anesthesia. It is very rare with our type of general anesthesia to have nausea or prolonged recovery. This gives us the best of all worlds. The patient has absolutely no pain, awareness of surgical sounds, and for longer surgeries is much more comfortable than with local. As for safety, in more than 30 years of doing this we have never had any anesthesia problem requiring the patient to receive hospitalization or serious problem. Doctors who use all types of anesthesia in their office will be better able to tailor each patient to the best one for each. Beware of the setting where the doctor only does local anesthesia because sometimes the doctor cannot get qualified anesthesia providers to give their anesthesia.
Local with IV sedation yes!
Having performed thousands of facial plastic surgery operations with both general anesthesia and IV sedation I can say with confidence that IV sedation has all the advantages of general anesthesia (patient comfort) and very few of the side effects of general. The main advantages of IV sedation anesthesia are:
- It does not require putting a breathing tube in the throat
- It does not require a breathing machine
- The recovery is much faster
- There is much less "hang-over" from anesthesia
- There is much less nausea
During IV sedation anesthesia a small flexible IV (intravenous) needle is placed into one of the veins of the back of the hand. Through this IV line, relaxing medication is given to make you fall sleep. The amount of medication given is adjusted to the specific needs of each person. After you are sleeping, some numbing medicine is also placed in the skin to numb the area that is being operated on.
The beauty of IV sedation is that during the procedure you are unaware of anything going on and cannot hear anything, yet you are still breathing on your own. When the procedure is finished, the relaxing medication is discontinued and you begin to wake up.
Because the medications used in IV sedation anesthesia clear the system rather quickly, most of our patients are able to go home in less than 15 minutes after the procedure is completed. For more information about face lift surgery under IV sedation visit:
Type of anesthesia best for facelift surgery
General anesthesia and local anesthesia with sedation are both good options for facelift surgery. You should probably stick with your surgeon's preference. When the sedation choice is used, I prefer that a board certified anesthesiologist be present for safety issues.
The more important question in my mind is appropriateness of facelift surgery in someone your age. I suggest you attain a second opinion before embarking on surgery.
Local with IV Sedation is the best compromise
The great thing about this website is that a prospective patient can ask a question and receive educated opinions. My opinion is that local anesthesia with sedation provides the best compromise of pain control, relaxation, and safety while allowing the surgeon to work efficiently. I use this technique for most cases (using a CRNA or Anesthesiologist), with the exception of rhinoplasty, where general anesthesia is employed. Can general anesthesia be performed safely? Absolutely. However, the downsides are as follows:
1) Intubation (placing an airway past the larynx into the trachea). The body will try intensely to protect the airway; placing a tube past this point causes a great deal of stimulation, and potential stress on the heart.
2) Pooling of blood in the legs or vasodilation. General anesthesia causes profound vasodilation, especially during induction, which increases risk of deep venous thrombosis (DVT), and possibly pulmonary embolus. It is the standard of care for use of compression hose and/or sequential compression devices to minimize risk of DVT during general anesthesia. All patients undergoing local anesthesia with sedation or general anesthesia in my facility have both devices placed prior to induction of anesthesia.
3) Drug hangover. Inhalational anesthetics are stored in body fat and there can be some drug after effect for several days. An exception to this is Sevoflurane, which has a relatively short half life. Inhalational anesthetics have a relatively higher incidence of postoperative nausea, which impedes recovery.
In summary, it is best to follow a path that you and your surgeon are most comfoprtable with. For the majority of my cases, local anesthesia with sedation is employed. However, there are circumstances (abdominoplasty, rhinoplasty, etc) where general anesthesia is more ideal for patient comfort and airway control.
Both are O.K., my preference is sedation.
Advantages of general anesthesia:
- No pain with injections
- Ease for the surgeon
Disadvantages of general anesthesia:
- Higher risk (arguably)
- Higher cost in some practices where an in office procedure can be done with sedation but not general anesthesia
- More nausea associated with general anesthesia
- Blood pressure can increase on waking which can lead to hematomas
The procedure can be done either way and I have and do both. My preference is excellent local anesthesia with sedation for the reasons discussed above.
Local anesthesia with sedation is excellent for facelift
The sedation our Center provides is a deep or twilight sleep. The medication is "dissociative" or in other words the patient is breathing and responsive though unaware. We have preferred this technique because we have had less nausea than we have with general anesthesia and our patients have done very well and been free of discomfort. Nobody wants to be uncomfortable or feel anything and sedation has been an excellent solution for us.
Sedation and anesthesia take skill, training, and careful monitoring. Be sure to ask where your procedure will be performed and who will provide sedation and monitoring during your procedure. The Center should be certified by AAAASF, or another of the major certification organizations. This is your assurance that your surgeon maintains high standards of care and safety.
Sedation or general anesthesia can be a personal choice and both work well. Safety is not an option.
Best of luck,
Long Lasting Results & Patient Comfort / Safety with Local Anesthesia
I agree with the excellent and comprehensive advice given here.
As a Surgeon who has performed over 1,000 Facelifts with local anesthesia (with mild sedation as requested) I wanted to add a few comments.
In my experience long lasting and natural looking results are easily accomplished with local anesthesia. I have found over the years that in patients with mild to moderate aging changes, in their 40s and 50s and good overall medical health, equivalent results can be acccomplished with local anesthesia that are seen with general anesthesia.
I no longer utilize SMAS plication only procedures as I feel that indeed the duration of the results is not optimum. Rather a combination of cranial suspension with some form of subSMAS elevation provides excellent results that are very durable. These techniques can be easily, safely and comfortably accomplished with local anesthesia.
Also over the years I have started to use tumescent solution (a mixture of local anesthsia, epinephrine, saline and sodium bicarbonate) which allows for safe levels of local anesthetic, mechanical plane dissection, excellent hemostasis and a comfortable injection experience for the Patient.
Platsymaplasty / Neck Lifts or liposuction can also be performed easily at the same time using tumescent solution ensuring that the neck / area under the chin is also completely addressed.
Patients with moderate to severe aging changes or who are undergoing multiple facial rejuvenation procedures are encouraged to undergoe the process with IV Sedation or General anesthesia.
You are asking all the right questions. Continue to do your research with your Physician and in the end you will be able to arrive at an approach that you are both comfortable with and confident in that will get the very best results for you in the safest way possible.
Always speak with Patients who have already had the type of procedure you are considering at least one year ago to gain some valuable insight from their experiences.