Facelift six-hour surgery with local and oral sedation?

Question

I am planning to have a facelift, cheek lift, fat transfer, and laser in one operation. The doctor favors local with oral sedation. I am concerned that a six-hour procedure may have me aware and exceed my tolerance level. I'd love to hear from others who have gone through six-hour facial procedures under local with only oral sedation.

George Bitar, MD · Answer

With the proper experience facelift procedures can be performed comfortably under local anesthesia with oral sedation.  Having said that if you have concerns about your tolerance, discuss this matter with your surgeon.  It is ok to stage your procedure.  Best wishes.

Randy Wong, MD · Answer

Depending on your pain tolerance and the doctor's skill, this is very possible, but over a 6 hour procedure, both of you may be exhausted.  We try to keep our facial rejuvenations to less than 4 hours, but combining multiple procedures will need proper strategy and consideration for sequencing the local anesthetics properly.  Timing the length of local anesthesia effectiveness can be like conducting an orchestra when everything goes smooth, but we have so much more comfortable options to offer with IV sedation for anxious patients.  We make an effort to determine how each patient will tolerate these procedures for an easy experience and best results with the least amount of stress.

Michael I. Echavez, MD · Answer

While it would be possible to undergo facial cosmetic procedures with local anesthesia and oral sedation, I would not recommend it.  At a minimum, I would say that local anesthesia with IV sedation would be recommended but I normally limit the surgery time to 4-4.5 hours for this type of anesthesia.  If the procedure is longer, I would recommend either general anesthesia or at least monitored anesthesia, where a medication can be used in the IV to produce deeper sedation.  I find that patients can become restless after about 4-4.5 hours when a procedure is done with IV sedation.

Benjamin M. Maser, MD · Answer

Everyone is different.  Some people do really well with local and sedation, others do not.  That said, 6 hours is an awfully long time for local anesthesia and oral sedation to keep you comfortable, and I think you are at risk for exceeding your tolerance.  Your comfort will be much better assured with IV sedation or a general anesthetic, both of which are quite safe when performed by qualified physicians.  In our practice, facelifts alone or in conjunction with other facial procedures are performed in a fully accredited operating room under local anesthesia with IV sedation, or general anesthesia.  This maximizes patient comfort and safety.

Todd C. Miller, MD · Answer

Hi Crystal, this is a great question! Local anesthesia with oral sedation is a very reasonable option for a facelift. There are several things that you need to consider. First, it is important that the surgeon is experienced with this technique. The simple process of getting you adequately numb is critical. I have found the use of tumescent Lidocaine to be very effective. Your comfort during the procedure is very important. If you have back or neck pain issues, restless leg syndrome, or anxiety or panic disorder, local anesthetic might not be for you.Another consideration is the length of the procedure. Six hours is a long time to have to lay still. If you were my patient and I anticipated a procedure would take six hours I would probably encourage you to consider IV anesthesia at a minimum. I've had numerous great facelift experiences using local anesthetic but I always tell patients that the surgical experience is as important as the outcome.

Adam Hamawy, MD · Answer

It is possible and in some cases even better for you if you have the a facelift with laser and fat transfer under local and sedation.  However, it should not take six hours.  If it takes the surgeon that long to do it, then you probably should find someone that has some more experience.  That is too long under local or general anesthesia.

Samuel Sohn, MD · Answer

Hi Crystal8491,While it is possible to consider doing all that your doctor has suggested under a local anesthetic with some oral sedation (xanax or valium, and a narcotic such as vicodin or percocet), that doesn't mean it's the best way of approaching your facial rejuvenation.  It will be a difficult 6 hours for both you and your surgeon.  Longer procedures done under local will need to be timed appropriately due to the length of action of the local anesthetics - and be aware of maximum safe doses of the local if it needs to be readministered.  One of the most common complaints I hear with longer procedures under local is back pain while laying in a static position for a long period of time.  I myself try to limit local procedures to 2-3 hours max.  Please also make sure your doctor has the option of operating in an accredited surgical facility; some physicians who are not board certified surgeons only have the option of performing this type of surgery under local, as they are not able to obtain privileges to perform surgical procedures at a surgery center or hospital under a general anesthetic or conscious sedation.  Good luck with your intended set of procedures.

Dean P. Kane, MD, FACS · Answer

Dear Crystal8491:

I prefer
local anesthetic and intravenous sedation with monitoring by a anesthesia
provider. Most surgeons request general anesthesia provided by an anesthesia
provider too.

Local
anesthesia with oral sedation does not provide you the same level of monitoring
or anesthetic risk / benefit ratio.

Due to
the length of the procedure, under local / oral sedation, the surgeon must
perform the procedures during which he / she is also monitoring your vital
signs ( heart rate, blood pressure, respiratory rate, oxygen saturation and
level of consciousness). Longer procedures will expose you to greater levels of
local anesthetic risk whereas a "cocktail" of mixed sedatives or
inhalant anesthesia reduces this concern.

In the December 2014 article “Local Anesthesia
and Plastic Surgery: Marketing or Reality?” sited below, Heather J. Furnas MD
states:

“An increasing
number of patients ask to have their surgery done with local anesthesia  
“because it’s safer.” Guess what? That isn’t always the case.

The Mayo Clinic has weighed in on the use of
general anesthesia, explaining it should be considered if your operation:

1 Takes a long time

2 Exposes you to a cold environment

3 Affects your breathing, such as
chest or upper abdominal surgery.They also state
that: “Most healthy people don’t have any problems with general anesthesia.
Although many people may have mild, temporary symptoms, general anesthesia
itself is exceptionally safe, even for the sickest patients. In general, the
risk of complications is more closely related to the type of procedure you’re
undergoing, and your general physical health, than to the anesthesia itself.”

She also
notes the increasing concern amongst properly trained surgeons and patients
alike that MD's offer this marketed advantage at the disadvantage of the
patients health.”

It is
also noted in another physician comment, that such an option should raise flags
of concern that the facility in which the procedures are performed may not be
fully accredited / certified by a state / or national regulatory agency and the
physician may not have been properly credentialed.

I desire
to provide my full concentration on the performance of the procedure and not
distracted from this which is the full time job of a anesthesiologist or
certified nurse anesthetist.

6 or
more hours of potentially listening to others conversing or should there be a
concerning occurrence during the procedure, become aware of and develop anxiety
from correction of this event, restlessness or discomfort / pain; I believe is
not in your best interest.

I hope
this is helpful. All the best!

William Portuese, MD · Answer

With local anesthesia and oral sedation patients will have total awareness of the entire procedure. Most patients cannot tolerate sitting completely still for 6 hours during a procedure such as this. In our practice,  board certified physician anesthesiologists perform general anesthesia for patient safety and comfort. The procedure is also performed in our state licensed  and Medicare certified outpatient surgery center. This type of surgery should not be performed in the office setting ,since it is real surgery

Todd C. Case, MD · Answer

Over six hours is a long time to lie there still while your surgeon is operating on you.  You should ask to speak to several of the surgeon's former patients who had the procedure done in this manner to hear their experience and thoughts.  Importantly, make sure the surgeon is operating in a credentialed and certified surgical facility.  If they are doing this in their office, make sure the office OR is certified and credentialed and that a Registered Nurse or CRNA or board certified anesthesiologist is going to be monitoring you during the procedure.  If you don't want to hear, see, feel or smell anything that is going on during the surgery go to sleep for the six hours or more.

Facelift six-hour surgery with local and oral sedation?

Answers (14)

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