I would like a (mini?) face lift and rhinoplasty - preferably done at the same time, but have an anesthesia question.

Question

I hear (slightly?) better results are obtainable for a facelift under local anesthetic, but rhinoplasty requires general. For these two procedures to be done in one surgery, is it possible to begin with a local for the face, and then have a general for the rhino as the second part of the surgery? Thanks!

Kevin Sadati, DO · Answer

The answer to your question is yes. I have performed many of these two procedures starting with local anesthesia and twilight sedation followed by rhinoplasty using general anesthesia.

Jonathan Pontell, MD, FACS · Answer

Hi and thanks for your question.  I have done thousands of rhinoplasties and facelifts.  I am not aware of any factors that adversely affect the outcome depending on which anesthesia type you have.  There would be no reason to do one awake and then go to sleep for the other.  Good luck. Dr. Pontell

Jonathan Kulbersh, MD · Answer

The reason surgeons prefer local anesthesia to general for a mini lift are twofold: 1. It’s easier on the patient and speeds recovery,  and 2) It allows us to evaluate the lift while the patient is awake and can move her or his face. However, an expert surgeon understands anatomy sufficiently that we can create the same natural effects for a mini lift under general anesthesia.
The choice, ultimately, is yours. If you’d like to remain awake for your mini lift so you can see what it looks like, that can be arranged. You would then be given general anesthesia for your rhinoplasty. If you’d rather sleep through both procedures, that’s possible, too. The surgeon’s expertise is much more important than choosing one type of anesthesia over another. I hope this helps.

P. Daniel Ward, MD · Answer

Dear Kic33,Thank you for your question. I don't know of any study that demonstrates better results for a facelift performed under local anesthesia instead of general anesthesia. In general, avoiding general anesthesia is a good idea, but it should not impact your final result. I would bring up your concerns with your surgeon, and if you'd like, your surgeon can refer you to your anesthesiologist for the procedure who can provide an answer as to the best option. Please let us know if you have any other questions!Sincerely,Dr. P Daniel Ward

Randy Wong, MD · Answer

The type of anesthesia should really be planned to optimize the patient's comfort.  The technical aspects of your rejuvenation have little to do with the choice of anesthesia as both face and nasal procedures can be done under combinations of local, sedation, or deeper anesthesia, but this depends on the patient's tolerance for discomfort, sensitivity to being aware under surgery, etc. I would suggest starting with the facelift and ending with the rhinoplasty as the latter has slightly higher concerns for your airway.  Discuss your desires with qualified board certified surgeons before committing to a procedure.

Christopher T. Maloney Jr., MD · Answer

Thank you for your question. An experienced board certified plastic surgeon should be able to get you a very nice result using local, MAC or general anesthesia. The surgical technique would be the same for all of the anesthesia methods. If you were just doing the face lift, local is a great way to have the procedure performed in my opinion in the right patient. A rhinoplasty procedure should be performed under general anesthesia. There is no reason not to do them both together under general anesthesia. Best of luck.

Summit Kundaria, MD · Answer

Thank you for the question.   I do not think you would have much of a difference if you did the facelift with some sedation followed by general for the rhinoplasty.  Many of us would do both surgeries in your case under a general anesthetic, though some would do both surgeries under local.  I think that picking a surgeon that does good work and has good outcomes is more important than the details of anesthesia.  Good luck!

Paul J. Leahy, MD · Answer

Thanks for your question. I've never done it that way before (starting a surgery w/ a local anesthetic and then converting to a general for another component), but I suppose it could be done that way. I would probably encourage you to do the mini facelift in an office setting w/ local anesthetic, heal from that, and then consider the rhinoplasty later. I hope that helps.

Matthew Kienstra, MD, FACS · Answer

Thanks for your question. It is definitely not true that facelift results are better under local anesthesia. The result is independent of the anesthesia chosen. Rhinoplasty and facelift are relatively long when performed together and I recommend you have them done under a general anesthetic to be most comfortable. It is, however, not unreasonable to do them BOTH under sedation or what we call monitored anesthesia care. Your surgeon and anesthesiologist can best advise you. The type of anesthesia is not what gives you the best result - it is your surgeon!

Francis R. Palmer, III, MD (retired) · Answer

Hi, I have performed many Rhinoplasties and SMAS facelifts for over 30 years and have performed many minimally, invasive SMAS facelifts.  I don't agree at all that the type of anesthesia affects the aesthetic outcome of a properly performed SMAS facelift.  As described below, I perform many SMAS facelifts under local anesthetic but this is for patients not interested in having a general anesthetic and not because using a "local" provides a superior result.  I do definitely agree that all Rhinoplasties should be done using a general anesthetic for proper airway protection.  This would not include minor tip-plasties or touchups that can often be done with a local anesthetic.  
 Following my beauty principles, women look the most feminine, youthful and attractive with heart shaped faces.  Heart shaped faces have cheeks that are full and round in the front.  Cheek augmentation with a dermal filler or using cheek implants for a permanent enhancement will create full, round cheeks that will feminize the entire face.
 If you have "jowls” these are sagging facial tissues and an indication for some form of a SMAS facelift.  The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured (not merely folded or suspended with threads or sutures that will not last).  The excess skin is then removed and the facelift incisions closed.
My most popular facelift is the minimally invasive, short incision facelift that has all the benefits of more invasive facelifts (traditional, mid-face, deep plane, cheek lift and subperiosteal facelifts) but with these added benefits:
very small incisions and no incisions extend or are placed within the hair.
minimal tissue dissection = less bruising and swelling = rapid recovery ( several days instead of weeks or months with the more invasive type facelifts mentioned)
can be performed in 90 minutes or less, with or without general anesthesia
no incisions within the hair = no hair loss
excess fat can be removed from the face and neck
excess skin removed from the face and neck
cheeks, chin and jaw line can be augmented with dermal fillers (I prefer Restylane Lyft) or facial implants
most patients fly back home to parts all over the world in as little as 3 days post-op
I combine facial shaping with every facelift procedure.  When jowls are present, these should be done in concert and not alone or separately in order to create a naturally, more attractive face.  You can have both procedures under a general or have the facelift under local and the Rhinoplasty under general at a later date.
Hope this helps.

I would like a (mini?) face lift and rhinoplasty - preferably done at the same time, but have an anesthesia question.

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