Mini Facelift, Neck Lift, Fat Transfer and Myectomy - Safe w/ Local Anesthetic?

I am a 50 year old female in excellent health. Recently I decided to look for a surgeon to perform a mini face/neck lift with fat transfer. My surgeon will also perform a myectomy of the lateral orbicularis. To save on the operating room cost he has suggested we do it in his procedure room. All searches indicate no more than 2 hours under a local for these types of procedures. My doctor said the time frame will be just over 5 hours. Can a patient withstand this time frame under local?

Doctor Answers 11

Face Lift, Beverly Hills Face Lift, Local Face Lift, Radiesse, perlane, Cheek Implants

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  I have performed Face Lifts for over 20 years and 5 hours seems like a very long time to perform a limited dissection Face Lift.  Our Celebrity Face Lift takes 90 minutes and we frequently do these under local.  The local typically lasts about 90 minutes, so in a 5 hour time span you'll have to have the injections repeated at least 3 times but the problem is that once the tissues are dissected, the local has nowhere to be injected.  Once the local wears off, bleeding and discomfort are the main issues.

 You could still have the Face Lift done in an OR with local anesthesia which allows you access to the cautery, suction, better lighting all which should be used for any Face Lift IMO. 

 I performed hundereds of fat transfers between 1989-91 and haven't used them since because they are not predictable and don't last.  From your photo, your cheeks would benefit more, IMHO, from a predicatble filler like Radiesse or Pelane or  for a permanent augmentation using Cheek Implants however for Cheek Implants you would need a general anesthesia.

Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

Face lift

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With the picture you provided. You need a full SMAS face lift. 5 hours local with sedation or general anesthesia.

You will be disappointed with miniface lift.

Samir Shureih, MD
Baltimore Plastic Surgeon

Cost saving on face lift.

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Local anesthesia is often given with other medications, such as Valium, before and during a procedure. Certain patients can tolerate this situation, others may not. Greater degrees of sedation or even general anesthesia may be desired by some patients and surgeons. Five hours of just local anesthesia would be difficult for most patients.Plus it is hard for a surgeon to work on an uncomfortable patient. A procedure room that is used for the kind and amount of work you describe serves as an operating room. Your safety should be of utmost consideration.The proper monitoring equipment and medication should be available. In California, accreditation of office operating facilities is mandatory if drugs are used that create a state of "conscious sedation" or deeper levels of anesthesia. More important, accreditation involves a commitment of compliance to many details of patient safety. Your surgeon's office should have a current accreditation certificate for you to review.

Sheldon S. Kabaker, MD FACS
San Francisco Facial Plastic Surgeon

Minilift, etc. Under local anesthesia.

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I do these procedures under general anesthesia in our certified operating center for two reasons. I concentrate on your surgery and the anesthetist concentrates on you! Secondly, severalhours of surgery is very uncomfortable for the patient.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 38 reviews

Facial procedures under local anesthesia

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Thanks for sharing.  Form your photo I feel a lower facelift including a neck lift, fat grafting, and possible upper lid blepharoplasty would be appropriate procedures.  I have performed thousands of these combined procedures under local anesthesia and oral sedation. I have performed these in a well equipped office base procedure room and currently in an accredited surgery center. I do recommend some oral sedation with the local anesthesia as it will be much more comfortable for both you and surgeon. Make sure your surgeon has performed many of these procedures under local anesthesia.  There is an art and science to being able to perform all these procedures with this type of anesthesia.

Raymond E. Lee, MD
Orange County Facial Plastic Surgeon
5.0 out of 5 stars 101 reviews

Cosmetic Facial Surgery Under Local Anesthesia

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If you are in good health then a facelift and necklift as well as a blepharoplasty with lateral obicularis myectomy can be performed safely by either local anesthesia with oral sedation, intravenous sedation, or general anesthesia in my practice. The key is for you to feel most comfortable. Many patients select local anesthesia with sedation as they are afraid of General Anethesia, whereas other patients are afraid of being aware or feeling the injections at the beginning of the procedure.
General anesthesia is safer than many patients think, but if you are uncomfortable with the idea of being fully knocked out then your facelift can be performed with local anesthesia with IV sedation. Your doctor will check thoroughly to be certain that general anesthesia is safe for you. In any case, you are safest in the hands of a Board Certified Anesthesiologist who can monitor you regardless of the anesthesia type you choose. The most important decision you can make is deciding on the most qualified plastic surgeon (see link below) whose job it is to guide you on decisions such as the ones you are considering.

5 hours is too time much for local anesthesia

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While the individual procedures you have listed can certainly be done safely and effectively with local anesthesia the amount of time outline for you is certainly too long to do with local anesthesia.

While I love and support the use of local anesthesia several things concern me with a 5 hour case:

1. At some point you will get uncomfortable lying there for so long and can have back or neck pain / spasms

2. You may need to go to the bathroom at some point

3. You will need at least 2 sets of injections and it will be crucial to make sure safe dosages are being used

4. Seems to me that all that all these procedures combined cross over into the realm beyond the scope of local anesthesia

Maybe your surgeon can do the surgery in 2 settings and make things easier for you (and for them)?

Kamran Jafri, MD
New York Facial Plastic Surgeon

Facelift anesthesia

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To me the real answer is why would you want to avoid the operating room?  I understand the cost considerations, however one needs to look at the overriding safety issues.  My suggestion would be to have the procedure performed in an accredited operating room.  The process of accreditation requires adherence to stringent safety standards.  To undergo a lengthy procedure outside of an accredited operating room implies that these safety standards will not be in place for your procedure.  Having the procedure under local anesthesia also implies that there will be no anesthesiologist present.  If one is going to forego both the safety of the operating room environment,  and all of the benefits of a trained anesthesiologist, then one should probably opt for a simpler and quicker operation.

Glynn Bolitho, PhD, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 15 reviews


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I think you need a more complete lift to help with your lower neck. Although, you can do this under local five hours is way too long and would be difficult for you. I prefer general anesthesia because you airway is protected and therefore safer

David A. Bray, Sr., MD
Los Angeles Facial Plastic Surgeon

Mini lift works well

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I perform mini lifts almost every week.  They do very well and most are completed in less than 2 hours, but some people can tolerate a much longer procdure.  I have at the most, completed a mini lift, open brow lift and all 4 lids for blepharoplasty.  Most patients tolerate it very well without any sedation.

Nasimul Huq, MD
Niagara Falls Plastic Surgeon
3.7 out of 5 stars 6 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.