Local Anesthetic w/Oral Sedation - Safe for Upper Eyelid and Lower Facelift Surgery?

Am 55 with skin in very good condition. But have drooping upper lids and banding in neck. To have a lower face lift/platysmaplasty and upper eyelid surgery, doctor has offered me either the option of IV sedation with board certified anes. or was also told I was a candidate for just local with oral sedation, which will save me a substantial amount of money. Is there any reason not to do it this way? Is one form of anesthesia riskier than the other?

Doctor Answers 43

Local anesthesia vs. Intravenous sedation in eyelid and facelift surgery

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Either type of anesthesia can be used safely with these procedures.  The length of time it will take to perform the surgery, the extensiveness of the techniques employed, and the aversion to being sedated are all considerations in determining what type of anesthesia is chosen.  Most commonly, these procedures would be done with some type of intravenous sedation, but in patients who do not want to be sedated, oral medications with local anesthesia is effective when the procedure will not last much more than 3 hours. In my experience, patients who elect to have oral sedation and local anesthesia and are who motivated tolerate these procedures quite well, 

Springfield Facial Plastic Surgeon

Face Lift and Eyelid Surgery under local or anesthesia

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I do all of the above as well as offer general anesthesia.  I do however, carefully pick and choose which patients I will use straight local infiltartion on when performing Minimum Incision Face Lifts, Lip Augmentation and other suitable cases.  With a local, you will feel the injections, you will hear the sounds of scissors working through your tissues and you will hear the typical sounds of an OR with monitors etc.  If you are very calm by nature this should not be a problem.  However, if you are the least bit anxious, you may have an unpleasant experience.  Remeber, no matter what, you can't move about during the surgery as things can happen if you do....none of them, good.

I do cases all the time under local, but will not do some patients that way.  The next step is IV sedation, which I believe is a happy medium.  It won't save you much money since you should be fully monitored and attended to by an anesthesia provider.  You are given meds during the local injections and allowed to wake up more during the procedure iitself....at least that's how we do it in my office.  The benefit is you get less anesthesia with this method versus a general anesthesia.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

Facelift and Eyelid surgery under local anesthesia with sedation

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Carrie Anne- I will try and address your 2 questions 1) Any reason not to use oral sedation and local anesthesia? If you feel comfortable awake and without feeling pain for an extended time period then you will do wonderfully. I use this same technique for some patients who do not want IV sedation and an anesthesiologist. Most people fall asleep during the procedure and comment later that the exerience was not at all unpleasant . 2) Is one form of anesthesia riskier? Use of IV sedation can result in loss of your own airway protective reflexes and requires close monitoring of all of your vital signs. In the hands of a qualified anesthesiologist the risks of sedation or general anesthesia are small, though greater than risks of oral sedation and local injection. Discuss any concerns with your surgeon and then make a decision which you feel most comfortable with. Best wishes- Dr S

Travis L. Shaw, MD
Richmond Facial Plastic Surgeon
4.8 out of 5 stars 22 reviews

Facelift with IV Sedation: More Comfortable

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I have done hundreds of facelifts with IV Sedation, as well as with oral medication plus local anesthesia.

In general, for healthy individuals with an uncomplicated medical history, the safety considerations between the two sedation approaches are not significantly different. You will find equally valid arguments on each side of the issue among experts.

It is easier to keep you completely comfortable, even completely unaware of the surgery (including the injections of local anesthetic), using properly monitored intravenous sedation.

Your comfort and therefore your good experience with this significant life event is very important. The reason we use IV sedation is to save you the discomfort of these procedures. I think it worth the money to make the experience less stressful, less uncomfortable and a good one.

Your surgeon's judgment and counseling for making the procedure safe and optimal in every way is necessarily personal and individualized for you.

Paul C. Zwiebel, MD
Denver Plastic Surgeon
4.7 out of 5 stars 46 reviews

Facelifts and eyelid surgery under local anesthesia

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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. Administered properly, patients are comfortable and have an easier recovery. 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 further reducing nausea. 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. Ultimately there is no right or wrong way to have anesthesia for a facelift. You and your surgeon will decide what methods are best for you.

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

Facelift and eyelid lift under local

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If you aren't getting your lower lids done, then it may be safe for you to proceed with surgery under local and sedation only. General tends to have more related complications.

Anesthesia for face lift

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Thank you for asking about local versus intravenous sedation face lift and blepharoplasty.

  1. Local anesthesia is safer. Upper lids - fine. The face lift results are likely to be limited because you will feel pain.
  2. Local with intravenous sedation not as safe because you are heavily sedated but have to breathe by yourself. General anesthesia is safer. Newer sedation techniques can sedate and breathe for you. Discuss the exact technique and your safety with the Board Certified Anesthesiologist before deciding.

Oral sedation and local anesthesia

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I always do my lower facelifts under general anesthesia but use local anesthesia in addition to allow the anesthesiologist to keep the amount of general anesthesia to a minimum.  Local, and oral sedation are certainly possible but its a mutual decision between the patient and the comfort of the surgeon.  When the patient is comfortable, the surgeon can better focus on the surgery and the outcome. Your safety should always be number one.

Facelift anesthesia

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Facelift can be performed under various forms of anesthesia- ranging from straight local anesthesia to general anesthesia. Various factors should be considered when deciding on the type of anesthesia recommendation. These include 1.The comfort level of the surgeon - what does he/ she usually use for this procedure, 2. How extensive is the surgery that will be performed, 3. Patient temperament - are they very nervous or have a calm demeanor,  4. Concomitant medical history may play a part in deciding the type of anesthesia  being used.

You may want to speak to other patients that your surgeon has operated on to get their input before proceeding. Good Luck

Wilfred Brown, MD
New York Plastic Surgeon

Local anesthesia with oral sedation is safe and effective

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If the surgeon has experience and confidence in doing surgery this way, then it's a good idea. Remember that the surgeon does not want you to be uncomfortable or have anything less than a great experience. If patients weren't comfortable with this approach, believe me, they would tell everyone and the surgeons practice would suffer. And no surgeon wants to have an uncomfortable patient during any surgery, let alone one as meticulous as eyelid and facelift surgery. That said, your level of comfort is assured with an anesthesiologist attending, as long as they are well versed in this type of surgery, and don't use narcotics.

Verne Weisberg, MD
Portland Plastic Surgeon
4.6 out of 5 stars 18 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.