Can a patient refuse insertion of urinary catheter for the duration of a facelift? If yes, when/why? If no, when/why?

This should be discussed with the patient prior to the procedure.  It should be part of the consent process. It may be possible to avoid it for shorter cases, around 3 hours, but anything longer would be too uncomfortable. 

Typically urinary catheters are placed if a surgery is expected to last over 4 hours. How long your surgery is expected to take depends on the technique and extent of dissection, as well as the surgeon. The amount of time it takes does not in and of itself make the surgeon good or bad. (Patients don't thank their surgeons for being fast. They thank them for delivering excellent results.) Also, they are typically place by the nurse after the patient is asleep, while the patient is on the operating room table. This is done for your own comfort, as you are correct it can be uncomfortable while awake. It strikes me as odd that you feel it is an invasion of your privacy because it is "done in an area where not a lot of people see". I don't know if you are referring the the body area as a place people don't see, or the operating room. Either way, it is actually to protect your privacy that it is done without a lot of people around to watch. Usually the nurse in the OR, male or female, is the one to insert it, and this is something they do daily for any surgery where it is indicated. The catheter is often removed before the patient wakes up, again for comfort. I do understand for the patient it is a private and sensitive matter, but the nurse performing the procedure is trained to do this as part of his/her job as a medical professional. The catheter serves a purpose, and is part of your surgical care, the same way inserting an IV, placing blood pressure cuff, protecting your body from heat loss during surgery, placing sequential compression devices to your legs to prevent blood clots, etc, are normal parts of your peri-operative care, and do not require individual consent forms. Whether a male or female inserts the catheter simply depends on who is staffing the operating room that day. If you have a preference, you can always ask the surgery center to make special accomodations. For example, I have had patients undergoing labiaplasty that request an all female team. I want my patients to be comfortable and as long as we know in advance, we are able to book all female staff members for those cases. If your surgeon feels the surgery will be long enough to warrant a catheter, it goes against your best interests to refuse it (unless there are other extenuating circumstances), and the surgeon will have to decide whether or not to proceed.

Hello and thank you for your question.  The
best advice you can receive is from an in-person consultation. I would recommend discussing this with your surgeon prior to surgery.  In my practice, I do use a catheter for a facelift procedure.   Make sure you specifically look
at before and after pictures of real patients who have had this surgery
performed by your surgeon and evaluate their results.   The most
important aspect is to find a surgeon you are comfortable with. I recommend
that you seek consultation with a qualified board-certified plastic surgeon who
can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon