Twilight or IV sedation for deep plane face and neck lift, with upper and lower eyelid?

A good surgeon will recommend the anesthetic that he or she prefers. Some recommend IV sedation or twilight to keep their costs down (it costs more to have an anesthesia professional present). I usually have an anesthesia doctor/nurse doing that part so I can focus exclusively on the surgery.

One certainly can be nervous before facelift surgery; after all, it is a big decision to undergo elective cosmetic surgery. The choice of anesthesia varies from surgeon to surgeon: some prefer general and others IV sedation. Personally, I never use general intubation anesthesia; in fact, some of our patients prefer to have their procedure performed under local. Two main factors should be considered in facial surgery: safety and comfort. It is probably not a good idea to ask your surgeon to perform your procedure differently than he usually does. If general anesthesia is important to you and your surgeon does not do it, then you may want to find a surgeon who uses this anesthesia mode routinely. 

We routinely perform our deep plane facelifts under IV sedation, which maintains patient comfort without the need for a breathing tube. General anesthesia can be used as well and both are excellent choices to help ensure your comfort and safety during the procedure. We also provide medication before and after the procedure to help with anxiety and any discomfort. Hope that helps and best wishes, Dr. Donath

Both general anesthesia and local anesthesia with IV sedation provided facelift patient with good pain control and sedation.  Most of my facelift cases are performed under local anesthesia with IV sedation.  Patients note that they wake up easier than when they are under general anesthesia.  I have the anesthesiologist use general anesthesia if we are concerned about breathing issues or if the patient specifically requests general. 

Grant A. Fairbanks, MD

I perform the majority of my deep plane facelifts under general anesthesia with a board certified anesthesiologist.  The surgery is about 4-5 hours long.  You are completely asleep for the procedure.  Patients wake up in the recovery room like they just had a long nap.  Patients tend to remain sleepy when they get home since it takes about a day for the medications to leave the system.  They are very comfortable.  The disadvantage is that this does require a breathing tube and patients can have a sore throat after the procedure.  Also, there is a risk of nausea/upset stomach.  A step down from this is monitored anesthesia care and heavy IV sedation which allows the patient to be completely asleep but breathing on his/her own.  IV sedation is on a spectrum and, if done lightly, the patient is lightly sleeping and breathing on his/her own but could wake up if asked a question or needed to shift positions.  Combining IV anesthesia with local anesthesia (lidocaine) can make patients very comfortable for the duration of the procedure.  Many surgeons perform procedures with MAC/IV sedation with excellent experiences and results.  If you are nervous about the anesthesia or what it will be like, I would ask more questions to the surgeon.  You may even be able to speak to a previous patient about his/her experience with the anesthesia.      

milamilaya,
Thanks for the question.  I think that both options are reasonable for a deep plane facelift, and that both give you a faster recovery than a general anesthesia.  Since you have reservations and questions, I would discuss these with your surgeon and anesthesiologist, as things can be really tailored to your needs (and concerns) if they are discussed prior to the day of surgery.  Good luck!

In our practice we perform facelifts and blepharoplasty under sedation. Two criteria need to be in place to insure patient comfort and safety: 1- the sedation, whether provided by the anesthesiologist or the surgeon himself, needs to be the right level for complete patient comfort; 2- the surgeon needs to be comfortable and experienced in performing the surgery on sedated patients. In our practice, we have been using this type of anesthesia for all facial plastic surgery procedures for the last 15 years. Our patients are very pleased with their experience as they have no recollection of the procedure, of any pain, and experience no anxiety before, during, or after surgery.In addition, it has been shown that sedation type anesthesia has much less of the unpleasant effects of general anesthesia, such as nausea, vomiting, excessive swelling, etc.. and is as safe or safer. Again, this is provided your surgeon and the person administering the anesthesia use this type of anesthesia regularly and is comfortable and experienced with it. Best. Mark Samaha, MD

A deep plane facelift can be performed under local sedation or general anesthesia. I prefer to use tumescent infiltration of lidocaine and marcaine to help with pain control. Both are fine options. 

We perform the majority of our deep plans facelift procedures under iv sedation provided by a board certified Doctor anesthesiologist.  During this type of a sedation you are out. You don't hear, feel, or remember everything. Your breathing is monitored the entire time but you do not have a breathing tube in. This is very similar to anesthesia used in colonoscopies, which many people over 50 are familiar with. In my view there are many benefits to this over general anesthesia. My patients also barely ever get nausea after surgery.

I prefer general anesthesia for this deep plane face lift procedure over IV sedation.  Even though IV sedation is quite sufficient to achieve anesthesia for the procedure, the patient tends to respond during the procedure, making the procedure to move slower, and creates unnecessary distraction during the procedure. Unless there is a health issue necessitating to avoid general anesthesia, I prefer general anesthesia, largely due to the fact that I can concentrate on the procedure much better.  Since you are young and healthy, general anesthesia is very safe.Best,