Medical Risk v Reward for Plasttic Surgery
Thank you for your question about having a facelift or neck lift under local anesthesia. Though these procedures can be performed successfully with local and sedation, that may not decrease risk in your circumstances. From your history, I would be worried about inviting more medical trouble with elective cosmetic surgery. Non surgical improvements would certainly be safer.
Can a neck lift and lower face lift be performed safely under Local? I have 2 DVTs and Sleep Apnea.
Just by your posted medical history you are NOT a candidate for any elective cosmetic surgery in my over the internet opinion... The risk reward ratios are tilted way over to the risk side. Using fillers and laser peels could only improve slightly but at least you would not be at risk to a calamity... Sorry.
Based on the brief history you gave, you are a very high risk for Deep venous Thrombosis and Pulmonary Emboli.
You will need a full hematology consult for hypercoaguability syndrome, a full cardiac workup. May be a venogram, Some surgeons would do a facelift under local anesthesia.
Even if you are pre-treated with lovenox you still may have a DVT, PE. and run the risk of bleeding I the face. in that case you will need surgery as emergency surgery under general anesthesia and you will be at a higher risk.
Samir Shureih MD. FACS
High risk for DVT/PE
You clearly have an exceptionally high risk of DVT/PE. Please realize that not all patients survive even one DVT, let alone 3. If the clot dislodges and goes to the lungs, it can be fatal. Consequently, any time you put yourself at risk i.e. long flights, surgery etc. it better be worth it.
Quite honestly, you have so much tissue laxity and sun damage, that anything really worth doing would take quite some time and the length of surgery increases your DVT risk. Long surgeries i.e. 4 hours are hard to tolerate under local also.
So, since there is no small fix for you that would be worth the money and recovery, my best advice would be to not do anything. Health should always come before cosmesis.
Anesthesia for neck lift and lower facelift
You do have multiple options for anesthesia. The most common anesthesia used for face procedures is MAC which is a sedation that is monitored by an anesthesiologist. It is best that the anesthesia is provided by an MD Anesthesiologist and that the planning of the surgery is done in collaboration among the surgeon, internist, and anesthesiologist.
Facelift in the Face of Multiple Medical Problems
A facelift can certainly be performed under local anesthesia with or without oral sedation, or IV sedation for twilight sleep without general anesthesia. Additionally TED stockings, Pneumatic Stockings and even anticoagulation can be utilized to minimize your risk of DVT or PE with the procedure though it may increase your risk for excessive bleeding. Most important is that you seek separate consulations with a hematologist, your family doctor and plastic surgeon to discuss in great detail risks vs benefit. In particular, how important is this surgery for you knowing that you are at much greater risk than the general population for complications some of which may be life threatening. Many plastic surgeons for example will not accept you as a patient because of this increased risk.
While you are considering these issues you might want to explore non-surgical ways to improve your appearance including fillers and skin resurfacing (peels and/or laser) which do not require sedation in many cases.
Facelift under local
I would perform a facelift under pure local on you. The only concern I would have is if you are still on anticoagulation which would make the risk of bleeding and haematoma too great. The risk of DVT and PE under local anaesthetic is no more than the risk of lying still in bed for a few hours. I would avoid sedation due to your apnoea, but if you were willing and able to lie still for 3 hours I do not see why you wouldn't benefit from a facelift.
Safety First: Medical Clearance is Mandatory
DVT's have a relatively higher association with Orthopedic procedures because of issues associated with mobility. A history of 2 DVT's separated by time and space beckons caution. Given your history, a medical clearance is mandatory before consideration of any elective cosmetic procedures. Local anesthesia won't necessarily make a procedure like a Facelift safer.
Facelift under local
I generally am not a fan of facelift under local. In your case it does not sound like general anesthesia is right. With that said a facelift in general might not be the right thing for you. I would meet with a plastic surgeon and come up with a plan - it might be not to have surgery at all.
you need to discuss this issue with your plastic surgeon and internist. Having the procedure under straight local May make it take longer than under sedation.