Considering a mini face lift - concerned about my sensitivity to epinephrine or adrenaline.

Question

During past dental procedures the use of Novocain injections cause my heart to race which is uncomfortable and scary. Are there other safer numbing drugs which can be used during a face lift?

Mike Majmundar, MD · Answer

I recommend my patients visit with an allergist and have the same anesthetic with epinephrine we inject during the surgery injected in a small amount in the skin in their office.  They have all necessary medications to treat an allergic reaction if it occurs and would also answer if you have a true allergy to epinephrine.  As I tell other patients, your body makes epinephrine so it would be difficult for a true allergy to be present.  During dental surgery, the anesthetic can be inadvertently injected in a vessel and is a common occurence.

Jason Emer, MD · Answer

For unique cases where a variety of modalities could be used to treat the condition, I would suggest an in-person or virtual consultation to develop a custom and effective treatment plan.  It is difficult to precisely define the best option without collecting the same information. I suggest reaching out to an expert for a consultation with surgical and non-surgical methods to get a comprehensive option. Best, Dr. Emer.

David Hansen, MD · Answer

There are various ways to make you comfortable and not get the epi anxiety effects. Don't worry, your doc will go over the ways so you have a great experience.

Jonathan Kulbersh, MD · Answer

A reaction to epinephrine or adrenaline is not uncommon, so most surgeons will be able to offer you a variety of alternatives to make your Mini Lift procedure comfortable. One option is a “twilight” anesthesia that avoids the longer recovery time of general anesthesia, but relaxes you sufficiently that you are just barely awake. Consulting with a facial plastic surgeon in person will allow you to discuss your concerns in more depth and come up with the best plan for anesthesia and bleeding control that takes your sensitivities into consideration. I hope this helps.

Keith Denkler, MD · Answer

Epinephrine concentrations in dental procedures are higher than the concentrations used for a mini-lift. Notify your doctor about your reactions so the medical concentration of epinephrine can be diluted further.  Dr. Keith Denkler#RealSelf100 Member

Robert H. Woods, MD · Answer

The addition of epinephrine is important for both decreasing the amount of bleeding one can experience as well as increasing the length of time the anesthetic will continue to work effectively. Dilute solutions of epinephrine and lidocaine (tumescent solution) can achieve the same effect without the uncomfortable side effect of increased heart rate, blood pressure, and anxiety. Lidocaine only infiltration creates a vasodilatory effect, thus increasing the amount of bleeding during the operation. This can be done, but is not ideal. If you are getting IV sedation or general anesthesia, then the side effects of epinephrine can be easily treated with medications given through a vein. If you are going to have this done under a local anesthetic only, I would suggest your surgeon give you some oral sedative medication which can diminish the negative side effects of epinephrine.

Paul J. Leahy, MD · Answer

I'm sorry to hear your experience with local anesthesia has not been pleasant. Most of the time, it is the epinephrine that causes the feelings of anxiety. That additive to the local anesthetic is very helpful to the facelift surgeon because it minimizes bleeding. Another solution would be to have you get a bit more sedation through an I.V., but there are downsides to that also. I'd meet with a surgeon near you to discuss the options. Best wishes

Terrence Murphy, MD · Answer

Although we typically use a low concentration of epinephrine during all facial surgeries it can still make your heart race some. We typically sedate our patients so you wouldn't experience or remember any unpleasant sensations. Light intravenous sedation is extremely safe in healthy people and in my experience leads to a much more pleasant surgical experience than local anesthetic.

Stephen Weber MD, FACS · Answer

Yes you can still undergo mini lift surgery. I perform all of these procedures using tumescent local anesthesia. This involves using a 1:1 million dilution of adrenaline, far less than what is used during dental block injections. This provides exquisite control of any bleeding and excellent local anesthesia. Best.

Francis R. Palmer, III, MD (retired) · Answer

Hi, I have performed facelifts for over 30 years and have performed many minimally, invasive type facelifts.  The vast majority of my minimally, invasive SMAS facelifts are done using local infiltration (lidocaine with epinephrine).  A sensitivity to epinephrine during dental procedures is not uncommon and we have successfully performed this type of facelift on a number of patients expressing epinephrine sensitivity as an issue.  There are ways to decrease the amount of epinephrine used (dental injections have a significantly higher amount of epinephrine that those used for facelifts) and the areas of the face can be injected at different intervals in order to make the patient less sensitive.  This has never been an issue, for us, when that technique is followed. Non smiling photos of your face from the front and side would help in the evaluation.  Following my beauty principles, women look the most feminine, youthful and attractive with heart shaped faces.  Heart shaped faces have cheeks that are full and round in the front.  Cheek augmentation with a dermal filler or using cheek implants for a permanent enhancement will create full, round cheeks that will feminize the entire face.
 If you have "jowls” these are sagging facial tissues which is the main indication for some form of a SMAS facelift.  The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured (not merely folded or suspended with threads or sutures that will not last).  The excess skin is then removed and the facelift incisions closed.
My most popular facelift is the minimally invasive, short incision facelift that has all the benefits of more invasive facelifts (traditional, mid-face, deep plane, cheek lift and subperiosteal facelifts) but with these added benefits:
very small incisions and no incisions extend or are placed within the hair.
minimal tissue dissection = less bruising and swelling = rapid recovery ( several days instead of weeks or months with the more invasive type facelifts mentioned)
can be performed in 90 minutes or less, with or without general anesthesia
no incisions within the hair = no hair loss
excess fat can be removed from the face and neck
excess skin removed from the face and neck
cheeks, chin and jaw line can be augmented with dermal fillers (I prefer Restylane Lyft) or facial implants
most patients fly back home to parts all over the world in as little as 3 days post-op
I combine facial shaping with every facelift procedure.  When jowls are present, these should be done in concert and not alone or separately in order to create a naturally, more attractive face.
Hope this helps

Considering a mini face lift - concerned about my sensitivity to epinephrine or adrenaline.

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