Can a jowl and neck lift be done under local anesthesia?

Question

I have heavy cheeks resulting to droopy jowls. Skin on neck is sagging. Can these be corrected using only local anesthesia?

Michelle Lee, MD · Answer

Hi there! 
Typically, surgeons offering facial rejuvenation surgery under local anesthesia (fully awake with only numbing medication) are performing a "skin-only" face or neck lift. This means that they are not lifting, tightening and repositioning the deeper layers of the face/neck and are simply pulling the skin to allow it to be tolerable with an awake patient. The "skin-only" lifts usually look much more unnatural, lead to worse scarring and do not last nearly as long as a deep-plane approach does. That being said, the deep-plane surgeries are often done under IV sedation as opposed to full general anesthesia with intubation which patients recover very well from.
I hope this helps!

Manish H. Shah, MD, FACS · Answer

Hello Robinsd999,
Thanks for your question. 
Yes, you can have a jowl lift (facelift) and neck lift under local anesthesia. Since 2005, I've performed thousands of facial plastic surgery procedures under local anesthesia. My face and neck lifts patients choose local anesthesia over general anesthesia 98% of the time. In my opinion, it is safer and has a quicker recovery. 
I perform preservation deep plane facelift and full neck lift surgery in the office with patients able to talk to me (they have Valium on board) and the local anesthetic lasts for hours. Average pain scores for the procedure are a 1-2/10. It is easier to manage bleeding and I can have you move your facial muscles so that I can examine function of the facial nerve to confirm safe surgery was performed.
If you have any further questions please let me know.
Good luck,
Dr. Shah

Gianfranco Frojo, MD · Answer

There are some surgeons performing facial rejuvenation under local anesthesia. I find it very challenging to get more aggressive results under local anesthesia due to patient discomfort (having to lay in one position for a long time/need for restroom use etc).

Lucian Ion, FRCS · Answer

Thank you for your question.

Considering a neck lift for skin laxity and correction of droopy jowls under local anaesthetic alone is an important decision. Based on your description of having heavy cheeks that contribute to droopy jowls, it’s important to understand the implications for your desired outcomes.

In general, when there is an association of heavy cheeks and jowl fullness, there is often excess volume in the neck as well. In this instance, the degree of correction achievable with local anaesthesia is more limited, and it is quite possible that you may not be satisfied with the outcome.

Local anaesthetic procedures are typically suitable when there is only skin laxity, both along the jowl line and under the chin. In these cases, lying down completely flat leads to a very good appearance of the neck. However, if the appearance of the neck still shows moderate fullness when lying down, it is likely that a local anaesthetic intervention would not yield very good results.

For more comprehensive correction, either sedation or general anaesthetic may be preferable. These approaches allow for a more thorough treatment of the underlying issues, including excess volume in the neck and heavy cheeks, resulting in a more satisfying outcome.

Another way to approach this decision would be to have a computer imaging and simulation of the desired changes, which would give you clearer identification of your preferred outcome and allow better clarity regarding the type of anaesthetic needed.

Steven Curti, MD · Answer

There are several different types of face and neck lifts. Mini lifts can be done under local anesthesia quite comfortably but don't deliver the same results as a more involved deep plane face and neck lift which is typically done under general or "twilight" anesthesia. Whether or not a mini or true deep plane facelift is best for you is up to your anatomy, goals and surgeons expertise. With that being said, in my experience, without a true deep plane release you will not be able to lift heavy cheeks. I would recommend consulting with a few different surgeons and reviewing their techniques and looking at their before and after pictures to help make this decision.

Ryan Rebowe, MD · Answer

While this can technically be done, it is better to go under at least heavy sedation for this procedure. A face and neck lift is very delicate and you will want your surgeon to be in control of everything. It is often possible to pursue this procedure under heavy sedation and not general anesthesia, avoiding the need for a breathing tube and the associated issues (sore throat, nausea, etc).

David Hansen, MD · Answer

There is no doubt that you get the best results for Lower Face/Neck Lifts when done under local and is by far the safest way to go as well. Better results, safer and faster recovery are all reasons to only consider local anesthesia.  A little iv sedation helps a lot for complete comfort but you are awake and comfortable.

Zoran Potparic, MD · Answer

Yes, it is quite reasonable to do neck lift and jowls removal in local anesthesia. The alternative is twilight anesthesia which includes mild to moderate sedation during injection of local anesthetic. It is best to discuss this issue with your surgeon. Good luck.

Michael S. Kluska, DO · Answer

In my experience, you would most likely need a deep plane neck lift with possible buccal fat pad removal. Because of the nature of the procedure, I would recommend anesthesia for your comfort and safety.

William Portuese, MD · Answer

It is possible to lift the jowls and do a mini facelift under local anesthesia, however, general anesthesia is going to be required to do a deep neck lift, which accomplishes removal of fat deposits above and below the platysma muscle, and a plasma plasty to significantly improve the jawline. Mini facelifts tend to give mini results, and we rarely perform them for that reason

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