A question about general v. conscious sedation during full facelift. How is it different for you when your patient is not out?

I am having a full facelift in June. I would like to choose "conscious sedation" to save money but I am wondering from the doctor's point of view, how is it different for YOU when the patient is not completely out? I also wonder- will I be bored? It's 5 hours or so lying on a table? I can't read, or listen to music! WIl I be out enough to make the time go? Will I have something in the drip that helps me forget?

Doctor Answers 40

Conscious sedation for a facelift

I find some of the comments from Dr Commons below extraordinary. "if you are foolish enough to choose being awake" " too many patients experience discomfort during a facelift" etc...  

These, I suggest, are the words of a clinician that doesn't know how to give local anaesthetic properly. I perform facelifts, only facelifts and lots of them. Of the last 200 full (not mini) facelifts I have performed under conscious sedation alone, not one has experienced discomfort during the procedure or would appreciate being called foolish. Of the 26 revision facelifts I have performed in the last 4 months, all of whom had previously had a general anaesthetic, none of them would prefer the process or recovery of their previous experience, All of them expressed how much more pleasant sedation was.

I am strongly of the opinion that conscious sedation is the ONLY way to lift a face. Our faces are the most dynamic and expressive parts of our body, so why lie them flat, stick a breathing tube in them, paralyse them and then guess on the vector of lift? Sure general anaesthesia is a gift for the surgeon to work on your tissues as he has a recumbent asleep patient whose blood pressure has been artificially lowered to minimise bleeding. The patient can't feel anything so local anaesthetic infiltration is a quick half hearted process. Result? a rebound hypertension and pain on awaking, sore throat and cough from the ET tube, drains to drain off the inevitable resulting fluid accumulation.

Conscious sedation enables real time assessment of the facial nerve " smile, raise your brow etc" during surgery. It enables assessment of lift vector and tension whilst sitting upright to see how gravity affects the lift. It is PAINLESS, if local anaesthesia is infiltrated meticulously and with care. During deeper dissection the sedation can be increased so that the patient is asleep.

General anaesthetic was the norm and convention in the past. 1970's, 80's and 90's facial plastic surgery. It is 2015 now, I suspect sometime in the not too distant future General anaesthetic for facelifting will be seen as an archaic relic from times of old.

Price should not be a factor in your decision which method of anaesthesia to undertake, but you need to be informed about the various options. I always have an anaesthetist attending all cases where sedation is given.

London Facial Plastic Surgeon
4.9 out of 5 stars 169 reviews

Facelift Under Conscious Sedation or General Anesthesia

I now only conscious sedation for facelifts.  It is the one thing that has been shown to shorten recovery.  A lot of tumescent local anesthesia is used and this reduces the swelling and bruising after surgery and allows for much faster recovery.  With conscious sedation you do not feel things and you are not necessarily awake either.  The term conscious sedation says it all.  You are conscious in the sense that you can respond to commands but you usually do not remember anything and generally sleep through most of the procedure but you are not completely out and in need of breathing support like you would if you were under general anesthesia.
I hope that helps.
Best regards.

Brian Windle, MD
Kirkland Plastic Surgeon
4.9 out of 5 stars 62 reviews

Conscious Sedation or IV Sedation During Surgery

Dear Leslie:
Medications and regulations have changed such that the description “conscious sedation” will mean different things to patient, RN, surgeon and anesthetist/anesthesiologist. Conscious sedation is a combination of medicines to help you relax (a sedative) and to block pain (an anesthetic) during a medical or dental procedure.
If the medications are provided orally, this is would be considered “oral sedation” and it is expected that you will breathe on your own. The amount of interaction between you and your environment is up to the surgeons use of oral medications and depth of sedation.
I prefer intravenous “general” sedation, also called “IV sedation” or TIVA provided by a nurse anesthetist for my patients. The patient is  breathing on their own, maintained at a continuous and stable level of sedation and pain relief and have no interaction with their environment. In this setting, the patient and the surgeon are most relaxed, there are no mis-understandings in any discussion which may occur with the patient and surgical team and the patient is monitored continuously by an anesthetic professional rather than a circulating nurse (who has other responsibilities) or the surgeon which is performing your surgical procedure first and foremost. It is a matter of safety and experience for all concerned.

It is in the interest of your surgical team to obtain an optimal result and a successful outcome. It is wise to let them do their primary job with out distracting them from their roles.

I hope this is helpful. All the best!

Dean P. Kane, MD, FACS
Baltimore Plastic Surgeon
4.8 out of 5 stars 81 reviews

Facelift under sedation

Face lift procedures can be performed under many different levels of anesthesia. I prefer MAC which is monitored anesthesia care, basically same as conscious sedation except that for a safety measure I have an anesthesiologist maintain the sedation rather than a nurse. It is extremely easy to perform any form of face lift under sedation, and general anesthesia is not necessary at all. I would not recommend local anesthesia only since that is very uncomfortable for the patient and the surgeon.

Shahriar Mabourakh, MD, FACS
Sacramento Plastic Surgeon
4.9 out of 5 stars 208 reviews

About the Facelift Procedure and Anesthesia

#Facelifts and ancillary procedures are usually performed as #outpatient in a surgery center. A one night stay in post-operative care facility may be advisable in some cases. But, local #anesthetic combined with intravenous sedation is usually used. This will allow the patient to sleep through most of the procedure. General anesthesia is available upon request however is usually not necessary.
Being this is an outpatient surgery, you will be provided the proper surgical wear to abide by surgical protocols and sanitation practices.
The Lite-lift™ is generally performed with a local anesthetic and medication by mouth, which will keep you comfortable during the procedure and allow for an easier recovery.
For more information about Lite-lift™, I welcome you to visit my website link provided below.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 109 reviews

Facelift Anesthesia Choices

Five hours is a long time for conscious sedation which is another name for "twilight sleep" - the feeling you have just as you drift off. Medications can be given through your IV to make you more comfortable. In my practice procedures over 4 hours are most often done under general anesthesia.

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 154 reviews

General Anesthesia vs Conscious sedation

For cases with conscious sedation or twilight anesthesia, the patient is usually asleep but breathing on their own. The decision of which type of anesthesia to undergo has to do with the comfort of the surgeon, the surgery center or hospital and the anesthesiologist. From a surgeon's point of view, as long as the patient is appropriately asleep, comfortable and taken care of by the anesthesiologist, it does not make a big difference which type of anesthesia is administered.

Eric J. Yavrouian, MD
Glendale Facial Plastic Surgeon
5.0 out of 5 stars 21 reviews

General anesthesia vs conscious sedation

In over 30 years of cosmetic surgery I have performed 95% of the facelifts under conscious sedation. When properly administered the patient is asleep, does not remember anything and I don't have to deal with tubes coming out of the mouth obstructing my field. I always make a point of asking on the post op visit how the anesthesia was. The uniform answer is that they don't even remember going into the operation room. If a patient insists on general I will oblige, of course. Go with what your PS does. As far as safety both are equal. Good luck.

Andrew Pichler, MD
Sacramento Facial Plastic Surgeon
5.0 out of 5 stars 3 reviews

General vs. Conscious sedation during a full facelift

Thank you for your question.  I give my patients the choice but insist on having a board certified anesthesiologist to administer the anesthesia.  This enables me to concentrate on performing impeccable surgery and leaves the anesthesiologist to monitor the patients vital signs.  Therefore, I really have no preference and I am comfortable with whatever the patient decides.

Glynn Bolitho, PhD, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 14 reviews

Facelift Anesthesia - Sedation vs. General

This question is an important one and should always be discussed before facelift surgery. I recommend to you to choose the mode of anesthesia preferred by your surgeon. There are some plastic surgeons who perform all surgeries under general. Then, there are others, who avoid general anesthesia. Personally, I belong to the latter group. Of the last 1000 facelifts, none was performed under general anesthesia and I find no reason to change this. 

Frank P. Fechner, MD
Worcester Facial Plastic Surgeon
4.6 out of 5 stars 48 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.