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

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.

I have performed well over 3,000 face and neck lifts under local anesthesia with oral sedation for over ten years. Without doubt it is safe and well tolerated by patients. Compare to the traditional facelift procedures that are performed under general anesthesia, the post operative complications associated with local anesthesia cases are lower and risk of bleeding is minimized. The key to a successful facelift procedure using local anesthesia is selection of the right patient by the surgeon and his or her comfort doing these cases. 

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.

#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.

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.#faceliftanethesia#faceliftanesthesiachoices

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.

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. 

I use IV sedation, also known as twilight anesthesia
or local mac. This technique, when combined with a Board Certified
Anesthesiologist, in my experience, is more comfortable than general anesthesia
for the patient, as there is less nausea and vomiting. Additionally, the
patients have less post-operative pain, as the surgical site is numbed prior to
performing the procedure. Patients also do not have a sore throat after their
operation, as this technique does not require a breathing tube during surgery
(intubation).

When patients have surgery with IV sedation, they go to sleep and wake up so
comfortably, that at the end of the procedure many patients often ask, when is
surgery going to start? I once had a patient ask me for a cheese burger while
she was waking up from IV sedation, highly unlikely with general anesthesia.
Look for a Board Certified Plastic Surgeon that works with a
Board Certified Anesthesiologist who are experienced in using IV sedation,
if you are considering a face lift with this technique.The cost for general anasethesia or consciousness sedation is the same in my surgery center, as  both techniques require an an anesthesiologist. Also, the cost of the drugs used for conscious sedation are more expensive then those used for general anesthesia. Many of my patients, who have had both general anesthesia and IV sedation,
prefer IV sedation.

Yours,

Jon M. Grazer, MD, MPH, FACSPlastic SurgeryNewport Beach, CA

I use oral sedation and local anesthesia for the majority of my facelifts and find it easy for the patient with very little trouble for me. With the proper mixture time will fly by, you will sleep and have very little memory of the event the next day. This includes the stings you will feel from the local anesthetic. You will not be bored but you will sleep. Make sure you have arranged a ride home and help for the first night you are home.Speak to your surgeon to get their experiences.Best of LuckDr. JA. Dean Jabs M.D., Ph.D.Board Certified Plastic SurgeonBethesda MD/McLean VA

I have done a number of faceless using both techniques. A general anesthetic in my opinion allows the operation to proceed more efficiently and for that reason I use it almost exclusively now my own practice.

Hi.  The choice of the anesthetic is really up to the surgeon, not the patient.  Both can be effective.Some surgeons prefer general anesthesia, particularly for a sub-SMAS facelift when you are working close to the important facial nerves.  Other surgeons, who use a plication technique or MACS technique would probably be quite happy with IV sedation.In either case, you should be monitored by an MD anesthesiologist or CRNA.In our practice, since you are paying for the anesthesiologist's time, the price is the same.All the best,