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 done facelifts using conscious sedation for my entire career. I do, however, have an anesthesiologist involved in every case so that my patients receive the best care and the most skilled sedation during their procedures. Typically patients drift in and out as the level of sedation is varied according the stage of the surgery, and afterward have little recall. They typically report no concerns after procedures that often take 4 to 5 hours to complete. I like this method as patients bleed less than when general anesthetic is used, I don't have to work around the breathing tube, and we can avoid the coughing that often occurs following GA, and so decrease the early swelling and bruising. All the best.

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.