Revision in office with local anesthesia vs. injections

Had a full face, neck and brow lift one year ago. Mixed results due to a parodic(sp?) leak which resulted in a lot of swelling and eventual drain placement. It resolved but still have deep marionette lines. This was all done in the hospital setting but still had problem of leak plus developed a DVT. Not really interested in more long surgery! PS says he will do revision in office under local or injections-my choice. Had juvederm 5yrs ago w no result. Is office procedure worth it and safe?

Doctor Answers 11

Marionette lines

Sorry for your experience. You have a couple of issues arguing against further surgery: the prior DVT and and the injury to the parotid gland. In any case, it is difficult to tell without pictures. The marionette lines may improve a bit with facelifting, but it is a long ways from the incisions, so there is less effect. A better option for you may in fact be filling them with Juvederm or Restylane. This will be less invasive, and more directly address the problem. You may have had some improvement with the facelift and would require less filler than before to get the result you seek.

Denver Plastic Surgeon
4.5 out of 5 stars 25 reviews

Revision facelift under local

You most likely can have a minor facelift revision performed under local anesthesia(although the parotid issue makes the entire situation a little more challenging). Depending on the type of facelift your surgeon initially performed, that procedure too could have been performed under local anesthesia with or without the assistance of an oral sedative like valium. With your history of DVT you are at an increased risk for developing an additional DVT or PE if you underwent the procedure under either general anesthesia or IV sedation. With all that said, your surgeon should discuss your options with you, calculate a caprini score and discuss this with you in detail so that you may make a well informed decision. Good luck.

Face, neck and brow lift -

Thank you for asking about your face, neck and brow lift.
  • I am so sorry you had two significant complications after your surgery.
  • It truly isn't possible to advise you without an examination.
  • I think you need a second opinion before you have anything more done -
  • Always see a Board Certified Plastic Surgeon. Best wishes  - Elizabeth Morgan MD PHD FACS

Office revision

Fillers or possibly even a direct nasolabial excision under local may be good options for you. Your surgeon can evaluate that best.

Robert H. Hunsaker, MD
Miami Plastic Surgeon
4.5 out of 5 stars 69 reviews

Minor revision in office vs. fillers

Thank you for the question. Without picture or a physical exam, I can't give you clear advice. However, I think this is a bit of a false choice. The parotid leak (sialocele) would cause swelling or irregularity on the lateral cheek or in front of the ear. The marionette lines are by the corners of the mouth. Treatment for marionette lines is not a facelift... this procedure will result in minimal improvement of these lines regardless of complications such as a sialocele. Marionette folds are treated with fillers or fat grafting, and possibly laser treatments for the surface texture. If you need a minor revision for the lateral cheek, doing this in the office would not be a problem in most cases. Best of luck moving forward!

Evan Ransom, MD
Bay Area Facial Plastic Surgeon
4.9 out of 5 stars 93 reviews

Revision face lift

You are potentially able to have a touch-up under local, but more information would be relevant regarding your DVT history.  Best of luck.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

Revision vs Filler

Facial rejuvenation surgery can be performed comfortably in an office setting with either oral or IV sedation, depending on the facility credentialing.  However, fillers also have a roll.  Like when you get your hair done, it looks much better when you get it washed, cut, dyed, and blown than just any single treatment, fillers and surgery, along with good skin care, provide the best results.Hope this helps, good luck on your quest!

Michael J. Rodriguez, MD, FAACS
Fort Lauderdale Facial Plastic Surgeon
4.7 out of 5 stars 60 reviews

Revision face lift

You can certainly do a revision with just local anesthesia.  We often do primary facelifts with just local.  When using only local, you will have to tolerate the injections of the local anesthetic which burn.  But once this has been given you should not have any more pain.  If you are anxious they can give  you some pills by mouth for the anxiety.  With your history it is definitely the safer way to go. 

John J. Martin, Jr., MD
Coral Gables Oculoplastic Surgeon
5.0 out of 5 stars 24 reviews

Facelift with local anesthesia

Thanks for sharing your story. It is stories like this that helped to develop the mini facelift techniques that can be done much more safely using local anesthesia in an office setting. You get to walk right out of the office when you are done, back to light activity. Yes, this can absolutely be done comfortably for you, and I would choose that over injections. Best wishes.

Paul J. Leahy, MD
Leawood Plastic Surgeon
5.0 out of 5 stars 6 reviews

Revision after facelift surgery via Juvederm

The type of revision that can provide the best results will depend on a number of factors.  In general, dermal fillers like Juvederm are suitable for soft tissue shrinkage and deep creases caused by loss of facial volume/fat.  But if there is a visible amount of sagging skin, then another surgical dissection might be needed to achieve good result

I hope that helps and good luck.

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.