Can you really perform a SMAS lower face and necklift as an in-office procedure with just a local anesthetic?

I am NOT referring to a mini-lift, weekend lift, LSL. I am referring to an actual comprehensive lower face and neck lift. Thank you!

Doctor Answers 26

SMAS facelifts under straight local anesthesia, no thank you

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You need to understand that while there may be an appeal to you for straight local anesthesia and while it might intuitively seem "safer" to you, this is not really the case. A properly done complete lower facelift with SMAS work needs a few hours in any good surgeons hands. That's a long time for you to lie there completely wide awake. If you become uncomfortable, your surgeon may need to back off on doing all they had planned. f you are given sedation without a trained anesthesia provider there all the time, it also is not safe since the surgeon should only need to concentrate on you and your procedure, not your level of sedation. 

It is amazing how anxious even the calmest patient becomes on their day of surgery, even for a tiny mole removal. It is a truly rare person who could have a real facelift done completely comfortably under straight local. So, the best plan is not to look for someone who will do this if you ask but to go to the very best facelift surgeon, ask how they prefer to do it and why, and let them do their thing and take great care of you. It is your FACE and needs to be done right, once.

True Facelift under Local Anesthesia

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There are several parts to your question.Yes, a full SMAS facelift can be done under local anesthesia.However, because a properly done facelift that will give you excellent rejuvenation and last for many years requires significant precise surgery and takes up to several hours, almost no one should do this without sedation.Therefore the answer to your question as you stated it, of doing a full SMAS facelift under just local anesthesia, is no, it is really not feasible.There are presently many people doing facelifts in the office under local anesthesia and giving you what they call "a little something to keep you comfortable."The problem is that if they give you enough to truly make you comfortable, they have essentially giving you an anesthetic dose of the medication.In order to do this safely, they need someone dedicated to watching your vital signs and overseeing your safety.They also need all of the emergency equipment that is possibly needed to reverse you if these medications provide too much anesthesia.Many of these people do not provide this safety net.Previously I did essentially all of my cosmetic procedures, including facelifts, under local anesthesia with IV sedation.Because you essentially need an anesthesiologist to oversee any medications given for a procedure such as a facelift and a fully certified facility, and because general anesthesia, in my estimation is much safer and recovery is faster (you awaken immediately after turning off the gas but IV administered drugs take a day or 2 to work out of your system), I now use nothing but general anesthesia.Both I and my patients are much happier and the cost is the same.

Robert T. Buchanan, MD
Highlands Plastic Surgeon

Local Anesthesia Facelift

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Excellent question.  The answer in short is "yes", but there is more to the story.

First, a true facelift, not some sort of "mini" version is an extensive operation that takes at least two hours.  I usually spend 2.5 to 3 hours on a lower facelift.  This can seem like a very long time while you lay there.

Second, the infiltration of the local anesthetic is painful.  In other words, it is a lot of shots to get you numb at the beginning, but it is definitely do-able and it only takes about 5 minutes.  With some gentleness and a few tricks, it doesn't hurt that much.

Third, just because you are not under anesthesia, a proper operating room is still a must.  A facelift should only be done in a properly accredited operating room regardless of anesthesia.  The facility should be certified by either AAAHC, AAAASF, or JCAHO.

Having said that, I offer all of my patients the option of local anesthesia.  Not surprisingly, I get very few takers.  But I still do sometimes. 

I perform the vast majority of my facelifts with the patient under IV sedation.  This is a strong sedation that keeps you asleep, but you still breath under your own power without a tube in your lungs or gas anesthesia.  I consider it to have most of the best qualities of local and general anesthesia while avoiding most of the undesirable issues.

Louis W. Apostolakis, MD
Austin Facial Plastic Surgeon
4.8 out of 5 stars 36 reviews

True facelift in office without anesthesia

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Some surgeons might do this in office under straight local.  I would not.  I am not sure that it is wrong, but I like the control that general anesthesia provides me.  It allows me to be more precise and deliver the results of which I have pride.  The extra expense is minimal especially if you consider it amortized over many years of enjoying a high quality natural appearing face and neck.

Adam Bryce Weinfeld, MD
Austin Plastic Surgeon
4.9 out of 5 stars 62 reviews

Can you do it? Yes. Would I recommend it to my Mother? No

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Without being redundant, because several posts have addressed this topic very effectively, local anesthesia facelift is technically possible. However, in today's marketing atmosphere, it is really more of a marketing gimmick than a desirable or recommended practice.  Think about how long you would like to sit and do something relaxing like sit beside a pool (1-2 hours max). Now consider 65 degree temperature, multiple local anesthesia shots, followed by inexplicable sensations and sounds for 3-4 hours. That's a local anesthesia Facelift.  If it's done in an hour, your satisfaction will likely last for several months if at all. I encourage all patients to research this before diving in. 

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
4.9 out of 5 stars 103 reviews

SAMS facelift

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A full SMAS facelift is much more comfortable to you and the surgeon to be done under local with sedation type of anesthesia. Other option is general anesthesia. SMAS facelift can be done then with or without fat transfer to the face, for complete facial rejuvenation. Laser resurfacing if needed and indicated.
Samir Shureih MD. FACS

Samir Shureih, MD
Baltimore Plastic Surgeon

Full facelift - local anesthesia

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The answer to your question is YES. However, one needs to ask WHY is this question even  being posed? What are the circumstances?

Prior to face lift or any other facial cosmetic surgery all of us infiltrate into the cheeks and neck local anesthetic for 1. numbing and 2. assistance with blood vessel constriction. IV sedation or general anesthesia are not needed for the analgesic effect (pain control) but instead are needed to improve your tolerance of the entire procedure. Patients who undergo inadequate numbing due to discomfort of the injections and patients who are anxious tend to have unpleasant experience. That is why some of the patients who undergo surgery with minimal or no sedation give such negative reviews about their experience. Just keep on doing your research on line, and be careful in your selection.

Jan Zemplenyi, MD
Bellevue Facial Plastic Surgeon
5.0 out of 5 stars 17 reviews

Wide awake facelfit?

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Thanks for your question. It certainly is possible to perform a comprehensive facelift procedure under local anesthetic. I do think however that it would be more uncomfortable if not downright BORING for the patient to have to lie still for up to 3 hours. The sedation most surgeons use is safe and effective in making the experice much more pleasant. In the odd case of patients with significant sleep apnea who might be difficult to sedate this could be a reasonable option. 

Good Luck

Thomas Buonassisi, MD
Vancouver Facial Plastic Surgeon
4.9 out of 5 stars 114 reviews

Comprehensive face neck lift under local anesthesia

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A comprehensive face and neck lift is not performed in the office setting, but in a certified and licensed out- patient ambulatory surgery center. The procedure can be performed under local anesthesia, IV sedation, or general anesthesia depending upon the surgeon and  patient preference. Many patients simply cannot tolerate performing a three-hour surgery under local anesthesia, so we usually recommend a general anesthetic performed by a board-certified physician anesthesiologist for patient safety and comfort. For many examples of a comprehensive face/neck lift, please see  the link below

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 157 reviews

Local Anesthesia for a Facelift

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It is possible to perform a full facelift with local anesthesia, but sedation is usually needed in addition to the local injections.  Sedation allows you to relax better for the length of the surgery and helps you to keep still so that your surgeon can focus on doing the best possible work for you. I think a general anesthetic is actually less stressful on you, the patient but there can be good reasons to use local and sedation.  Make certain your surgeon is very expereieced and certified by the American Board of Plastic Surgery.

Mary Lee Peters, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 117 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.