Anesthesia Alternative for Lidocaine in Facelift Procedure?

I had allergy testing with preservative free lidocaine to rule out methylparaben sensitivity. I developed red papules and itching at the injection areas. No life threatening reactions just the rash for several days.

Now my plastic surgeon will not do a Facelift unless I use general anesthesia which I don't want to use. Is there any other local anesthesia that could be substituted for lidocaine? Is a topical skin reaction to PRESERVATIVE FREE lidocaine dangerous?

Doctor Answers 10

Local Anesthetic Choices

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Marcaine, also called bupivicaine is a different type of local anesthetic (an ester) and lasts longer than lidocaine (an amide) so that it is unlikely you would also be allergic to this medication. However skin testing might be wise before hand in your case. One of the reasons to do this procedure under general of IV sedation is that an anesthesiologist would be present that could take care of any allergic reactions you may have during the procedure. It would seem that your plastic surgeon has your best interests in mind when he made this decision.

Marcaine or general anesthesia

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There are many alternatives to lidocaine on the market that can be safely used. The most common alternative in my practice is Marcaine, also called bupivicaine. If you wanted to avoid all anesthestic injections, you also could have your facelift done under general anesthesia and your doctor could inject a dilute solution of epinephrine to accomplish the bleeding control that is an important reason for the injections. If no anesthetic injections are done though, you will probably experience more discomfort in the first day or two.

Reginald Rice, MD
Folsom Facial Plastic Surgeon
4.3 out of 5 stars 8 reviews

A general anesthetic is the way to go with your facelift

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Your surgeon is giving you great advice. While Lidocaine allergies are very rare there is no sense in risking a major dangerous reaction when you can avoid it with a general anesthetic. In fact almost all my face lifts are now done under general anesthesia because I find it easier on the patient and on me. With today's modern anesthesia the risks are so rare that i would not hesitate.

Carl W. "Rick" Lentz III, MD
Orlando Plastic Surgeon
5.0 out of 5 stars 17 reviews

Lidocaine alternative for Facelift procedure

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Most likely not, but the issue you present is one of your safety. You can ONLY be operated upon in a hospital setting. The risk of a severe allergic reaction is too high. That is why your plastic surgeon is offering to do your surgery under general anesthesia with most likely epinephrine soaks to decrease the bleeding. See other plastic surgeons in your area to get a consensus of the type of care you will be needing. Regards.

General Anesthesia Offers Comfort and Safety

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Although allergies to lidocaine are extremely rare they do occasionally occur. When this situation arises facelift procedures can still be performed, but the anesthetic technique needs to be modified.
When patients are allergic to lidocaine other types of local anesthetics may be helpful. Local anesthetics fall into two categories, these include amides and esters. In most cases when patients are allergic to an anesthetic, they’re able to use anesthetics from the opposite group. For instance Lidocaine is an amide. For this reason patients might be able to use Marcaine which is an ester.
Although you’re not interested in general anesthesia, this might be your best option. General anesthesia offers high comfort levels and excellent patient safety. The majority of plastic surgeons prefer this approach to local anesthetic with or without I.V. sedation. With your history of allergies the presence of an anesthesiologist provides added safety.
If you’re still interested in facelift surgery, it’s important to discuss these issues with your plastic surgeon. Your surgeon should be able to formulate a treatment plan that addresses your concerns about anesthesia.

Lidocaine allergy

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I always do my facelifts under general anesthesia but use local anesthesia in addition to allow the anesthesiologist to keep the amount of general anesthesia to a minimum. There are many alternatives to lidocaine but I think that Gen is the way to go for a facelift.  The patient is comfortable and I can focus on the surgery and the outcome.

Local Anesthesia for Face Lift Surgery

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As other plastic surgeons have mentioned, you may consider being tested with other anesthetic solutions to determine allergy. You will require more anesthesia beyond any topical cream for any face lift surgery.

A face lift is not one operation, but rather many potential operations dependent on the surgeon and patient to improve neck line, jowls, and facial aging. Typically most have face lift surgery on either IV sedation (twilight anesthesia) or general anesthesia. Either are good, safe options, with their own advantages and disadvantages. Some facial plastic surgeons perform face lift surgery under local anesthesia. Anesthesia may be provided by a board-certified anesthesiologist and/or nurse anesthetist dependent on the surgical facility.

The decision on the type of anesthesia depends on the extent of face lift surgery, combined cosmetic surgery procedures along with the face lift, patient factors/preference, and surgeon factors/preference. Face lift surgery is a completely elective procedure, and safety is the most important concern. While cosmetic surgery may be performed for many individuals in an office setting, it's safer in your situation to have surgery in a hospital setting.

Only after a comprehensive evaluation by a plastic surgeon can one choose the appropriate anesthesia type for plastic surgery. Best of luck.

Houtan Chaboki, MD
Washington DC Facial Plastic Surgeon
4.9 out of 5 stars 89 reviews

Lidocaine Allergy

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First of all, test for allergies to other local anesthetics. Unless you have significant medical problems which have not been mentioned, a very light general anesthetic is very safe. There are many different techniques and levels of general anesthesia. Investigate your alternatives.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 43 reviews

Yes there are alternatives to lidocaine anesthesia.

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 You can be tested the same way with Marcaine. The surgeon probably feels you will be more comfortable with general anesthesia at the same time which is the way most surgeons do this.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 38 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.