​Is it normal to be on local Anesthesia on a Facelift? Are you totally wide awake?

Hi Kelloway,This is something which can be clarified pretty easily by contacting the Plastic Surgeon's office and find out if there was a misunderstanding.  All Facelift procedures use local anesthesia, even if you are going under general anesthesia.  We cannot make the skin incision without first injecting the skin with local anesthesia.  The local anesthesia completely numbs the skin and more importantly adrenaline is added to the local anesthesia to constrict the blood vessels for a more much less bleeding during the facelift surgery.Most "mini-facelifts" are around 1-2 hours only and can be performed "wide awake" without any sedation.  Some surgeons will at least add some Valium which is taken by mouth to make the patient "sleepy" so that they can at least sleep through a portion of the procedure.  Since the local anesthesia will make the skin completely numb, the patient will not feel any pain, but may feel some pushing and pulling as well as "hear" sounds of surgery, such as snipping of scissors, or beeping and buzzing from the electrocautery which helps to stop bleeding.I regularly perform a 3-3.5 hour lower face and necklift procedure which I call the Necklift plus.  To see what is possible with an awake facelift, please check out the Web reference link below.   I give the patient Valium and use local anesthesia injections.  This is more than just a mini-facelift which I consider a "shortcut" procedure and if the patient were under full IV sedation or general anesthesia, the same procedure I would perform.  The main complaint of the local anesthesia facelift with Valium is not from the facelift procedure, but instead from lower back pain or neck pain from laying still for so long.  In order to help relieve the back and neck pain, I will have a pillow place under their knees to reduce lower back discomfort, and as for the neck stiffness on the back of the neck, the patient's head is moved in three positions.  One is looking straight up towards the ceiling for about 30-45 minutes.  Then, head turned to the right for 45-60 minutes, and head turned to the left for 45-60 minutes.  When transitioning from the under chin/neck area, to the left cheek then to the right cheek, the patient gets some time to turn their neck from side to side to loosen up their neck.  Most surgeons do not offer a true lower face and necklift under local anesthesia with Valium, and will either offer a mini-facelift which is shorter, or simply use full IV sedation or General anesthesia for 3-4 hour facelift/necklift surgeries.  Ask your surgeon if an IV sedation similar to a colonoscopy will be used, but without using a breathing tube (general anesthesia.)  IV sedation has the same benefits of general anesthesia, which is amnesia of the entire procedure, but will a faster wake up, and often times less nausea during the recovery.Best,Dr. YangP.S. There is a new feature on Realself, which is the "Follow" button. It is similar to the "Like" button on Facebook. If you like my response or any of the doctor responses while you research on Realself, you should "Follow" them. You will get email updates, when the doctors you follow post any new answers to questions, post new photos, or have any new reviews.

Thank you for your question. I have performed many Facelift under local anaesthetic administered properly, patients are comfortable and have an easier recover.  I have pioneered my Concept Facelift, which targets the SMAS muscle and skin, therefore giving the same longevity as a traditional facelift, however is performed under local anaesthetic.  This ensures a significantly reduced recovery period, with minimum swelling and bruising, therefore patients returning to their daily routines within 5-7 days. My reasons for pioneering this were because patients did not want the health risk of going under general anaesthetic (especially as is it not a necessity procedure), local anaesthetic or twilight sedation would be a great alternative, not only for health reasons but your recovery period will be shorter.  My patients will experience slight discomfort when injecting the local anaesthetic, then will feel very relaxed and calm throughout the procedure (please watch video).

Please make sure you find a reputable and qualified plastic surgeon who can assess you properly to give you a realistic idea of what outcome you can achieve. 
All The Best

If you are in good health then a facelift and necklift can be performed safely by either local anesthesia with oral sedation, intravenous sedation, or general anesthesia in my practice. The oral sedation with local anesthesia relaxes the patient and often they sleep during a good portion of the surgery and forget the details of it afterwards. The key is for you to feel most comfortable. Many patients select local anesthesia with sedation as they are afraid of General Anesthesia, whereas other patients are afraid of being aware or feeling the injections at the beginning of the procedure. General anesthesia is safer than many patients think, but if you are uncomfortable with the idea of being fully knocked out then your facelift can be performed with local anesthesia with IV sedation. Your doctor will check thoroughly to be certain that general anesthesia is safe for you. In any case, you are safest in the hands of a Board Certified Anesthesiologist. The most important decision you can make is deciding on the most qualified plastic surgeon (see link below) whose job it is to guide you on decisions such as the ones you are considering.#faceliftanesthesia#faceliftanesthesiachoices

Thanks for posting your question. I have performed thousands of facelifts, neck lifts, mini lifts, blephs, lasers and chin implants all under local anesthesia and oral sedation. Administered properly, patients are comfortable and have an easier recovery. There is an art and science to this local anesthesia technique to acquire a high level of patient comfort. My patients do not even require a narcotic prior or during their their procedures thus further reducing nausea. The risks, both short term and long term, of general anesthesia are eliminated. Please consult with several board certified surgeons experienced in facelifting and also in local anesthesia techniques. Ultimately there is no right or wrong way to have anesthesia for a facelift. You and your surgeon will decide what methods are best for you.

A properly executed facelift is a fairly extensive operation. I have done the procedure with sedation and local but mostly with general anesthesia. I've never done with local anesthesia only. In my opinion patients do better and more predictably was general anesthesia.

Like other sureon's opinion, I agree that 4 hours is a long time for you to be awake during a facelift. However with right tumescent technique, oral sedatives and surgical technique, it can be done with outstanding results and fast recovery.The other option is to have IV sedation or general anesthesia which is nice too. However, it may add to the cost of procedure.It's best to communicate with your surgeon and have a mutually agreeable plan.

Hi. Most of the facelifts I perform are under general anesthesia. It takes me 3 hours to perform a facelift under local (longer than under general), and some patients find it difficult to sit still for this length of time. You should definitely have some oral sedation/pain relief before to help you relax. Most patients I have performed this to reduce costs, as having a general anesthetic has increased costs.General anesthesia does make it more pleasant for you, and if you are fit and healthy there is no reason not to have a general. You should discuss your concerns with your surgeon. All the best for your surgery. Regards Dr Charles Cope

I rarely perform facelift procedures under local anesthesia. That is actually a long time for someone to lay still in an operating room without any sedation. Further, the local anesthetic injected periodically during the procedure is painful. For a small procedure or a small area that needs to be numbed this is OK. However, having both cheeks and possibly the entire area under the jaw numbed while you're awake can be upsetting for patients. I agree with my colleagues that IV sedation or general anesthesia typically creates the best experience for my patients. I hope this information is helpful for you.Stephen Weber MD, FACSDenver Facial Plastic Surgeon

You need to ask your surgeon if it is just local, or local with some sedation.  Sedation can be in the form of some oral pills such as valium or Xanax.  Or it can be IV sedation which can provide a much deeper level of anesthesia.  There is no need to do it with general.If you have a good anesthesia provider, it can be easily done with local and IV sedation.Some patients do not want any or minimal sedation.  They will have to be able to tolerate the discomfort of the local injections.  After the injections the surgery is usually painless.  For anyone with anxiety about the procedure or a fear of needles, then IV sedation is the way to go.   

A fcelift is possible under local anesthesia.  Some plastic surgeons (including myself), would reserve a lift under local if the area to be corrected is minimal, say with a short scar lift and neck lipo.  If you require a full procedure, and open neck with defatting, platysmaplasty, etc., general anesthesia is preferred.Four hours is NOT a long time under anesthesia.  My patients prefer general for most procedures over 2 hours, as they become uncomfortable laying very still for that long.Make sure your surgeon has privleges in an accredited OR prior to your surgery, so you can make your own choice.Good luck!