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

I am having a facelift done on the 30th of April,when I had my appointment with the Plastic Surgeon he informed me that it would be done using a local Anesthesia .I asked why not a General Anesthesia & he explained that the surgery was four hours & that is a long time to be under & that recovery from a local is much easier & faster.I am a little nervous about doing a local ,is this normal to do a local fir a facelift & are you totally wide awake ?

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

Doctor Answers 23

All Facelift procedures use Local Anesthesia: ranging from wide awake to general anesthesia

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.


Dr. Yang

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New York Facial Plastic Surgeon
4.8 out of 5 stars 33 reviews

Facelift Under Local Anesthesia

A short scar or mini facelift done under local anesthesia is actually preferable to one done under general anesthesia. It makes for a much safer surgery and little to no post procedure recovery time before going home after the surgery. These types of procedures are typically suitable for younger patients with minimal jowling and a neck that requires minimal rejuvenation. Typical duration for this type of procedure is under two hours and it is a much more pleasant experience for the patient not to have to metabolize all the gas anesthetics. 
The procedure you are describing which is a four hour surgery, is likely a full facelift. While it is possible to comfortably perform this surgery under straight local in some patients, most would benefit from the addition of Intravenous sedation for added patient comfort. The extra medications would be given via an IV and be administered by an anesthesiologist or nurse anesthetist. No breathing tube is necessary and the patient is not exposed to any anesthetic gasses. 
This is my preferred method of anesthesia for facial cosmetic surgery as it is still a very comfortable experience for patients even for longer cases that can last six hours when you combine a full facelift with upper and lower blepharoplasties, brow lifts, dermabrasion, and structural fat grafting to give the ultimate surgical makeover. Patients under local with IV sedation maintain the resting tone of their facial musculature which allows for more precisely controlled and predictable results. Also, resting blood vessel tone is maintained, resulting in less bruising and less incidence of hematoma formation in my experience.
The most important factor in your surgery is safety. Is your surgeon certified by the American Board of Plastic Surgery? Does he have privileges to perform the same procedures in a hospital setting? Is the surgical facility properly certified (AAAASF, AAAHC)? Are properly qualified providers administering the IV sedation and monitoring you throughout the procedure? If the answer to these questions is yes, then you are in good shape and there is no need to endure the additional coughing, sore throat, nausea, and prolonged recovery time associated with several hours of general anesthesia.

Mark Gaon, MD
Newport Beach Plastic Surgeon
4.9 out of 5 stars 10 reviews

Local Anaesthetic Facelift

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

Local Anesthesia for Facelift

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.

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 154 reviews

Facelifts can be done under local anesthesia and oral sedation

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.

Raymond E. Lee, MD
Orange County Facial Plastic Surgeon
5.0 out of 5 stars 86 reviews

Face lift with local anesthesia

Facelifts are commonly done with general anesthesia and it is considered standard.
Facelifts take time and can cause pain.

A local anesthetic with intravenous sedation is used by some surgeons - and is an acceptable alternative but you should have an anesthesiologist with you to monitor your breathing. At times the surgery needs to switch to general anesthesia.

With only local anesthetic, your face lift would be quite limited. Ask your plastic surgeon to explain what surgery is planned and what anesthesia - to be sure you are having the operation you want done.

Elizabeth Morgan, MD, PhD
Atlanta Plastic Surgeon
4.6 out of 5 stars 43 reviews

General versus local anesthesia for facelift

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.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.7 out of 5 stars 35 reviews

Local or General for facelift

I would suggest contacting your PS and clarifying what operation you are having, length of operation and telling your PS which type of anaesthesia you wish to have. 
If a general anaesthetic is the method of anaesthesia you wish for, then this should be your choice. If you are not able to be offered general anaesthesia by your PS then go and see another PS.
I personally have a preference for general anaesthetic for face/neck lifting. With modern general anaesthesia recovery is quick. I accept that the recovery is longer than being wide awake under local anaesthetic but I cannot perform a full face/neck lift under local anaesthetic only. If you have any doubt then consult with another PS.  

Gary L. Ross, MBChB, FRCS
Manchester Plastic Surgeon
5.0 out of 5 stars 165 reviews

Choice of anesthesia for facial rejuvenation must balance surgeons' needs with patients' safety

Do confirm the exact "cocktail" of anesthesia which will be utilized for your procedure.  The choice of anesthetic techniques for facelift surgery is wide and ranges from local with oral sedation, intravenous sedation with local, general anesthesia with local.  Even though your perception may be blunted with either IV or inhalational anesthetic agents, the addition of local anesthesia can decrease bleeding and decrease the need for narcotics, which in turn may cause post-op nausea, vomiting and slow recovery.  Ultimately the correct selection of anesthesia will optimize the patient's safety as well as be acceptable to the operating surgeon. I have offered general anesthesia but generally prefer IV sedation administered with full cardiac and Brain wave  (BIS) monitoring by a BC Anesthesiologist in my licensed surgical suite.  Patients breathe spontaneously and the absence of an endotracheal tube really facilitates the approach to the neck. When administered by a BC Anesthesiologist, IV sedation is safe and effective as GA.

Lavinia K. Chong, MD
Orange County Plastic Surgeon
4.8 out of 5 stars 58 reviews

Anesthesia for Facelift

Dear kelloway, thank you for your question.Facelift surgery can dramatically improve the cheeks, temple area, jawline, and neck. Anesthesia type will vary by surgeon and their experience. Consult with a board certified facial plastic surgeon who can offer a variety of options. Good Luck!

Roy A. David, MD
San Diego Facial Plastic Surgeon
4.5 out of 5 stars 23 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.