General or twilight sedation? I had a consult for lower face, neck and brow lift.

Local anesthesia with a little iv sedation for complete comfort is the very best and safest way to get a lower face/neck lift done. You can get a better result as well since you can sit up and the doc can fine tune the results better. Why be sick for a week from general anesthesia when you don't need to?

I only do facelifts under general anesthesia by a board certified anesthesiologist for utmost comfort for the patient. For the delicate surgery to be performed on the face, I do not want the patient moving around. General anesthesia is very safe. Be sure to choose a board certified plastic surgeon. Good luck.

Generally, general anesthesia is used for browlift/facelift. It allows patients to be most comfortable and the surgeon can do what she/he needs to do and can focus on the surgery. Full anesthetic also minimizes bleeding risk from wavering blood pressures. Anesthesia is extremely safe. You should discuss your options with a board certified plastic surgeon. Maximal impact surgery needs anesthesia.

I have done these both ways, and each has its own advantages/disadvantages. It really depends on what your priorities are. The best thing to do is discuss this in person with your surgeon, who can go over all of this with you in detail. hope this helps!dr. silver

 In our practice we perform these two procedures under general anesthesia by a board-certified physician anesthesiologist for patient safety and comfort. Both procedures could take upwards of four+ hours to perform, so it will be very difficult for patients to undergo this  sedation for that length of time. You will also most likely have some degree of conscious awareness of the  operative procedure unless you are completely asleep.

The choice of general, partial sedation, or awake local is based on the preferences and experience of you surgeon.  Published research studies support any type as long as it is done by experienced professionals.  My recommendation is that you find the best, most experienced, board certified plastic surgeon and follow his or her recommendation about the type of anesthesia they use for their patients undergoing facelift, necklift and browlift.  

Hi, I have performed many brow lifts, facelifts and neck lifts for over 30 years and have performed many minimally, invasive SMAS facelifts.  Non smiling photos of your face from the front and side would help in the evaluation.  Whether or not a general anesthetic is best will depend on part by the anticipated length of time for your planned surgery.   The reality is, there are many different ways to perform a facelift from incision length, incision placement, level of tissue dissection (skin only, SMAS, Deep Plane, Subperiosteal), different degrees of tissue undermining, how to lift and support (imbrication versus plication of the SMAS layer), how much excess skin to trim, is excess fat going to be reduced and finally will the overall shape of the face be made more feminine or masculine (while avoiding the over pulled, windswept appearance).  
 In my humble opinion however, there are some basic requirements that must be met in order for a facelift to be "effective", yielding "aesthetic pleasing" and "naturally attractive" results.  These include: 
 1. Some type of incision either curved around the front (preferred) or straight in front of the ear.  This is how excess skin is removed which is not possible with an incision behind the ear alone.  If you have so little excess skin on the face that "none" needs to be removed you are not a candidate for a facelift in the first place.
2. The facelift must address correction and softening of the "jowls" using a long lasting and effective technique.  If you have "jowls” these are sagging facial tissues and the main indication for some form of a SMAS facelift.  The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured (not merely folded or suspended with threads or sutures that will not last).  The excess skin is then removed and the facelift incisions closed.
3. Facial shaping must be combined to properly shape the cheeks, chin, jaw line and lips for feminizing or masculinizing the face as the case may be. Similarly, there are numerous ways to perform a brow lift, some are minimally effective while the coronal Brow Lift remains the "gold standard" for brow lift procedures.  I don't perform a Coronal Brow Lift with a facelift and neck lift as the continuous incisions required decrease the blood supply to the mid and lower face post facelift.  I prefer to perform the facelift and shape the face, wait 6 to 12 months and then perform the brow lift.
  If you have "jowls”, in the lower face, these are sagging facial tissues and the main indication for some form of a SMAS facelift.  The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured (not merely folded or suspended with threads or sutures that will not last).  The excess skin is then removed and the facelift incisions closed.
 My most popular SMAS facelift is the minimally invasive, short incision SMAS facelift that has all the benefits of more invasive facelifts (traditional, mid-face, deep plane, cheek lift and subperiosteal facelifts) but with these added benefits:
very small incisions and no incisions extend or are placed within the hair.
minimal tissue dissection = less bruising and swelling = rapid recovery ( several days instead of weeks or months with the more invasive type facelifts mentioned)
can be performed in 90 minutes or less, with or without general anesthesia
no incisions within the hair = no hair loss
excess fat can be removed from the face and neck
excess skin removed from the face and neck
cheeks, chin and jaw line can be augmented with dermal fillers (I prefer Restylane Lyft) or facial implants
most patients fly back home to parts all over the world in as little as 3 days post-op
 I combine facial shaping with every facelift procedure.  When jowls are present, these should be done in concert and not alone or separately in order to create a naturally, more attractive face. Following my beauty principles, women look the most feminine, youthful and attractive with heart shaped faces.  Heart shaped faces have cheeks that are full and round in the front.  Cheek augmentation with a dermal filler or using cheek implants for a permanent enhancement will create full, round cheeks that will feminize the entire face.
 When the chin is weak, this creates an imbalance making the nose appear larger, the mid face top heavy and the lower face look short that de-emphasizes the lips and allows early formation of a double chin.  Chin augmentation using a chin implant will add projection to the chin creating harmony and balance to the lower face.  I have found placement of a silastic chin implant, through a small curved incision under the chin (also allows excess skin removal) to be very safe, quick and highly effective.
 Along with the minimally, invasive SMAS facelift described above, some of the excess skin below the chin can be removed using a small, curved incision under the chin.  This along with skin removed in front and behind the ear will tend to reduce the skin excess by around 70% or more.
 If anterior platysmal bands are present or the maximal amount of neck skin is to be removed, a "formal" neck lift can be done.  In this procedure, the face and neck tissues are elevated using a curved incision around the front (explained later) of the ear that continues in the crease behind the ear and then 3 inches into the posterior hairline.  The tissue is dissected from that point all the way across the entire neck to the same position on the other side of the head in a dissection that is as long vertically as the entire neck.  The Platysma muscles are tightened using a curved incision under the chin and each side is pulled upward and back again being tightened at a line behind each ear (under the tissues).  Since the skin flap pull is up and back, this will pick up any tissue laxity along the jaw line or "jowls" which must be dissected and flattened out using a lower facelift (incision around the front of the ears).  If this isn't done, pleats of excess skin will appear below each ear.  This is an extensive surgery taking 4 1/2 to 5 hours with large incisions, requires placement of drains, possible hair loss and months of recovery.  
 I have been a board certified facial plastic surgeon with The American Board of Facial  Plastic and Reconstructive Surgery since 1993.  There are several boards that certify plastic and or cosmetic surgeons (summarized below):
The American Board of Facial Plastic and Reconstructive Surgery for facial plastic surgeons that specialize in plastic surgery of the face, head and neck area.
The American Board of Plastic Surgery for plastic surgeons performing plastic, reconstructive, (some also perform hand and back surgery).
The American Board of Cosmetic Surgery for cosmetic surgeons performing cosmetic surgery of the face and or body.
You can google each specific board to learn more about them and the specialty they represent.  
In my experience and humble opinion, board certification by any board (and you can see that since there are at least 3 such certifying boards, no one board can "claim" ownership or superiority in Plastic Surgery...doing so is more "hype" and "marketing" than fact), so logically there must be some other way to find the surgeon that's "right" for you.
**Medical Boards of each state keep records of safety and or malpractice issues with all doctors, including any plastic & cometic surgeon.
**Avoid price as an initial determination of how your select your plastic and cosmetic surgeon.  If it sounds too good to be true it probably is.
**Do rely on reputation, experience and of course a "sound aesthetic judgement" on what will or will not make you more naturally attractive.
**Finally, always follow that little voice in your head that says this is the right place or perhaps you might want another opinion.
Hope this helps.