Twillight: is it safe?

One of the doctors that I consulted for a facelift is considered to be the best “nose doctors” in my region. He specialises in facial surgery and he is a renowned plastic surgeons. He use “twilight” type anaesthesia which he does himself without the presence of an anaesthetist. Is this a “normal” approach? Is it safe?

Doctor Answers 11

Twillight anesthesia is a safe method for facelifts.

The sedation the intravenous medications can provide plus the pain blocking effects of the local anesthetic injections can provide most patients with a comfortable way to undergo their facelift/necklift procedure. I feel the IV sedation should be monitored by someone other than the doctor, so a qualified person should be present so the surgeon can focus on the surgery and the nurse/CRNA/anesthesiologist can provide the sedation and monitor the vital signs. Whatever the type of anesthesia used for your facelift, it should be preformed in an accredited, fully licensed surgery center.

Boston Plastic Surgeon
5.0 out of 5 stars 102 reviews

Safe in Experienced Hands

This is a good question. "Twilight" is a nonmedical term that refers to a level of anesthesia that involves either conscious or deep sedation. There are a number of advantages over general anesthesia: absence of a sore throat (no tube), a lower incidence of nausea and vomiting, less of a hangover feeling, and potentially less risk because of some of the possible complications associated with intubation and use of muscle relaxants in general anesthesia. However, the critical factor in safety is the adequacy of monitoring and the ability of the person(s) administering anesthesia to handle any issues that can arise if the patient slips into a deeper level of anesthesia. In general, the lighter the level of anesthesia, the less need there is for the presence of an anesthetist. All cases of deep sedation require the skill of a nurse anesthetist or anesthesiologist, but conscious sedation can be performed safely in an experienced and properly trained physician's hands. Conscious sedation is frequently used by radiologists, gastroenterologists, dentists, and ER physicians and in other medical settings with a high degree of safety. It is important to discuss your concerns with your physician.

Thomas A. Mustoe, MD, FACS
Chicago Plastic Surgeon
4.8 out of 5 stars 97 reviews

Yes, it is safe!

"Twilight anesthesia" has numerous advantages if done correctly.  We find that patients have a more predictable recovery with less problems than we have experienced with general anesthesia (patients wake up more predictably and without nausea commonly seen with general anesthesia, even in the best anesthesiologists hands).  The key is not over-dosing the IV anesthetic and truly keeping the patient in "twilight", not in a deep anesthesia. It is my favorite way for anesthesia for facelifts and many other procedures.   However, nasal surgery can be quite stimulating and sometimes general anesthesia is best, particularly if there is a predictable amount of bleeding and airway management is important.

John Frodel, MD
Atlanta Facial Plastic Surgeon
5.0 out of 5 stars 1 review

Twillight: is it safe?

I prefer general anesthesia with a board certified anesthesiologist.

Find a plastic surgeon with ELITE credentials who performs hundreds of facelifts, necklifts, facelift revisions, and facial procedures each year. Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results.

Kenneth Hughes, MD

Los Angeles, CA

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 496 reviews


Twilight anaesthesia is extremely safe and appropriate for most facial surgery including facelifts.In my opinion it is safer than general anaesthesia as some complications such as blood clots in the legs are considerably reduced with twilight anaesthesia.Having said that ,it is important that a trained individual monitor the anaesthesia and the patient so that the surgeon can concentrate on the surgery.This can either be a certified anaesthetist or certified nurse anaesthetist.For any procedure performed in a free standing surgical facility,the facility should be fully accredited and the patient should be healthy.Ihope this helps.

Lorne M. Tarshis, MD
Toronto Facial Plastic Surgeon
4.2 out of 5 stars 5 reviews

Anesthesia for Facelift

Twilight anesthesia, or IV sedation, is frequently used for cosmetic facelift surgery for a healthy patient. If you have any health concerns or are extremely nervous about surgery then deeper sedation with an anesthesiologist may be a better alternative for you. Both options can be safe with a physician experienced in sedation.

Jill Hessler, MD
Palo Alto Facial Plastic Surgeon
5.0 out of 5 stars 27 reviews

Twilight anesthesia

Twilight sedation means that patient will have conscious awareness of their procedure, and local injections for approximately 3 hours. We recommend general anesthesia by a board-certified physician anesthesiologist for patient safety and comfort.The facelift should be performed in a certified AND licensed outpatient ambulatory surgery center

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 146 reviews

Twilight anesthesia

Any type of sedation or anesthesia, even local anesthesia, is as safe as the level of skills and protocols of the provider.

Sheldon S. Kabaker, MD FACS
San Francisco Facial Plastic Surgeon
4.4 out of 5 stars 35 reviews

Twilight anesthesia safe for facelift

For a healthy patient, monitored intravenous sedation plus local anesthesia is a safe and comfortable way to do a facelift. Typically the sedation is administered by a nurse under the doctor's supervision, a CRNA (certified registered nurse anesthetist), or an anesthesiologist. It should be done in an accredited surgical facility.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 54 reviews

Is Twilight anesthesia safe for a facelift?

I believe that twilight anesthesia can be very safe for a facelift when done correctly. Normally when this is done, there is some medication ordered by the doctor that is given through the IV while there is a nurse constantly monitoring the patient. The face is also injected with a local anesthesia to prevent pain. I perform almost all of my facelifts in this manner and find it to be very safe. General anesthesia can carry additional risk because of medications that are used and there is a longer recovery period with general anesthesia as compared with twilight anesthesia.

Michael I. Echavez, MD
San Francisco Facial Plastic Surgeon
4.5 out of 5 stars 18 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.