Why Does One Typically Have to Stay Overnight After a Face and Neck Lift?

Facelift surgery takes several hours (done carefully, completely, and properly) in the operating room, and general anesthesia regimens utilizing "standard" inhalation anesthetics have as high as 30% nausea rate. Vomiting after facelift can cause hematomas requiring re-operation, so even the best surgeons with skillful techniques can have their careful surgery "undone" by post-operative nausea and vomiting (PONV). Overnight stays are one way of trying to compensate for these concerns. Pills, suppositories, and injections of anti-nausea medications don't always work to prevent PONV from these drugs, and sometimes from the narcotic pain medications as well.

That is the reason I stopped doing facelift surgery in hospitals or hospital-affiliated surgicenters over 20 years ago, and instead began doing all of my elective cosmetic surgical procedures in our own AAAASF-accredited on-site office surgical facility, where we can offer BETTER anesthesia options, such as TIVA (total intravenous anesthesia) which allow PONV rates in the low single digits (our latest rates are at 3.5%, including 7-hour lower body lifts and other "big" operations such as facelifts, eyelids, and browlifts done all at one operation). For the past 21 years we have performed all of our cosmetic surgeries as outpatient procedures, so NO ONE is hospitalized overnight. Out-of-town patients are asked to stay in town overnight, and are seen by me the following morning after they check out of their hotel and before returning home.

Many of my plastic surgical colleagues who operate their own accredited surgical facilities have similar statistics (and offer similar better anesthesia practices that allow these kinds of results with outpatient ambulatory procedures). It's not about OUR surgical skill or expertise--it's about the difference anesthetic practices make!

You don't HAVE to stay overnight in a hospital, but it may be best with certain anesthetic choices. Ask your surgeon where he or she does their facelift surgery, what type of anesthetic is used, and what the PONV rate is. You may be surprised at the answer. You may also want to ask if your anesthesiologist stays in the operating room for the entire surgery, or if they just "supervise" your actual anesthesia provider. Best wishes! Dr. Tholen

 As you can see from the other answers given here, surgeons differ on whether an overnight stay is necessary. This depends on many factors. Some patients are more comfortable with an overnight stay, whereas others prefer to recover at home. If a procedure is done under general anesthesia, there will be more nausea and tendency to bleed after surgery than with local and IV sedation. Longer operative times (over four hours) may also warrant an overnight stay. Some surgeons are simply more efficient than others due to experience and operative skill. My personal preference is to discharge a patient home under the care of a responsible adult if there is no medical reason for an overnight stay. My experience has been that patients tend to be over medicated and ambulate less than at home, simply because there is a nurse present to wait on them hand and foot. In other words, staying overnight in a recovery facility can actually delay your recovery.

Some surgeons have their patients recover overnight at a post op facility, but I send my patients home after surgery. They are more comfortable at home as long as there is a responsible adult with them.  

Since my Facelifts are performed under IV sedation which is rapid onset, rapid offset in effect, there is no medical reason to stay in a medical facility overnight.  The majority of my patients prefer to recover in the comfort of their own homes than to stay at my facility.  Overnight stay is an option on request, but is by no means required.  Out of town patients most frequently stay in a nearby hotel located 5 minutes from my office.  Having a responsible adult stay with you overnight is mandatory to help with medications and make a phone call if any problems arise.  Some of my patients prefer to avail of private nursing to assist with this process. In my opinion, hematoma prevention is most strongly rooted in thorough preoperative teaching.  I encourage patients to walk around their house in the days prior to the procedure and look for activities or items which could tempt them to stretch the limits on activity restriction or lead to bending over.

Almost all my facelifts are done under local anesthesia with oral sedation and do not require an overnight stay. However, it is important to have someone who can help you out the first night of recovery. They can help you take your medications, place ice on your face, and notify the doctor if a problem arises. The most common problem that requires immediate attention is a post operative hematoma of the face or neck. This will need to be drained right away to prevent damage to your facelift. So it helps to have somebody that can recognize this and call the doctor.

  An overnight stay is not mandatory after a facelift.  Hematoma is the concern here.  I typically start the facelift at 7 am and finish at 9:30 or 10 am.  The patient then recovers for 4 hours or so in the recovery room.  Patients typically go home the same day.  Kenneth Hughes, MD Los Angeles, CA

Surgeons' opinions vary on post operative guidelines. An overnight stay may be a convenient option if you do not have a friend or family member available to take care of you after surgery. Following a facelift, it is generally necessary to have someone with you full time for the first 24 hours following your surgery.  This is for the safety of the patient, and to help make the initial healing process as smooth as possible. Guidelines can vary further depending on:

1) How invasive the procedure was
2) Whether or not multiple procedures were performed during the same surgery

I would recommend speaking with your prospective surgeon regarding his or her specific recommendations for post-operative recovery. Thanks and good luck!

Although decades ago it would be standard and typical to keep just about all patients overnight or longer in a hospital for facelifts, this is no longer the case. There is nothing wrong with this practice, although slightly increased risk for infection with a resistant bacteria, this would be very uncommon. At Pacific Center for Plastic Surgery, we do all of our facelifts on an outpatient basis and perform more than 200 facelifts per year without any increased complications. On the other hand, for our out of town patients, those living alone without someone to stay with them, we will arrange for them to stay in an after care facility which is typically in a home set up for this purpose or send a nurse to stay with them in their hotel room for the first night. An exception to this would be to take care of other pre-existing medical problems requiring special care.

Most important is to use the routine that your Plastic Surgeon is most comfortable with.

Staying overnight after a facelift is prudent. In my practice, which I’ve had for over 20 years, I think it is not only prudent, but safe. It also optimizes post operative care and comfort of the patient. I generally keep our patients two nights and then remove the dressing and drains. We have around the clock nurses and have a nursing facility at both of our practices both at UTSW and Dallas Plastic Surgery Institute. We are very fortunate to have this at our expertise which we’ve planned into our practice as a service, and a safe convenience for our patients.

 Its not necessary to stay overnight at a surgery center after a facelift but this is an option that some patients prefer. In my practice our patients recover at the surgery center for several hours before returning home.

All of my facelift/necklift surgeries are done as outpatient procedures in an ambulatory surgery center so every patient goes home after 2-3 hours of recovery in the recovery room.  During that time we take care of pain and nausea issues, as well as all other concerns.  There is always a risk of a post-operative bleeding complication, but this is rare and usually recognized in the immediate post-operative time frame.  Some physicians prefer their patients stay overnight.  It would be best to speak to a board certified plastic surgeon and once you are comfortable with them do it however they recommend.  Best of luck to you.