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

I perform all my face and neck lifts under local anesthesia in my office procedure room. My patients go home after the procedure and return for an evaluation and dressing change the flowing day. As you can see from the responses, different surgeons have different preferences depending on what they are used to doing. You should discuss with your surgeon the reasons to your satisfaction. 

 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.