Thank you for your question. It is absolutely possible to perform a comprehensive facelift under local anesthesia. In fact, it is preferable in many regards, and I perform 90% of my facelifts that way. There is clearly less bleeding during a local anesthetic facelift, as general anesthesia tends to make the blood vessels dilate. That means less bruising, swelling, and as a result, a quicker recovery. If you had told me ten years ago that I would be doing the vast majority of my facelifts this way, I would not have believed you. A few things happened to make this possible. I became much more efficient in my facelift technique. You obviously don't want a semi-awake patient to lie down on an operating table for hours and hours, so I had to become very adept at the procedure and not wonder what the next step was. Next, I had to make the infiltration of local anesthesia as painless as possible. After years of trial and error, I have a local anesthetic mixture that hardly stings at all when injected, yet lasts hours. The benefit of this that when we are done with the case, patients are awake, alert, and are not nauseated like they would be with general anesthesia.