SMAS lower facelift/neck lift should it be performed under general anesthesia or local anesthesia sedation?

Both options have their pros and cons. In general, a better job can be done on the neck if the patient is under general anesthesia. Plus the patient is much more comfortable as the injection of local anesthesia does hurt. However, if only the jawline needs to be improved, this can often be effectively done under local anesthesia. Be sure to see a facelift specialist for consultation.

A facelift/neck lift can be performed under locally anesthesia, usually with some sedation, or general anesthesia. It is partly the patient’s choice and partly the doctors choice. Performing the surgery under local anesthesia with sedation would help keep your cost down because you’re not paying an anesthesiologist for anesthesia. However if having the surgery done while you are in a twilight stage of awakeness may bother you then general anesthesia is the way to go. With general anesthesia you simply drift off to sleep and when you awake, your surgery is over. I prefer to perform my facelift and necklace under generally anesthesia as I believe it gives the patient the very best experience. Best wishes.

Thank you for your question.

There are differences in technique used for facelift and neck lift, and depending on them the type of anaesthetic that is appropriate differs.

Local anaesthetic is more commonly used for plication of the SMAS, but it is technically possible to do more intervention on the SMAS also under local anaesthetic. There is significant variability between patients in terms of tolerance of local anaesthesia procedures.

Local anaesthetic and intravenous sedation is the next degree of anaesthesia and often allows for quite extensive procedures for both neck and face.

General anaesthesia eliminates discomfort for the patient during the procedure and is compatible also with deeper work in the neck.

Ultimately, the decision factor should be predominantly guided by the results that your surgeon of choice achieves with their intervention, rather than by the type of anaesthetic, so it is useful to examine before and after images that guided towards characteristics of the results achieved.

There are pros and cons to facelifts under each type of anesthesia.
Local is nice in some ways because you are awake (or just sleepy on some sedation medications), it avoids needing an OR with an anesthesiologist, and it helps avoid some things like nausea which can happen with general anesthesia. The downsides of local are that the surgeon is then the anesthesiologist and the surgeon so their attention is divided, you don't have the same control over your blood pressure (which is very important for a facelift), and it is uncomfortable to lay still that long for some people or to position your head the way it needs to be for a facelift. Also, if you are receiving sedation but aren't intubated, there are some risks like breathing problems if you get too much sedation.
The downsides of general anesthesia are the side effects (like nausea) and risks of the anesthetic itself, which are very low in otherwise healthy individuals, and the cost and inconvenience of needing to go to an OR with an anesthesiologist. The upside is that there is an anesthesiologist there to make sure you are comfortable/still/safe and your blood pressure is under control which helps the surgeon tremendously, and it allows the surgeon to focus completely on your facelift.
In my practice, I prefer general anesthesia almost universally for facelifts, and usually reserve local anesthesia for patients who can't have general anesthesia for some reason, and for some smaller cases or revisions where much less work is being done.

Thank you for your great question. Deciding between general anesthesia and local anesthesia with sedation really comes down to your comfort level with your facial plastic surgeon, as well as their comfort level with their anesthesiologist. Both methods are safe, effective, and commonly used in facelift/neck lift procedures. Some plastic surgeons prefer using general anesthesia to keep patients as still as possible during surgery. Others find that their patients experience fewer side effects, such as nausea, with local anesthesia and sedation. I would recommend choosing the board-certified facial plastic surgeon that you feel most comfortable with.

HI Norma,

I think that the answer lies in the comfort zone for each surgeon and amount of local anesthesia that would have to be given with purely local alone.

I do my facelifts with a general aesthetic, but some local anesthesia is also given , mainly because the local anesthetic is combined with some epinephrine (a vasoconstrictor) so you do not bleed so much. I also use a medication in the very dilute local anesthetic that decreases the amount of bleeding as well (Txa).

Even if you have a local anesthetic without an intubation ( general anesthesia), your surgeon and anesthesiologist will give you some sort of sedation because one must watch the amount of the local anesthetic given. Also the surgeon does not want you to move a lot so as to avoid damage to the underlying nerves and structures.
Some surgeons like the patient to be totally asleep and have the airway strictly controlled. These surgeons would use a general anesthetic. Others who work with an anesthesiologist who is comfortable with monitoring the airway with heavy sedation would choose a monitored with local anesthestic. Some feel that patients have less nausea with the latter combination.

Again, the real answer is the comfort of the plastic surgeon and their anesthesiologist.

Hope this helps a bit,

Good Luck,

Dr. Christine Rodgers

A facelift can be performed with different types of anesthesia. The decision as to which type of anesthesia to use is predominately the preference of the surgeon but the patient can also have input. I normally use local anesthesia with IV sedation for a facelift but there is nothing wrong with using general anesthesia. I find the anesthesia recovery is much faster with local anesthesia and IV sedation than it is with general anesthesia. It is possible that the costs may be different as well. Sometimes, local anesthesia with IV sedation may be less than general anesthesia.

Both are good choices. Local anesthesia with sedation is a gentler form of anesthesia with lower incidence of. nausea and vomiting and less hangover feeling. With local anesthesia, There can be less blood pressure fluctuation and there is less chance of blood clots but those are rare. Some surgeons prefer the greater immobility of the patient under general anesthesia. I would base your choice on the skill of the surgeon and your comfort with them. That is far more important than the type of anesthesia. Both are very safe with a good anesthesiologist.

Thank you for your question. I think you may be comparing general anesthesia with the use of an endotrachial tube vs intravenous sedation with an anesthesia provider titrating an intravenous solution. A facelift can be performed with either type of anesthesia. It is my preference to perform a full facelift including the neck lift to be done under general anesthesia so that the patient does not move at all during the procedure. This allows the procedure to progress more rapidly without intermittent “wake-ups”, which also allows me to progress thru the procedure more effectively as well.