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

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.