Anesthesia

When you are deciding on a facelift or cosmetic surgery in general, the anesthesia is a major concern for most people. Although anesthesia has developed significantly over the years, it still carries a small risk. Virtually all major complications with facial cosmetic surgery one hears about are due to anesthesia and not secondary to the procedure itself. Therefore, when selecting the right anesthesia for your facelift, safety should be the number one concern for you as well as your doctor.

Interestingly, there are various anesthesia options available and you should discuss with your surgeon these different anesthesia techniques. The anesthesia is closely linked to the setting where the facelift procedure will be performed: doctor’s office, surgical suite or hospital. These various procedure settings also determine patient privacy in comfort.

Below, we discuss the various anesthesia options, their usual settings, advantages and disadvantages of each. The financial aspect should not guide one towards choosing one anesthesia technique over the other.

General Anesthesia for Facelifts

General anesthesia means that the patient is entirely asleep and not aware of any surroundings. Usually, the patient is intubated, which means that a tube is placed in the windpipe (trachea) which is connected to a respirator machine. Thereby, all control of breathing function is taken over by the anesthesiologist who monitors the patient’s vital signs: heart rate, electrocardiogram (ECG), blood oxygen saturation, blood pressure, and so on.

The experienced anesthesiologist uses all these data to decide which inhalation gases and intravenous (IV) medications to administer to the patient. Many surgeons and patients alike shy away from general anesthesia and prefer conscious sedation instead. The surgeon’s philosophy training, experience and comfort play an important role in his or her preferences.

Facility: Hospital, free-standing and accredited surgical centers. Some doctors own surgical centers that are accredited for general anesthesia.

Advantages: painless procedure, no memory of the procedure, monitoring of body systems by anesthesiologist.

Disadvantages: most invasive choice of anesthesia, inability to communicate with patient, frequent post-operative nausea and vomiting as side effects of general anesthesia, lung complications possible, prolonged wake-up phase from anesthesia itself – sometimes long hang-over effect, possibly increased blood loss during facelift surgery, increase in procedure time.

Price: $$$; the operating room and the anesthesiologist often charge separate fees.

Conscious Sedation (“Twilight Anesthesia”) for Facelift

In twilight anesthesia, the patient is comfortable, does not experience pain and is unaware of its surroundings. Different from general anesthesia, the patient is still breathing spontaneously without a breathing tube inserted. Usually, additional oxygen is delivered to the nose through small plastic tubing. The anesthetist follows the patient’s vital signs and delivers the medications through an IV. Most of these medications are very short-lived which requires a watchful and experienced anesthetist to ensure enough but not too much relaxing and narcotic medications. Once the medication drip is turned off, the patient regains full consciousness within a couple of minutes ensuring a smooth awakening without coughing and retching. This anesthesia technique requires an anesthesiologist experienced with conscious sedation, a skill usually mastered by specialists working in day-surgery centers. Twilight anesthesia appears to gain popularity with the modern patient and surgeon alike.

Facility: Hospital, free-standing and accredited surgical center.

Advantages: No airway intubation thereby limiting potential lung complications, post-operative nausea and vomiting rare, quick wake-up, possibly decrease in blood loss.

Disadvantages: Requires anesthetist experiences with conscious sedation.

Price: $$$; the operating room and the anesthesiologist often charge separate fees.

Local Anesthesia with Pre-Medication for Facelift

Local anesthesia is comparable with the experience at the dentist office. The region to be operated is anesthetized with a mixture of Lidocaine (“Novocain”) and epinephrine. Once everything is injected, the regions are entirely numb and the procedure can be performed painlessly. Because epinephrine constricts blood vessels and the lack of vessel-dilating anesthesia medications, there is usually only minimal oozing. Because one is usually apprehensive before the facelift procedure, most doctors administer relaxing medications (i.e. Valium or similar) before the procedure, either by mouth or as an injection. The local anesthesia with pre-medication technique is often not employed for full facelifts (i.e. deep-plane facelift etc.) but for partial lifts (i.e. necklift) or minimal invasive facelifts (i.e. Lifestyle lift). Because surgical training happens in hospitals and major operating rooms, most doctors are not comfortable with this local anesthesia technique but prefer that the patient is entirely asleep. Although basic vital signs are usually monitored during the procedure, the patient is either comfortably awake or snoozing but easy to awake.

Facility: Surgeon’s procedure room, free-standing surgical center.

Advantages: Minimal administration of drugs, no post-operative nausea and vomiting, no recovery from anesthesia, decreased blood loss, faster recovery, decrease in procedure time.

Disadvantages: Requires surgeon comfortable with this technique, patient will feel lidocaine needle sticks. Reserved for shorter procedures.

Price: $; fee for procedure room.

What is the Right Anesthesia for your Facelift?

You should have a thorough discussion with your surgeon about anesthesia options, the doctor’s experience and recommendations. Then, decide whether this is what you are looking for. Again, there is no one right anesthesia technique. The decision should be made between you and your doctor depending on the operative plan. How long does your surgeon need for a specific facelift procedure? Are ancillary procedures planed (i.e. browlift, eyelid lift, and so on)? What facilities are available? Once all questions are answered and a good plan has been formulated, you will hopefully have a pleasant facelift experience.

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