For most of my fifteen years in practice, I performed the vast majority of my facelifts under general anesthesia with the patient asleep. About three or four years ago, a very determined young lady practically begged me to do her mini-facelift under local anesthesia, meaning that she would be awake. Because she had a high pain threshold and was stoic by nature, I agreed to do so. The procedure was a breeze and she raved about how easy the process was and how quickly she recovered. After that, I began to do more and more mini-facelifts -- and even more extensive facelifts -- under local anesthesia. I realized that in some cases, I could accomplish the majority of what I needed to accomplish without general anesthesia – the key was to choose the patients carefully and to educate the patient beforehand about what to expect.
When performing a facelift under general anesthesia, we routinely require the patient to obtain preoperative blood work and other tests, including an EKG and a chest X-ray. General anesthesia requires that an anesthesiologist be present, which adds to the expense. Furthermore, there is typically a bit more recovery involved after general anesthesia. Mini-facelifts under local anesthesia, however, usually don’t require the preoperative lab work and an anesthesiologist is not required to be present.
Local anesthesia typically also involves giving an oral medication like Valium; this type of anesthesia is known as “local with oral sedation”. The patient is given Valium approximately 20 minutes before beginning the procedure; that way, the patient is drowsy when he or she is taken into the operating room. Once in the operating room, local anesthesia (lidocaine) is injected into the face, not unlike at the dentist’s office. This is, perhaps, the most uncomfortable part of the entire procedure, more so than the surgery itself. The Valium, however, really takes the edge off this part and most patients say afterward, “The injections really didn’t hurt much at all!” After the local anesthetic has taken effect, the patient typically feels little or no discomfort for the rest of the surgery.
The mini-facelift takes a little over an hour and the patient is walking and talking immediately after the procedure. We typically wrap the face and neck in a light bandage that is removed the next morning when we see the patient in the office. After surgery, we send many of our patients to an after-care facility where they are watched by nurses. However, in some cases, the patient is able to go home if there is a family member or friend who can keep an eye on the patient overnight. Where the patient spends the first night after surgery depends on many variables, including the complexity and length of the surgery and the health and age of the patient. The stitches, located around the ear, are removed in seven to ten days; bruising and swelling is usually minimal. In fact, I am always amazed how quickly patients recover from these procedures. Most are back at work in a week.
In younger patients (30’s and 40’s), the mini-facelift may all they need. In patients in their 50’s and older, other procedures such as a browlift and upper and lower eyelid surgery may also be indicated. As the list of procedures increases, I lean more and more toward general anesthesia.
In older patients, a mini-facelift may still be appropriate. However, these patients need to be educated that a mini-facelift has limits in what it can do. If the neck is extremely saggy, for example, a mini-facelift is probably not the best procedure. Simply put, the mini-facelift can’t accomplish as much compared to what can be accomplished with a more extensive facelift.
In conclusion, the mini-facelift under local anesthesia is a quick and simple procedure that I am incorporating more and more in my practice. The results are excellent and the patients are happy – and that makes me happy.
