Local anesthesia and face lift surgery

A couple of years ago, I wrote  this post about performing facelift surgery under local anesthesia: Facelift surgery under local anesthesia

The other day, I saw that the technique is now being offered as a  training course for cosmetic plastic surgeons.  A nice holiday in Portugal, and any plastic surgeon can learn to do face lift surgery under local anesthesia. That is a good thing.

Like most other cosmetic plastic surgeons, I learned how to do a facelift with the patient under general anesthesia. Training plastic surgeons has to occur, and some patients are always going to be learned on, especially those who go to teaching hospitals with residents. Facelift surgery is particularly sensitive, since any error can be easily seen by all. That is why few training programs afford that particular luxury to their residents and fellows. I  was lucky enough to go to such a training program in Houston and saw and was trained in many different types of facelifts, including:

  • deep plane face lift
  • skin only face lift
  • Smas face lift
  •  S-lift
  • Fat injection face lift

I was not trained in face lift under local anesthesia. I had to start my own practice to do that.

I don’t really remember when or why I started to perform all my facial surgery under local anesthesia, but it was at least 15 years ago. These days, I perform my face lift surgery, blepharoplasty surgery (eyelid surgery), chin enlargement surgery (mentoplasty) and tip rhinoplasty (nose tip surgery) under local anesthesia.

Many cosmetic plastic surgeons simply do not want to interact with the patient during surgery and prefer to have a silent body to work on. Perhaps they find it too stressful to cut and sew a person who is actively chatting! On the other hand, I enjoy talking with the patients during facelift with local anesthesia, though at some point most patients fall asleep!

Advantages for face lift with local anesthesia

  1. Less physiologic trauma to patient; blood pressure remains more stable
  2. Less anesthesia concerns post-surgery
  3. More natural look after surgery due to inherent muscle tone
  4. Lower cost for patient
  5. Faster recovery

Disadvantages of face lift with local anesthesia

  1. Need for patient to interact with surgeon—say when it hurts!
  2. Need for surgeon to interact with patient
  3. Time limitation of about four hours, the amount of time before patient usually becomes fidgety
  4. Limitation on amount of anesthesia given, though I have never found the need to use high levels

As I have said many times before, there is no right or wrong way to do surgery if you go to a properly trained, board-certified cosmetic plastic surgeon. Each plastic surgeon will have their own techniques and preferences that give them the best possible results.  Don’t ask your plastic surgeon to deviate from the technique they feel most comfortable with; if they are happy, so will you be!

I should have given a course years ago, but Lisbon sounds more fun than D.C.

Morad Tavallali, M.D., FACS