Thank you for your question!
You’re asking a question, can a brow lift facelift be done under twilight anesthesia
or does it have to done under general anesthesia. It’s a very simple question and I can certainly
give you my perspective on how I practice and what my preference it.
I’m a board certified cosmetic surgeon and fellowship trained oculofacial plastic and
reconstructive surgeon practicing in Manhattan and Long Island for over 20 years. Brow lifts
and facelifts are a very significant part of the procedures I perform as well as cosmetic
eyelid surgery. So I can tell you how I developed what I’ve done in my practice because I
think that it’s a very important question at many levels.
Well first of all, to answer the question directly, the answer is yes, you can do these
procedures under twilight anesthesia and avoid general anesthesia. Now the question then
becomes why and what are the pros and cons? Well, I can tell you that in my experience
and when I trained in cosmetic surgery, a lot of the people whom I’ve learned from
preferred to do their procedure under general anesthesia but this was in the early 90s and
this was a time when a lot of people who are having these cosmetic procedures were people
who were accustomed to certain process of going to a hospital, going to a surgery center,
having general anesthesia and then going somewhere to recover often in the hospital or in out-patient
surgery or overnight facility. Once I went into practice, I quickly realized that the
majority of people that I was taking care of were people who, regardless of what level
of their socioeconomic status was, they were too busy and they didn’t want prolonged
healing time and recovery. And so, from what I say during my training, I saw a lot of people,
the surgery would be great and no problem but it was the anesthesia recovery that really
took its toll. And I always felt that the less you put someone under deep of general
anesthesia, the safer the procedure becomes.
So what I advocated from the beginning was local anesthesia with LITE™ sedation. LITE™
sedation means getting a little bit of a liquid valium or propofol to help reduce anxiety
but what’s wonderful about what we do are the areas that we treat are very straightforward
and numb. And a colleague of ours who is a dermatologist invented a method, Dr. Jeff
Klein, who invented a method of a local anesthetic called Tumesant anesthesia and he did this
in the mid-80s and it changed how the practice of liposuction was done and it literally saved,
I would say, hundreds of hundreds of lives over the many years of people who would otherwise
have complications from traditional liposuction.
My point is that in our practice, what we do is we combine a modified version of that
Tumesant anesthetic method with LITE™ intravenous sedation and for 20 years, it’s been working
extremely well. I like doing the procedures in a way our patients are able to get up and
walk out and be comfortable and they go home. They don’t need these types of special aftercare
and this includes patients whom I do full, extensive face and neck lift surgery. It’s
not like it’s limited to mini lifts or limited procedures. Doing a full face and neck lift
with cheek implants, chin implants, platysmaplasty, deep plane, you name it, can be done under
local anesthesia with sedation.
Now, it is still important that you have this conversation with your prospective surgeon.
A lot of times, you just want to use your judgement. If a procedure is going to be done
under local anesthesia and if it’s going to a shortcut procedure or it’s going to
be rushed, well that’s not acceptable. What you want is you want the benefit of the best
procedure for you and make sure the procedure is done in the safest way that is right for
you. Now in no means am I disparaging any surgeon who does general anesthesia. In fact,
a lot of my friends and colleagues do use general anesthesia. That’s what their comfortable
with and they and their patients have that understanding. But for the people who come
to me and patients come to me from all over the world, they really like that they don’t
have to be put under general anesthesia like have a tube in their throat, be put on a respirator
and risks that are associated with that. Medical literature continuously reinforces the proof
that local anesthesia and local anesthesia with limited sedation is considerably safer
for patients than general anesthesia.
I also feel that when I do this type of procedure, I’m actually doing the procedure more accurately
and the reason is that there’s no tube or anything distorting the face. The patient
is not paralyzed. And I see this as living sculpting. I’m actually able to do the procedure
and get a better sense of what the person will look like after the procedure is done.
Again, this is a personal approach and by no means does that mean that anyone else’s
approach is bad. It’s just how I approach and how I take care of my patients. Basically,
I use the same rule: what I do for my family, I do for my patients. And for me, that means
local anesthesia with LITE™ sedation is preferred unless there’s no other option
than general anesthesia and then there has to be a good meeting of the minds.
So I hope that was helpful, I wish you the best of luck and thank you for your question!