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Local Anesthesia in Facial Surgery: Can You Do Facelift Without General Anesthesia?

Facelift with local anesthesia and sedation: advantages, tumescent technique, patient selection and Modern Face protocol for outpatient procedures.

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Dr. Roberio Brandao

Creator of Modern Face

• Updated December 17, 2024

The General Anesthesia Paradigm

Historically, facial surgery was synonymous with general anesthesia: intubation, complete operating room, hospitalization, anesthetic risks. This created a real barrier for many patients who wanted rejuvenation but feared — with reason — the risks of general anesthesia. The evolution of surgical techniques, especially those with minimal dissection and well-defined planes, allows a different approach: local anesthesia with conscious sedation.

“If the surgical technique is elegant enough not to require endoscopic vision, it can also be elegant enough not to require general anesthesia.”

  • — Dr. Robério Brandão

Local Anesthesia + Sedation vs General Anesthesia

Aspect Local + Sedation General Anesthesia

Consciousness Sedated but responsive Unconscious

Airway Spontaneous breathing Intubation/mask

Recovery 30-60 minutes 2-4 hours

Hospitalization Outpatient Frequent overnight

Nausea/vomiting Rare Common (20-30%)

Cost Lower Higher

Risks Lower Higher

Tumescent Technique for Face

Tumescent anesthesia, popularized in liposuction, was adapted for facial surgery:

Typical Tumescent Solution

  • • Normal saline: 500-1000ml (vehicle)
  • • Lidocaine: 0.05-0.1% (anesthetic)
  • • Epinephrine: 1:500,000-1:1,000,000 (vasoconstriction)
  • • Bicarbonate: 10mEq/L (buffering - reduces burning)

Advantages of Tumescent Technique

Hemostasis: Epinephrine causes vasoconstriction, reducing bleeding

Hydrodissection: Volume helps separate anatomical planes

Prolonged analgesia: Effect lasts 4-8 hours

Structure protection: “Pushes away” nerves and vessels

Patient Selection

✅ Good Candidates

  • • Controlled/mild anxiety
  • • No allergy to local anesthetics
  • • Moderate duration procedures (<4h)
  • • Preference to avoid general anesthesia
  • • ASA I-II (low anesthetic risk)
  • • Motivation for outpatient procedure

❌ Prefer General Anesthesia

  • • Severe anxiety/phobia
  • • Documented allergy to lidocaine
  • • Very extensive procedures
  • • Need for uncomfortable positions
  • • Comorbidities requiring invasive monitoring
  • • Patient’s expressed preference

Modern Face Protocol

Preoperative

Oral anxiolytic (alprazolam or similar) 1h before. Calm environment, music if desired. 2.

Monitoring

Oximetry, BP, ECG. IV access for sedation and emergencies. 3.

Initial Sedation

Midazolam + fentanyl IV in titrated doses. Goal: relaxed but responsive patient. 4.

Infiltration

Tumescent solution infiltrated slowly. Wait 10-15 minutes for vasoconstrictor effect. 5.

Procedure

Surgery with sedation reinforcement as needed. Communication with patient maintained. 6.

Postoperative

Recovery in appropriate room. Discharge with companion after outpatient discharge criteria.

Frequently Asked Questions

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Safety & Complications

Learn how technique and anesthesia choices impact surgical safety.

Recovery Timeline

How local anesthesia contributes to a faster return to daily life.

Surgical Planning

Mapping out the procedure for optimal results and comfort.

For surgeons: Learn our complete outpatient protocols in our [advanced surgical mentorships.

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Frequently Asked Questions

Is it possible to perform facelift with local anesthesia?

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Yes. Techniques like Endomidface and Deep Neck can be performed with local anesthesia + conscious sedation. The tumescent technique allows safe dissection with less bleeding. Many patients prefer to avoid general anesthesia when possible.

Does local anesthesia hurt during application?

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Initial discomfort exists but is brief (seconds). Techniques of slow infiltration, solution warming and use of prior sedation minimize discomfort. After complete infiltration, the procedure is painless.

What's the difference between sedation and general anesthesia?

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In conscious sedation, the patient breathes independently and can respond to verbal commands, although relaxed and drowsy. In general anesthesia, there is complete loss of consciousness with need for intubation. Sedation has faster recovery and fewer risks.

Can all patients have surgery with local anesthesia?

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Most yes, but not all. Very anxious patients, those with allergy to local anesthetics, or with specific medical contraindications may need general anesthesia. Selection is individual.

Is surgery with local anesthesia cheaper?

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Generally yes. It eliminates costs of anesthesiologist, anesthetic gases and operating room time. It also allows outpatient procedure, eliminating hospitalization. Savings can be significant.

Will I feel anything during surgery?

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You may feel pressure and manipulation, but not pain. Sedation creates a state of relaxation where these sensations don't bother. Many patients don't remember much of the procedure.

How long does the local anesthesia effect last?

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Anesthetic blockade lasts 4-8 hours depending on anesthetic used (lidocaine vs bupivacaine). This provides analgesia during procedure and in the first postoperative hours. Oral analgesics cover after.

Can I go home the same day?

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Yes, procedures with local anesthesia + sedation are typically outpatient. You need companion to go home. Rest at home is sufficient — no need for overnight stay.

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