We do a LOT of elective surgery in our certified O.R.s. We can do all types of anesthesia, but tend to prefer one type over others. Let’s take a look at what types of anesthesia are available in the office setting for facelifts and what the pluses and minuses are of each type.
General Anesthesia
At one end is general anesthesia. The type you use for the most painful and most aggressive forms of surgery. General anesthesia involves putting you completely asleep and often requires you to be paralyzed so that an endotracheal (breathing) tube can be placed. It offers the surgeon the ability to go as quickly as desired without worrying if the patient is feeling anything. The downside is that the tube can get in the way when operating on the neck, and patients tend to bleed a little more easily because of blood vessel dilation. This is seldom, if ever, indicated for a facelift.
Local Anesthesia
At the other end of the spectrum is local only anesthesia, where the patient’s pain is eliminated by injecting local anesthetic into the soft tissue. Some patients desire this because they fear losing control. The downside is that the injections are awfully painful, which makes everyone uncomfortable, and blood pressure can go sky high with the pain.
Heavy IV Sedation
Another option is to use heavy IV sedation, think propofol, and adjust the dose based on the patient’s response to noxious stimuli (local injections). This can be done by the surgeon alone, but is best done by an anesthesiologist in attendance. The downside is that if done by the surgeon, he/she must also monitor the patient’s vitals constantly while doing surgery. Not ideal in any sense.
One thing patients hate about anesthesia is nausea afterward, which can lead to vomiting and increased blood pressure, which can result in bleeding. It is always best to avoid this. Nausea is frequently caused by narcotics used to block pain, as well as being awoken from anesthesia too quickly.
Dr. Jabs’ Preferred Approach
I have been using a very safe and effective form of anesthesia for years with excellent, safe results. I sedate the patient an hour before the case begins with pills that take effect gradually. A sleeping pill, a narcotic, and an anti-nausea medication are given together. Over the course of the next hour, an IV is started, and the patient is brought to the operating room and connected to a full spectrum of monitors.
Once prepped and draped, ketamine and a valium like medication are given to further calm the patient. A local anesthetic can then be given to numb the face. The patient will not feel or remember the injection. Over the ensuing hours, while the case is done, minor adjustments in medications are made and given IV. The patient breathes on their own and is responsive to requests, but feels nothing. Once finished, they are cleaned and wrapped and sent home, where they will continue to sleep for a few hours before evening. I have personally experienced this regimen and can tell you that you feel and remember nothing. Many people tell me it is the best sleep they have ever had.
Schedule a Consultation
If you have additional questions for our team at Cosmetic Surgery Associates, or would like to learn more about Dr. Jabs’ anesthesia approach for facelift surgery, please contact our office to schedule a personalized consultation.
Article by Dr. Arthur Jabs, board-certified plastic surgeon in the Washington, D.C. metro area, specializing in deep plane facelift and natural facial rejuvenation.
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