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PURPOSE:
Face and neck-lifts are usually performed under either general anesthesia or local anesthesia with intravenous (IV) sedation. Side effects of general anesthesia like nausea, vomiting, generalized weakness, and post-extubation hematomas are not uncommon. Additionally, the need of an anesthesiologist or nurse anesthetist (CRNA) significantly increases the costs. The aim of this study is to determine the feasibility of performing face and neck-lifts under local anesthesia with neither IV sedation nor general anesthesia.
METHODS:
Patients were enrolled prospectively to undergo face and neck-lifts under either general anesthesia (GA) or local anesthesia with no IV sedation (LA) between 2011-2012. Patients were allowed to choose the type of anesthesia based on their preference. LA consisted of 0.25% lidocaine with epinephrine administered to the subcutaneous tissue of the face and neck with a ‘painless technique’; plus a single sublingual low dose of short-acting BZD. Pain was assessed intra-op and immediately post-op for patients under LA. Hear rate (HR) and blood pressure (BP) was evaluated in both groups during and after the procedure. Post-surgical nausea and vomiting as well any other complications like hematoma formation were assessed in both groups.
RESULTS:
A total of 40 patients were enrolled in the study. 25 patients underwent face and neck-lifts under LA and 15 under GA. The average time for neck and face-lifts under LA and GA was 5h and 4.5h respectively. All patients operated under LA tolerated the procedure well. Pain evaluation showed that patients operated under LA only felt the initial small needle-sticks of the procedure, but not intra-operative pain. Patients under LA keep both their HR and BP stable during and right after the procedure. No patient operated under LA presented post-surgical nausea or vomiting. All patients operated under GA presented nausea and vomiting post-op (besides intra-op administration of anti-nausea medication). There were no other intra-op or immediate post-op surgical complications in either group. Cost analysis showed that face and neck-lifts performed under LA were economically preferable to patients seeking facial surgical rejuvenation.
CONCLUSION:
Our study shows that face and neck-lifts can be performed under local anesthesia with neither IV sedation nor general anesthesia. Face and neck-lifts under LA are associated with minimal intra-operative pain, no increase of HR and BP both intra or immediately post-op, and no development of post-surgical nausea, vomiting or hematoma formation.