When Amir Karam, MD, a double board-certified facial plastic surgeon in San Diego, performed a facelift on his 52-year-old wife Neda Karam earlier this year, he also gave her a fat transfer and a lower eyelid “skin pinch,” which is when you remove a small amount of skin underneath the eyelids. “Crepiness under the eyes can be exaggerated by the vertical lifting of the cheeks so this helps,” he says.
3. You might not go under general anesthesia.
There are different schools of thought on the best way to sedate facelift patients, but we were surprised when some of the patients we interviewed told us they did not get general anesthesia for their surgeries. “I had nine hours of surgery, but I was under IV sedation, not general anesthesia, so I didn’t feel nauseated [after] or anything,” says Maria C., 53.
During IV sedation, you can still be asleep for a procedure—but you don’t have to be. Dr. Karam performs his facelifts under local anesthesia with IV sedation. When we asked what it was like operate on his wife, he told us, “Once I started the procedure, it really did feel like every other day that I’m operating.” Except for one thing: “She’s the only patient I’ve ever had who was asking toward the end of the surgery, ‘Are you done yet?’”
Chris L., 54, also described being awake during her facelift. Her doctor used local anesthetic along with oral sedation (Diazepam and hydrocodone). “They also let me have laughing gas to get nice and relaxed.” (Nitrous oxide gas was administered only during initial injections of the local anesthetic.) “It did not hurt, but it was a lot of pulling and tugging and pressure and talking,” says Chris. “If I winced, he would stop immediately and go, ‘Did you feel that?’ And I’d say, ‘Well, yes, sir.’ And he’d get more of the local anesthetic, then there would be no more discomfort and the tugging would just continue.”
We asked David Shafer, MD, a board-certified plastic surgeon in New York City, how common this is. “For the right patients, it is possible to offer local anesthetic or laughing gas. However, this is the exception and not the rule,” he explained. “The face is delicate with complicated anatomy and having an awake patient risks the patient moving around during the surgery, which adds more risk. Additionally, in terms of safety, surgeons performing facelifts under local anesthesia generally don’t have another doctor in the room such as an anesthesiologist. When a patient is having traditional anesthesia, the anesthesiologist [focuses] 100% of their attention on the patient’s vitals and comfort while the surgeon can [focus] 100% of their attention on the actual procedure. With local anesthetic, the doctor is constantly distracted by the patient moving or needing more local anesthetic, etc., and can potentially lose focus on the procedure at hand. Fortunately, modern anesthesia is much safer and gentler than the anesthesia available when their mom or grandmother had surgery.”
