Q: Dr. Eppley, I am interested in a facelift bit can’t decide if doing it under local or a general anesthetic is best. The use of local anesthesia is appealing as it lowers cost and avoids the risks of a general anesthetic. But I want to be comfortable and have a good experience. What do you recommend?

A: The debate of local vs. general anesthesia for facelift surgery is an historic one and continues to this very day. I have heard it many times and like many chronic debates the issues are not black and white and sometimes the main point of the discussion is overlooked. Let me provide some clarification for you.

The discussion of local vs general anesthesia for a facelift makes the assumption that the facelift part is the same and the only difference is in the level of anesthesia. This is a mistaken assumption and is actually the incorrect question on this issue. The real question is what type of facelift can be done under local vs general anesthesia? As I can assure you the type of facelift obtainable does differ with patient comfort. So the question is what type of facelift does the patient need and does it require general anesthesia to be done in the most through manner possible and with the greatest patient comfort. More complete facelifts that include a lot of neck work usually need to be done under general anesthesia. Smaller or more limited facelifts may be able to be done under local anesthesia with IV sedation. (aka conscious sedation)

One erroneous assumption about anesthesia that is not a general anesthetic is that it costs less. While on the surface that is true. (you do not pay for anesthesiologist’s time) But those cost savings are wiped out as it will take the surgeon more time to do the procedure. For example if it is takes the surgeon 50% more time to do the same procedure under local or IV sedation that could be in less time under a general anesthetic, the surgeon’s charge for doing the surgery can not be the same. One important but often overlooked element in calculating the cost of the surgery is the surgeon’s time. To some degree the surgeon’s charge for doing any surgery is highly influenced by the time it takes to do it. The point being is that it rarely makes good sense to choose a local/IV sedation option vs general anesthetic for many elective cosmetic procedures because you are trying to save money.

Dr. Barry Eppley
Indianapolis, Indiana