Plastic surgeons have long known facelift surgery performed under general anesthesia requires a longer recovery due to the side effects from the general anesthesia administered during surgery. Addressing post-surgical facelift swelling has always been an important factor to most facelift surgeons. However, facelift surgeons have never figured out how to reduce it when the procedure is performed under general anesthesia. The face swells in recovery when the patient’s blood pressure goes up.
General anesthesia is a state of reversible coma induced by intravenous drugs and inhalation anesthetic agents. The effects of the drugs and inhalation agents cause the entire body to become insensate, cannot feel pain, and have both amnesia and what is called, retrograde amnesia, so that the patient has no recollection of the surgical events or the preceding days in some instances.
While under the effects of the anesthetic drugs, the CRNA (Certified Registered Nurse Anesthetist) under the supervision of the MD Anesthesiologist, must control all bodily functions, mainly breathing and oxygenation, blood pressure and patient awareness. About one in twenty thousand patients experience awareness and pain even while under the effect of the anesthetic agents.
Very few patients die under general anesthesia (one in three hundred thousand). They are usually the highest risk patients who are ill and at the extreme of the age groups: either very young or very old. People “allergic” to an anesthetic agent or have a congenital disease that effects the metabolism of certain drugs is even rarer yet. Malignant Hyperthermia Syndrome is a reaction to certain anesthetic agents and is also very rare.
The anesthetic agents have improved incrementally over the last thirty years but have not improved the incidence of minor complications such as memory impairment (post-operative delirium), prolonged sleepiness, inability to urinate, sore throat, muscle aches, nausea and vomiting. Another complication which could be considered minor is swelling after head and neck surgical procedures, and sometimes whole-body edema.
Swelling is considered more of an expected sequella than a complication because it happens uniformly, especially in patients over fifty and those with high blood pressure.
The practice of administering anesthesia has changed dramatically over the last three decades. It used to be the convention, and still is in hospitals, for the MD Anesthesiologist to be present for the induction of anesthesia, including the securing of the airway, and for the emergence from and reversal of the anesthetic agents. It was assumed that these are the most dangerous parts of the “anesthetic flight”: likened to the take-off and landing of an airplane.
Now the take-off and landing must be safer as many office operating facilities do not require the presence of an MDA for general anesthetic procedures. This is true for virtually all the office-based operating facilities that provide cosmetic plastic surgery delivered under general anesthesia.
Alabama State Board of Medical Examiners and the Alabama State Board of Health-Division of Licensure and Certification require registration with the state and the practice of general anesthesia to be performed by competent licensed personnel working under a physician certified and licensed in the State of Alabama. There is no actual requirement for a CRNA or an MDA to preside over general office-based surgical anesthesia.
Fifteen years ago, unhappy with the way general anesthesia was being delivered without the presence of an anesthesiologist, we began working on the techniques used today in our practice to perform facial plastic surgery under specialized local anesthesia with oral sedation.
Two things became clear immediately: The patients were happier not suffering from the effects of general anesthesia and they had very little facial swelling and bruising causing their recovery to be much shorter and more comfortable. A second and equally important improvement was that the procedures are done in the office without the high OR and anesthesia fees charged for general anesthesia.
Local anesthesia is least likely to cause side effects. Local anesthesia with sedation requires much less of the strong medicines that shock the system and therefore is always preferred for older patients who may take a number of medicines that would interact with general anesthetic agents and who would take longer to emerge from general anesthesia sometimes requiring professional care for a day or two after surgery.
Younger patients, who usually have jobs and family commitments, simply prefer the cost and much shorter down times for return to normal activities.
Some discerning shoppers ask what kind of facelift can be done under local anesthesia, usually having been told only minor or skin-only facelifts can be done under local. The fact is that I do the same facelift I used to do when I used general anesthesia. In fact, the facelift I now do under local is much more intricate and modern than before as shown in our facelift gallery of photos at paulhowardmd.com or thehowardlift.com. My Howard Lift facelifts involve minimal discomfort for the patient during the procedure. Most of my patients have stated their facelift was “far easier than getting a root canal.” As a facelift surgeon, patient comfort is very important to me during and after the procedure.
General anesthesia administered by a nurse or anesthesia aide is no longer necessary for facelift surgery, blepharoplasty (eyelid lift), fat injections or any other facial cosmetic procedure. There is practically no pain involved, swelling and bruising are almost eliminated, Facelift recovery is smoother and shorter, and post-anesthetic sickness is non-existent.