Overview
The authors evaluated whether tumescent local anesthesia can replace general anesthesia for facelift with neck surgery in an outpatient setting. Between 2012 and 2022, 80 healthy patients (ASA I-II; mean age 56, range 47-65) had SMAS plication facelift, midline platysmaplasty and submental liposuction under this anesthesia, with sedation as needed. Patients were followed up to 36 months.
Findings
- 80 patients, ASA I-II; mean age 56 (range 47-65).
- Workup before surgery: blood tests, ECG and cardiology clearance.
- Tumescent solution: 25 mL 2% lidocaine, 8 mEq sodium bicarbonate and 1 mL epinephrine in 1000 mL saline, at 100 mL per side of the face.
- Mean infiltrated volume 200 mL per patient.
- Midazolam sedation given as needed.
- Surgery averaged 150 minutes, including 40 minutes for anesthesia.
- Patients monitored for 3 hours after surgery.
- No lidocaine or epinephrine toxicity; no conversions to general anesthesia.
- Complications over 36 months: 10% total; hematoma 2.5%, seroma 1.25%, scarring 3.75%, paresthesia 1.25%, "pixie ear" 1.25%.
- No infections or anesthesia-related events.
- Patients reported high satisfaction, rapid recovery and minimal discomfort.
- Level of evidence: IV.
What it means for a patient
- A SMAS plication facelift with neck tightening can be done under local numbing, with sedation as needed, as an outpatient.
- In this series no one needed to be switched to general anesthesia, and there were no anesthetic drug reactions.
- The authors report less bleeding, swelling and bruising and a quicker recovery, though the abstract gives no comparison group.
- Limits: 80 healthy patients aged 47-65, retrospective, one center, and satisfaction not measured on a stated scale.
Why this paper matters
It gives 10-year data on facelift with platysmaplasty under tumescent local anesthesia, including the exact solution used. It supports local anesthesia as an option for selected healthy patients.
Terms
- Tumescent local anesthesia (TLA): a large volume of dilute numbing solution injected into the surgical area.
- General anesthesia (GA): medicine that makes the patient fully unconscious.
- SMAS plication: folding and stitching the SMAS layer to tighten it.
- Platysmaplasty: surgery to tighten the platysma, the thin muscle sheet of the neck.
- ASA I-II: healthy patients or those with mild, controlled illness.
- Lidocaine: a local numbing drug.
- Epinephrine: a drug added to narrow blood vessels and reduce bleeding.
- Pixie ear: an earlobe pulled down and stuck to the cheek after facelift.