Will twilight anesthesia be OK for a 4+ hour facelift, along with upper and lower eyelid surgery?

Janet, thank you for your excellent question.  The type of anesthesia performed is usually determined by both your plastic surgeon and the anesthesiologist they work with.  In many cases, the procedure you described could be done  under twilight.  In our institution our anesthesiologist prefers general anesthesia for most of what we do.  The most important thing is that you are cared for by an ABMS board certified plastic surgeon and anesthesiologist in an accredited facility. 

Face lift and blepharoplasty can be done under twilight anesthesia, as well as general anesthesia.  It is a matter of your level of comfort as well as the surgeon and anesthesiologist's preference.

Some surgeons believe there is less risk of blood clots with twilight anesthesia; however it would depend on how deep the twilight anesthesia is.

Yes, many practitioners of facial plastic surgery prefer the approach of IV sedation or twilight anesthesia.  This approach according to some data indicates this type of anesthesia is somewhat safer.  It is also much less costly to provide to the patient.  

However, having been a patient who received this “Twilight Anesthesia” and woke up several times during the procedure, I would never consent to have it again.  This is just my personal experience which is anecdotal.  Discuss these issues with your anesthesia provider and surgeon.  Hopefully, your plastic surgeon is a member of the ASAPS and will give you options on the type of anesthesia you will receive for your procedure.

Best,

Gary R. Culbertson, MD, FACS

Twilight anesthesia does work for facelift and blepharoplasty.  In fact, I used to do all mine this way.  I have, however, found that general anesthesia works much better both for me and, especially, for the patient.  I believe it is also much safer.  If you are going to have twilight anesthesia, make sure the person doing it is a board certified anesthesiologist and that the procedure is done in a facility where general anesthesia is possible.  Otherwise the person caring for you may not be able to care for an emergency and the facility may not be equipped to handle one.

Twilight anesthesia can mean different things, but in general it refers to some sort of sedation administered through an IV line in addition to local numbing medication injected into the surgical site.  If done by a qualified anesthesia provider (nurse anesthetist or anesthesiologist) in an accredited surgical facility then it should be a safe and comfortable option.

Twilight anesthesia can safely be done in this situation at an accredited facility with a board certified anesthesiologist.  From the standpoint of the patient and surgeon, this may not be the best option for a procedure lasting that long.  The safety of general anesthesia and twilight sedation are fairly equivalent for a healthy patient but the use of general anesthesia often can result in a much smoother procedure from a comfort standpoint for the patient and from an ease of flow for the surgeon.  Discuss these options with your plastic surgeon.

Susan D. Vasko, MD, FACS

Either sedation or general anesthesia may be used for a facelift and blepharoplasty.  It depends on the concerns of the patient as well as the experience and preference of the plastic surgeon and the anesthesiologist.  The key issues should always be safety and the comfort level of the patient.

No matter what method of anesthesia, the procedure should be performed only in an accredited facility by a national organization like AAAASF (the American Association for the Accreditation of Ambulatory Surgery Facilities) or a state licensed facility, and by a board certified plastic surgeon, with anesthesia delivered and monitored by an appropriate anesthesia provider.

Robert Singer, MD, FACS

Anesthetic “depth” is on a spectrum, and practitioners will mean different things while using the same terms.  In general, twilight anesthesia means that the patient is just on the verge of being asleep and can still respond and protect their own airway - they are just at the precipice of slipping into general anesthesia.  Once you enter the realm of general anesthesia, the patient cannot protect their own airway, so some type of breathing tube is used to keep it open (such as a Laryngeal Mask Airway or an Endotrachial Tube).  General anesthesia is quite safe, as your airway is fully protected.  Twilight is a bit of a balancing act, but can be done quite well by vigilant anesthesiologists.  My concern with twilight anesthesia is that it does not necessarily require an MD anesthesiologist to be present - it could be managed by the operating surgeon and monitored by an RN.  Some surgeons will go this route as a cost savings measure (MDs are more expensive than RNs), but I do not think this is a good place to cut corners.  If your surgeon uses an anesthesiologist and they prefer twilight, then it should be fine.  I would not recommend twilight if it is going to be managed by the operating surgeon.  (Think about it - are you better at concentrating on one task, or trying to do two things at the same time?)