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.
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.
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.