What the research shows
A 2026 review of facelifts under local anesthesia found low complication rates, steadier blood pressure, fewer blood clots and a shorter recovery than with general anesthesia. Bleeding under the skin (a hematoma) was the most common problem, in about 1 in 40 (Beaufigeau 2026). Large operations can be done this way: deep plane facelifts with a neck lift under local anesthesia and oral sedation had no major bleeding, skin loss or nerve injury (Novis 2026), and deep plane lifts with deep neck work under diluted local anesthesia had no cases of lidocaine toxicity (Claytor 2025). Diluted lidocaine with epinephrine at about three times the usual maximum dose stayed well below the toxic blood level (Ramon 2007).
Blood pressure is the main thing the anesthetic controls. Swings in blood pressure are a main cause of bleeding, and a series under pure local anesthesia reported bleeding in under 1 in 100 (Moris 2019). An older series found that every hematoma appeared within 48 hours and that the rate under general anesthesia fell once low blood pressure during surgery was avoided; the authors stressed sealing vessels while blood pressure is normal (Rees 1994).
Nausea and vomiting were tied to hematoma as early as 1978 (Thompson 1978). Ondansetron cut vomiting under sedation (Marcus 2002). Celecoxib, an anti-inflammatory pill, given before and after surgery lowered pain, opioid use and nausea (Aynehchi 2014). The sedative dexmedetomidine lowered blood pressure and the need for opioids and anti-nausea drugs (Taghinia 2008), and in a large intravenous anesthesia series nausea or vomiting affected fewer than 1 in 100 (Moore 2022).
Injecting a large volume of diluted anesthetic fluid before dissection made the operation easier and reduced swelling, bruising, skin loss, hair loss and scar problems, without changing the hematoma rate (Jones 2004). Blood clots in the legs or lungs after a facelift under local anesthesia were rare, about 1 in 6,000 in a multicenter survey, and less common with surgeons who perform many facelifts (Santos 2014).
Where surgeons disagree
- Local alone or with sedation. One large series found more hematomas under local anesthesia alone than with monitored intravenous sedation (Rees 1994); another found pure local anesthesia lowered bleeding (Moris 2019). An office series under local anesthesia and oral sedation reported hematomas in about 1 in 8, most of them small and drained with a needle (Frojo 2019).
- Which sedative. Propofol was linked to twice the hematoma rate of an older drug mix (Kamer 1995). Dexmedetomidine steadies blood pressure (Taghinia 2008), yet a 2026 series linked it to unplanned overnight stays (Alnemri 2026).
- Intravenous or gas anesthesia. In a randomized trial, intravenous anesthesia with brain monitoring led to faster waking and discharge readiness, while nausea and pain did not differ clearly (Jones 2015).
What is new
- Deep plane facelifts, traditionally done under general anesthesia or intravenous sedation, are now reported under local anesthesia with low complication rates (Novis 2026, Claytor 2025).
- Unplanned overnight admission after an outpatient facelift was tied to longer anesthesia, more combined procedures, obesity and high blood pressure, which helps patients and surgeons plan the night after surgery (Alnemri 2026).
What is still unknown
- How local and general anesthesia compare head to head. Local anesthesia series compare their results with published rates, without a control group (Novis 2026), and the one randomized anesthesia trial asked for larger numbers (Jones 2015).
- The safest local anesthetic and how to manage top-up injections, which add to the total dose given (Koeppe 2005).
Key papers
- Thompson 1978: linked nausea and vomiting to bleeding after a facelift.
- Rees 1994: showed hematomas appear within two days and fall when blood pressure is kept normal during surgery.
- Jones 2004: diluted anesthetic fluid reduced skin loss, hair loss and scar problems.
- Ramon 2007: measured blood levels of high-dose diluted lidocaine and found them safe.
- Taghinia 2008: dexmedetomidine sedation steadied blood pressure and cut opioid and anti-nausea use.
- Aynehchi 2014: celecoxib lowered pain and opioid use after a facelift.
- Moris 2019: facelift under pure local anesthesia with a low bleeding rate.
- Beaufigeau 2026: review of facelifts under local anesthesia; safe, with fewer blood clots and a faster recovery.
- Novis 2026: deep plane facelift and neck lift under local anesthesia with no major complications.