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What type of anaesthesia is required for a facelift?

The traditional way facelift surgery is performed is in a hospital setting under general anaesthesia with an overnight stay. Although no facelift procedure is risk free, there are increased risks associated with general anaesthesia, these include increased bleeding, pain, clot in the legs as well as side effects including nausea and sickness during the recovery period. The UK has been slow to adopt twilight anaesthesia for cosmetic surgery (local anaesthetic and sedation) which is common place across Europe and the United States. I travelled to LA and NYC to gain experience in these techniques to enable my benefits to patient from this technology. Twilight sedation removes a significant risk factor from my surgery and only with rare exceptions do I perform facelift surgery under general anaesthesia.


General anaesthesia means that your body is completely unconscious, the medications used in general anaesthesia are given by a specialist doctor, an anaesthesiologist. The normal protective mechanisms of the body are subdued and a breathing tube is used to protect the airway and maintain breathing. General anaesthesia has become very safe and is only given in Hospital or Surgical Treatment Centres. The disadvantages of general anaesthesia include a longer recovery that with other forms of anaesthesia, common side effects of the medication are drowsiness and nausea, sickness and a sore throat from a breathing tube. In addition general anaesthesia carries a risk of a blood clot in your leg (termed deep vein thrombosis), although rare this has serious health implications.

Sedation anaesthesia is also known as “twilight anaesthesia” or MAC (Monitored anaesthesia care) means that your body is sleepy and relaxed, you are still conscious and able to respond to questions and instructions. The benefits over general anaesthesia is that the recovery is quicker and with less side effects such as nausea and vomiting. Typically the procedure is very relaxing as your asleep and the recovery is much faster, you are able to walk out of the operating theatre within thirty minutes after the procedure. During sedation anaesthesia all your natural protective reflexes are working normally, hence there is not the same risk of a deep vein thrombosis that can occur in general anaesthesia.

I ask every patient about their experience and how it can be improved. Over 20% of my patients have had surgery elsewhere and usually had general anaesthesia. Patients who have sedation anaesthesia with us, who have previously experienced general anaesthesia, overwhelmingly prefer sedation anaesthesia, it offers a faster recovery, improved safety, and a more pleasant and relaxing experience. I have shifted my practice from using general anaesthesia to sedation anaesthesia as a result of patients experience and satisfaction.

Sedative anaesthesia is popular in the cosmetic centres of New York and Los Angeles, and facelift surgery is performed in private operating theatres under sedation and as day-case procedures. Sedation is also termed “twilight” anaesthesia and is generally regarded as safer than general anaesthesia, patients breath on their own, have rapid recovery after sedation and are able to home quicker without symptoms of nausea or the hang over of general anaesthesia. There is no need to stay in hospital, as hospital stays are associated with issues such as infection and MRSA.

What does sedation anaesthesia mean?
Another word for sedation is twilight anaesthesia, you are neither wide awake or completely out of it, you are relaxed-calm-comfortable. You literally sleep during your surgery, just like when you sleep at night. The twilight state is achieved with a fine cannula in your arm. Common misconceptions of twilight sedation include patients asking me “I would rather be asleep”, “I don’t want to feel anything” or “ I don’t want to remember it, “I don’t want to wake up”. All of these are true with twilight sedation. If patients did not have a good experience, I would not choose to use this type of anaesthesia, it offers faster and safer type of anaesthesia. In the future I believe far more surgery will be completed under sedation anaesthesia as it hold the capacity to completely transform and modernise currently provided hospital anaesthesia.

What is different with Dr. De Silva’s Sedation Anaesthesia?

We use a customised sedation anaesthesia that is specific to each individual patient, in other words some patients need a modest amount of medicine, others may require several times the amount. In some NHS hospital sedation is used for procedures (for example endoscopy), this often uses one medicine (midazolam) and can be the doctor performing the procedure administering the sedation. At The Centre for Facial Cosmetic & Plastic Surgery, we use a Customised approach to Sedation Anaesthesia, we have refined the technique every year for more than 5-years, to give a Specialised Sedation Anaesthesia protocol, this utilises 4-5 sedation medicines. By using a combination approach, only very small amounts of medicine are required, however in combination they are effective and result in reduced recovery and side effects. For example conventional general anaesthesia results in approximately 30% feelings of nausea or vomiting during recovery. With our Specialised Sedation Anaesthesia reduces this to between 1-2%. How does our modern sedation anaesthesia offer an advantage:

  • Faster recovery. With conventional general anaesthesia recovery after facelift or neck lift surgery could take from 5-6 hours. With our sedation anaesthesia, you can walk out of the operating theatre 30-minutes after surgery.
  • Reduced side effects. With conventional general anaesthesia recovery after facelift or neck lift surgery, approximately 30% of patients feel substantial nausea, feeling sick and a sore throat from conventional surgery.  With our sedation anaesthesia 1-2% of patients have nausea and sickness.
  • Safer. With conventional general anaesthesia there is a rare serious risk of general anaesthesia including a blood clot in the leg (termed deep vein thrombosis). With our sedation anaesthesia all your natural protective reflexes are working normally throughout the surgery, you are essentially sleeping during the surgery like you sleep at night.
  • Less discomfort. With conventional general anaesthesia recovery after facelift or neck lift surgery, strong pain relief medicine is required. With our sedation anaesthesia and enhanced techniques more than half our patients do not use any analgesia after surgery, and those that do only use a few medicines the first 24-48 hours.
  • Personalised care. With conventional general anaesthesia recovery after facelift or neck lift surgery, patients used to report to me hospital staff that give a you a sterile feeling of being sick. With our customised The Centre at 23 Harley Street, Dr. De Silva’s hand picked staff will care for you. Dr. De Silva will see you the morning after your surgery to check you personally.
  • Modernisation. Gone are the same old techniques used for decades. We are continually improving and using innovation in technology to offer safer, faster and enhanced natural results.

More information on Facial Cosmetic & Plastic Surgery:

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