For many patients considering facelift or neck lift surgery, the prospect of general anesthesia or IV sedation is a meaningful deterrent — sometimes the deciding factor that delays the procedure for years. The concern is reasonable: anesthesia carries its own risks, post-operative nausea and vomiting are common, recovery from anesthetic agents can leave patients feeling exhausted for days, and the medical clearance required for general anesthesia excludes some patients who would otherwise be excellent candidates for facial rejuvenation. There is good news, however. Performing a facelift and neck lift under local anesthesia only is not a compromise — it is a genuinely safer approach with proven scientific support, expanding access to facelift surgery for patients who would otherwise be poor candidates for general anesthesia, and producing equivalent surgical results without compromising any aspect of the outcome.

Dr. John Anastasatos performs facelift under local anesthesia at his Beverly Hills practice using the technique developed by his direct mentor, Dr. Luis Vasconez at the University of Alabama at Birmingham. Dr. Vasconez and his associates published a foundational peer-reviewed study in 2012 at UAB establishing the efficacy and safety of performing facelift and neck lift without general anesthesia or IV sedation — and Dr. Anastasatos had the privilege of being trained directly by Dr. Vasconez during his plastic surgery residency at UAB, learning the precise technique the published study describes. This is a peer-validated, mentor-trained surgical approach, not an experimental alternative. Dr. Anastasatos has also been an invited lecturer at the Royal Society of Medicine in London on advanced facelift techniques (returning as a featured speaker in 2026). Board certified by the American Board of Plastic Surgery, a Fellow of the American College of Surgeons (FACS), a member of the American Society of Plastic Surgeons (ASPS) and American Society for Aesthetic Plastic Surgery (ASAPS), and named by The Luxe Insider as one of the Top 10 Plastic Surgeons in the World.

Why Local Anesthesia Is Genuinely Safer

There is no scientific debate about this point. Performing a facelift or neck lift under local anesthesia only is safer than performing the same operation under general anesthesia or IV sedation. The 2012 UAB study by Dr. Vasconez and his associates demonstrated this clearly, and the underlying reasons are straightforward.

Patients sometimes assume that IV sedation is a meaningful safety improvement over general anesthesia. It is not. IV sedation uses the same or very similar medications as general anesthesia. Furthermore, monitoring a patient under IV sedation for the four to six hours that a comprehensive facelift takes in expertly skilled hands is genuinely more challenging for the anesthesiologist than maintaining a patient under general anesthesia. Anesthesiologists generally prefer general anesthesia to IV sedation for procedures of that duration.

The post-operative problems commonly associated with both IV sedation and general anesthesia include nausea and vomiting — driven primarily by the hypnotic agent propofol and the narcotic medications used during the procedure. These are not minor side effects: post-operative nausea and vomiting can prolong recovery, complicate healing, and create real distress in the immediate post-operative period.

The Vasconez Local Anesthesia Technique

Historically, facelift under local anesthesia had poor patient acceptance for several legitimate reasons:

• Patients were anxious about being awake in the operating room
• Local anesthetic injection was painful when administered with traditional technique
• High-concentration adrenaline in the injectate caused fear, anxiety, and hypertension
• Many patients described the experience as the worst of their lives

The Vasconez technique, which Dr. Anastasatos learned directly from Dr. Vasconez at UAB and uses in his Beverly Hills practice, addresses each of these problems. Patients feel an initial “mosquito bite” sensation at the very first injection, but the remaining injections produce limited to no pain. Blood pressure and heart rate remain stable throughout the entire operation — eliminating the cardiovascular stress that made earlier local anesthesia approaches uncomfortable and unpopular. The result is a procedure that is genuinely well-tolerated by appropriately selected patients.

Specific Medical Benefits of Avoiding General Anesthesia

The advantages of facelift and neck lift under local anesthesia only extend well beyond patient preference:

• Genuinely Safer Anesthetic Profile: No general anesthesia means no risk of anesthetic complications, intubation issues, or anesthetic-related cardiovascular events.
• No Overnight Dehydration: Patients can eat breakfast the morning of surgery rather than fasting from midnight as required for general anesthesia.
• No Post-Operative Nausea and Vomiting: The propofol and narcotic-driven nausea common after general anesthesia is avoided entirely.
• Immediate Recovery: The exhausted, drained sensation that follows general anesthesia is eliminated. Patients return to normal mental clarity essentially as soon as the procedure ends.
• Significantly Reduced Hematoma Risk: Post-operative hematomas after facelift and neck lift typically occur in the recovery room and are driven primarily by the hemodynamic blood pressure swings associated with emerging from general anesthesia. With proper local anesthesia technique, this risk is largely eliminated.
• Reduced Post-Operative Blood Clot Risk: Performing facelift and neck lift under local anesthesia significantly reduces the risk of post-operative deep vein thrombosis and pulmonary embolism — a meaningful safety benefit, particularly in patients with relevant risk factors.

Expanded Patient Eligibility

The most important practical implication of facelift under local anesthesia is who can now undergo the procedure. General anesthesia excludes or strongly discourages patients with:

• Hypertension (high blood pressure) — particularly when not optimally controlled
• Diabetes — especially in patients with cardiovascular complications
• Heavier body habitus with thick necks — which complicates airway management under general anesthesia
• Cardiac conditions that increase general anesthesia risk
• Pulmonary conditions that complicate intubation

Many of these patients are excellent candidates for facelift and neck lift performed under local anesthesia only. The procedure becomes accessible to a significantly broader population of patients who would otherwise have to forgo facial rejuvenation surgery entirely.

“My training under Dr. Vasconez at UAB shaped my entire approach to facelift surgery, and the local anesthesia technique he developed and published is one of the most important elements of that training. The 2012 study he and his associates published demonstrated what skilled surgeons had observed clinically for years — that facelift and neck lift under local anesthesia produces equivalent surgical outcomes with a meaningful safety advantage. Using his technique allows me to offer facelift surgery to patients who would otherwise be excluded, and to offer it more safely to every patient who selects this approach.” — Dr. John Anastasatos

Cost Considerations

The cost of facelift or neck lift under local anesthesia is generally comparable to the same procedure under general anesthesia or IV sedation. Although vital signs are closely monitored throughout the local anesthesia procedure, an anesthesiologist is not typically required — producing some cost savings on that side. However, facelift under local anesthesia requires additional operating room time to properly and comfortably administer the local anesthetic injections, which adds operating room cost. The two factors largely offset, leaving the total cost approximately equivalent.

The procedure is performed at an accredited surgical facility or first-class hospital — there is no compromise of facility quality or surgical safety in pursuing the local anesthesia approach.

Frequently Asked Questions About Facelift Under Local Anesthesia

Will I be awake during the entire procedure?

Yes, you will be awake — but you will not be in pain, and your blood pressure and heart rate will remain stable throughout the procedure. Many patients describe the experience as comparable to a long dental procedure: they are aware but comfortable. Some patients listen to music or audiobooks during the procedure.

Will the surgical result be the same as a facelift under general anesthesia?

Yes. Dr. Vasconez’s 2012 published study at UAB confirmed equivalent surgical outcomes between facelift performed under local anesthesia and facelift performed under general anesthesia. The local anesthesia approach does not compromise the surgical result in any way.

Is the local anesthesia approach right for me?

It depends on your medical history and your personal preferences. Patients who have anxiety about general anesthesia, who have medical conditions that complicate general anesthesia (hypertension, diabetes, cardiac or pulmonary issues, heavier body habitus), or who simply prefer the safety profile of local-only anesthesia are excellent candidates. The consultation evaluates whether you are a good candidate.

How long does the procedure take?

A comprehensive facelift and neck lift takes approximately four to six hours in expertly skilled hands. The local anesthesia approach adds some additional time at the beginning of the procedure for proper anesthetic administration, but the overall procedure timeline is comparable.

What is the recovery like?

Recovery from the anesthesia portion is essentially immediate — there is no exhausted, foggy recovery from general anesthesia agents. Recovery from the surgery itself follows the standard facelift recovery timeline: most patients return to private daily activities within 10-14 days, with continued refinement over several months.

Can the procedure be combined with other facial procedures?

Yes. Dr. Anastasatos frequently performs blepharoplasty, brow lift, fat transfer, and other facial procedures in the same operative session under local anesthesia. The combined procedure approach produces comprehensive facial rejuvenation in a single coordinated recovery.

Why Choose Dr. Anastasatos for Facelift Under Local Anesthesia

• Trained Directly by Dr. Luis Vasconez at UAB: The only widely-published authority on facelift under local anesthesia is Dr. Vasconez — and Dr. Anastasatos trained directly under him during his plastic surgery residency, learning the precise technique the 2012 published study describes.
• Royal Society of Medicine London Advanced Facelift Lecturer: International peer-recognition with invited 2026 return as featured speaker.
• Two Decades of Beverly Hills Practice: Sustained experience in facelift surgery since 2007.
• Board-Certified, FACS, ASPS, and ASAPS: Certification by the American Board of Plastic Surgery and full membership in the specialty’s most respected peer societies.
• Procedure Performed at Accredited Surgical Facility: No compromise of facility quality, monitoring, or surgical safety.
• Expanded Eligibility for Patients with Medical Conditions: Hypertension, diabetes, and other conditions that complicate general anesthesia do not preclude facelift surgery with the local anesthesia approach.
• Top 10 International Recognition: Named by The Luxe Insider as one of the Top 10 Plastic Surgeons in the World.

Schedule Your Consultation in Beverly Hills

If you have considered facelift or neck lift surgery but have been deterred by concerns about general anesthesia — or if medical conditions have made general anesthesia surgery inadvisable for you — facelift under local anesthesia may be an excellent option. Dr. Anastasatos welcomes patients to the Beverly Hills office at 436 North Bedford Drive, Suite 202, Beverly Hills, CA 90210, for a private consultation evaluating whether the local anesthesia approach is right for your specific situation. Contact the office today to schedule your consultation with Dr. Anastasatos.