Facelift surgery under local anesthesia: A scoping review of current practices and outcomes

Facelift surgery is a common aesthetic procedure designed to address facial and cervical aging by mobilizing soft tissues through various dissection techniques, particularly those involving the superficial musculoaponeurotic system (SMAS). Traditionally performed under general anesthesia, recent protocols have demonstrated the feasibility of performing facelifts under local anesthesia, with or without sedation. This scoping review evaluates the available evidence on surgical approaches, anesthetic methods, and reported outcomes and complications.

We conducted a scoping review of the MEDLINE database in accordance with PRISMA-ScR guidelines. Eligible studies included facelift procedures performed under local anesthesia. Extracted data encompassed surgical techniques, anesthetic protocols, and perioperative outcomes, including complications.

Twenty-one studies met inclusion criteria, representing 7115 facelift procedures. Most patients were women (92.9%). Lidocaine was the most frequently reported anesthetic, typically combined with epinephrine. In some cases, sodium bicarbonate or nerve blocks are used to optimize comfort and reduce the required dosage. Sedation strategies ranged from none to oral benzodiazepines or intravenous agents administered under anesthetic monitoring. Surgical approaches most commonly involved SMAS plication or resection, with several studies also reporting adjunctive procedures such as lipofilling or thread lifting. Complication rates were low, with hematoma being the most frequent (2.35%). Compared with general anesthesia, local anesthesia was associated with fewer thromboembolic events and greater hemodynamic stability.

Facelift surgery under local anesthesia appears to be a safe and effective alternative to general anesthesia, offering shorter recovery times and reduced morbidity. Careful patient selection and standardized anesthetic protocols remain critical to optimizing outcomes and ensuring patient comfort.