The type of anaesthesia remains one of the factors that concerns my patients most.
If you’re considering a Facelift, it’s natural for questions to arise about different aspects of the process (recovery, scarring, which technique to choose, how to choose the right specialist…) and undoubtedly anaesthesia is one of them.
Of the over 500 facelifts I’ve performed to date, I’ve done many under intravenous sedation. And also many others under general anaesthesia.
Let me explain the difference between these two options so you have all the information you need.
And I’ll tell you what I do with my patients and why.
Let’s begin!
Intravenous sedation
- What does it involve? Medications are administered intravenously to induce a sleep state (light / moderate / deep) whilst maintaining spontaneous breathing.
- Recommended duration: the SEDAR (Spanish Society of Anaesthesiology and Resuscitation) establishes no limitation regarding maximum sedation duration. The time limit will therefore depend on the depth of sedation and each patient’s tolerance.
- What does it involve? Medications are administered to induce a deep sleep state where the patient is unconscious and requires ventilatory support.
- Recommended duration: no time limit
General anaesthesia is the procedure of choice for surgeries requiring absolute patient immobility, when invasive procedures must be performed, or when, due to duration, sedation wouldn’t be a safe alternative.
Additionally, certain conditions may contraindicate sedation.
Are there different types of general anaesthesia?
Absolutely. There are many ways to perform general anesthesia.
And the chosen method can significantly impact your wake-up experience.
Beyond the painkillers and medications needed to keep your vitals in an optimal range (just like with intravenous sedation), general anesthesia relies on two main types of hypnotic drugs:
- Inhaled anesthetics (e.g., Sevoflurane, Desflurane)
- Intravenous anesthetics (e.g., Propofol, Midazolam)
Although anesthetic gases are commonly used for their ease of administration, they are known to be emetogenic, meaning they can promote nausea and vomiting.
In contrast, drugs like Propofol have the opposite effect (they are anti-emetic).
This is precisely why some patients wake up feeling nauseous after surgery (they were likely put under using gases), while others enjoy a much smoother and more comfortable awakening (thanks to intravenous anesthesia).
Are all intravenous anaesthesias the same?
Not at all. Total Intravenous Anesthesia (TIVA) can vary greatly from one anesthesiologist to another—much like no two surgeons operate in exactly the same way.
These differences include the combination of drugs used and, importantly, how they are administered.
While it’s common to use infusion pumps that deliver a fixed, constant rate of medication throughout the surgery, there is a far more modern and patient-friendly method: TCI (Target-Controlled Infusion).
TCI uses sophisticated software to calculate and adjust the dose in real-time, maintaining the precise concentration of medication in your system needed for that moment. This ensures you receive exactly what you need—no more, no less—for an optimal state throughout the procedure.
The benefits for you are clear:
- A smoother induction (you’ll drift off to sleep peacefully)
- Precise anesthetic maintenance (eliminating any risk of waking during surgery)
- A calm and clear-headed wake-up
General anesthesia and sedation share several key characteristics, and one of them is absolutely fundamental: in both cases, the procedure must be performed by a specialist physician in Anesthesiology. This expert will monitor you throughout the entire procedure to ensure you remain in optimal condition.
This means they will continuously track your vital signs and use any necessary medications to, among other things, maintain your blood pressure and body temperature at ideal levels, administer fluids (saline, glucose solutions…), and, most crucially:
- Guarantee you feel absolutely no pain
- Precisely adjust your level of consciousness
Every anesthesiologist has their own preferences when it comes to selecting the specific combination of drugs for pain control (analgesics) and managing the level of consciousness (hypnotics).
Considering that my goal—and surely yours too—is to ensure you:
- Drift off to sleep peacefully
- Have zero risk of waking during the procedure
- Experience no nausea or vomiting upon waking
- Avoid coughing and minimize any risk of a respiratory infection
My choice is very clear: for my Deep Plane Facelift surgeries, I strongly prefer
an intravenous general anesthesia (gas-free) controlled by TCI (Target-Controlled Infusion).
In other words, I choose what I would want for myself: maximum safety and comfort.
What do you think?
My Anesthesiologist
Since 2022, I have worked with the same anesthesiologist for all my surgeries.
As I write these lines, we have already far surpassed a hundred facelifts together.
Along with several minor surgeries where I’ve relied on her expertise to perform sedation.
She is not only a technically excellent anesthesiologist but also incredibly attentive to detail.
Since we began working together, not a single patient has complained of a bad wake-up, nausea, feeling cold…
She will be by your side throughout the entire surgery, meticulously overseeing every detail to ensure your maximum comfort and safety.
