Concern about risks with total facial rejuvenation in a single session are unfounded


Concern about risks with total facial rejuvenation in a single session are unfounded

Multiple facial rejuvenation techniques can be safely and effectively performed in combination during a single operative session under local anesthesia, researchers reported here at a meeting of the American Society of Dermatologic Surgery (ASDS).

Brian Somoano, MD, a dermatologic surgery fellow with Greg S. Morganroth, MD at the California Skin Institute in Mountain View, CA, presented results in 102 patients who underwent a combined procedure out of 402 face lift patients during the last five years under local anesthesia. The combined procedure consisted of at least five of the following: face and neck lift, submentoplasty, two- or four-lid blepharoplasty, subperiosteal chin-jowl or jowl implant, brow lift, carbon dioxide laser resurfacing, and trichloroacetic acid (TCA) chemical peeling. The combined local anesthesia facial procedures provided a safe outcome without any major surgical or anesthesia-related complications.

"Dermatologic surgeons have increasingly incorporated minimally invasive facial rejuvenation surgical procedures into their practice, including neck and face lifts, upper and lower blepharoplasty, submentoplasty, and chin-jowl implants," Dr. Somoano pointed out. "While the safety of these individual procedures performed under local anesthesia has been well established, less is known about patient outcomes when five or more of these techniques are performed as a single combined procedure. We found that it is extremely safe to combine multiple facial procedures in a single session with high patient satisfaction."

Traditionally, dermatologic surgeons have been hesitant to perform a multiple procedure surgery, he said. The reasons include concern about time constraints to perform more than one or two procedures, the duration of local anesthesia effect, and concerns about patient tolerance.

The study included 99 women and three men that averaged 60 years of age. All patients were followed postoperatively for at least three months.

Patients received an average of 350 cc of 0.3% lidocaine with 1:500,000 epinephrine tumescent solution for the face and neck, and 27 cc of 1% lidocaine with 1:100,000 epinephrine for incision lines and nerve blocks. Pre-medications included Valium 10mg PO, as well as Demerol 50mg and Phenergan 25mg IM.

Patients reported that multiple procedure surgeries were highly tolerable, and all of them resumed their routine activities within ten days.

There were no cases of significant hemodynamic instability, permanent nerve injury, prominent scarring, or need for surgical revision. No patient needed to be transferred to a hospital for emergency treatment.

"We believe that patients who seek multiple facial procedures can safely and effectively undergo a single procedure under local anesthesia, and we continue to provide these procedures on a regular basis catering to patients who specifically seek our technique to avoid the risks of general anesthesia," Dr. Somoano said.

The ideal candidate, he added, is a patient who has been medically-cleared by his/her primary care physician and seeks to minimize risk, has realistic expectations regarding the procedure, and has been properly educated as to the pre-, intra-, and post-operative risks and benefits.

By contrast, patients who should probably not undergo multiple procedures in a single session are patients who have fears or phobias of surgery, have "white coat" syndrome risking hypertension during surgery, and are unable to tolerate listening to the operating room sounds.

"We have shown that dermatologic surgeons possess the skill set to provide a safe and valuable alternative to traditional techniques under general anesthesia," Dr. Somoano said. "Offering full facial rejuvenation under local anesthesia is a milestone achievement for cosmetic dermatologic surgery and will continue to become part of our daily practice."

How Local Anesthesia Makes Multiple Facial Cosmetic Surgeries Safer, and More Flexible (Video Medical And Professional 2020).

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