Caroline Shaw had no idea she would feel an overwhelming urge to use the bathroom in the middle of her facelift.
“My face was only half done, and they asked if they could take my picture, which they gave me as a souvenir,” the 57-year-old life coach, who splits her time between the Upper East Side and Geneva, Switzerland, told The Post.
Shaw is just one of many patients who are having “awake” surgery instead of going under general anesthesia or IV sedation. With the help of oral sedatives and numbing, while under local anesthesia, patients alternate between dozing off and waking up rather than being fully out or fully awake.
This option allows them to skip most of the time-consuming pre-op medical testing, while avoiding the anxiety and risks of anesthesia, to be able to stroll out immediately post-op, rather than being stuck in an hours-long haze.
Taking the local anesthesia route wasn’t Shaw’s original intention when she scheduled her series of procedures: a face and neck lift, fat transfer to fill out the skin, and a CO2 laser to improve texture.
The New Yorker endured tedious pre-surgical testing to make sure she was healthy enough to undergo anesthesia and abstained from food and water after midnight.
The one thing she failed to omit was her daily supplements. Upon revealing this right before her procedure, the anesthesiologist ultimately didn’t feel comfortable proceeding.
Shaw’s doctor, Park Avenue plastic surgeon Dr. Mark Albert, gave her two options: she could reschedule or continue without general anesthesia (or IV sedation), which meant Shaw would solely rely on valium and local numbing injections to get her through the multi-hour surgery pain-free.
“The idea of doing that [a face lift] under local was unimaginable; let’s be honest,’’ she said. “But I trusted Dr. Albert and I was already in my gown, so I went with it.’’
Albert assured Shaw she wouldn’t be in any pain. “It was like I was stoned. The only thing that was a little uncomfortable was getting the injections in my face,” she recalled to The Post. “After that, I could hear them working on me, but I was completely numb and mostly sleeping. It lasted 3 hours and there wasn’t a minute of pain. At the end of the day, it was no worse than dental work, and I’m 57, but now look 48.”
While some welcome this alternative approach as an easier, less risky option, others view it as a deviation from the standard of care.
“More surgeons are trying to push the envelope as to what can be done under local,’’ said Dr. Natalie McDole, a partner at Park Avenue Anesthesia. “Usually, it is in a small area, but it’s shocking that a facelift would be done under local. If someone is awake, you are interacting, and they are moving around, talking and moaning. They are feeling the tugging and pulling. For 4 or 5 hours, that seems like torture.’’
But Albert, who does 90% of his facelifts under local, disagrees. “There are a lot of people who are skeptical, but it’s really a phenomenal way of doing it, and I’ve never had a single patient have to stop the surgery,’’ he said. “Safety is still a top priority. We are watching O2 saturation, blood pressure, and heart rate, and the patient is wearing compression boots to make sure there are no blood clots.”
Doctors like Albert felt the need to offer sedation alternatives after realizing many patients don’t want to deal with the risks of anesthesia, which can include minor side effects like nausea, sore throat and shivering to very rare but more serious issues like post-op cognitive dysfunction, stroke, and even death.
Albert is confident in his approach, having performed a face, upper, and lower eyelifts, a brow lift, a lip lift, CO2 laser, fat transfer, and tip rhinoplasty on one patient under local anesthesia. “We did 3 hours in the morning, then took a lunch break and did another 2 or 3 in the afternoon,’’ he recalled to The Post. “This is not anything cavalier. I just did a facelift on a 92-year-old woman who wanted to avoid anesthesia at her age.’’
Regina Walsh, a 64-year-old Parsippany, New Jersey, resident, had a facelift under local anesthesia earlier this month, performed by Dr. Andrew Berlet, who practices on Park Avenue and in New Jersey, and she doesn’t regret her decision one bit. “I never would have gone under anesthesia for something elective, because of the risks and the after effects,’’ she explained.
“Once you are under, you’re under, and you don’t know what’s going on — whether you will wake up or not. It’s not like I was lying there making a fist and squeezing something. There was music, and it was very comfortable.’’ And she is pleased with her results. “I’m still swollen, but I’m very happy,’’ she said.
Of the 100 facelifts Berlet performs annually, only four to five are performed under IV sedation or general anesthesia — the rest are performed under local anesthesia. Although 25% to 30% of his patients need to use the restroom mid-procedure, he isn’t bothered by it and maintains that a facelift is not as serious a surgical procedure as some think.
“It’s a superficial operation; you are not in the gut where you will affect fluid shifts, it’s like taking out an oversized mole. If you can tolerate 15 minutes of discomfort for the shots, you can walk out without a hangover,” he told The Post.
Although it isn’t guaranteed to happen, the possibility of a patient interrupting or distracting a doctor during surgery, or even leaving the sterile OR, isn’t ideal, of course.
“The surgeon has one shot at getting the best result he can, and if a patient is talking to you and going to the bathroom, it’s not optimal,’’ said David Rosenberg, a leading facial plastic surgeon, known to have improved some of the city’s best-known visages. “The only reason I can see for doing it awake is to save money.’’
And eliminating an anesthesiologist definitely does that, lowering the cost of procedures by $1,500 to $2,000 per hour.
Many doctors, including Rosenberg, are now doing shorter cosmetic procedures under local. “My comfort zone is an hour; after that we will provide sedation,’’ he said. “I have done more than 6,000 facelifts, and not one awake, but this week I am doing a baby facelift under local. Some patients are so paralyzed with fear by the idea of going under, because it’s a loss of control, so I will do this for them.’’
Though it’s not his preferred method, he will also perform upper eyelid and endoscopic brow lifts under local. “Everyone has a period of time (when) they can sit still and deal with the unpleasantness,’’ he explained. “It’s not my typical approach, but if people ask for it, I will do it. They are quick procedures and you can walk out after and go for a coffee.’’
However, Rosenberg stressed that some patients are more suited to awake surgery than others.
“The danger is picking the wrong patient,’’ said Rosenberg. “You don’t want someone who is pain sensitive that you have to keep giving lidocaine to, and you don’t want someone too high-strung or type A, which is a challenge in New York.’’
Dr. Ira Savetsky, a general plastic surgeon, warns that doing a facelift under local sedation carries a risk of toxicity from the numbing agent. “If you are doing a lift under local and you inject the numbing solution into a blood vessel, you can quickly get lidocaine toxicity,’’ he said. “All it takes is injecting it into a blood vessel accidentally.’’
One of the foremost authorities on facial nerves, Beverly Hills facial plastic surgeon Dr. Babak Azizzadeh, said that, apart from being potentially toxic, lidocaine obstructs his ability to accurately gauge facial nerve activity. “I monitor facial nerves during a lift and excessive lidocaine reduces their activity,’’ he explained to The Post.
Azizzadeh does fat grafting and lip lifts under local anesthesia and explained how “Patients can be apprehensive ahead of surgery, but they love that you can make it super easy with local. They don’t have to get medical clearance, they can put on their glasses after and go.’’
Upper eyelid surgery under local anesthesia is on the rise because of its brevity and relative simplicity.
Dr. Sean Alemi, a top facial plastic surgeon, does that, as well as lip lifts, without general anesthesia or IV sedation. One of his patients, 44-year-old Upper East Sider Stephanie DiPaolo, was at a happy point in her life, planning a chic Palm Beach wedding, when she noticed her eyelids looked heavy. She decided to do a refresh before her big day, and when Alemi suggested local, she agreed.
“When I would think about it, it was a bug out, but on that day I was relaxed, and almost couldn’t believe I had surgery,’’ she shared.
The entire process lasted less than two hours. “There was nothing wild or uncomfortable — just a feeling of pressure. He asked me what kind of music I wanted, and I remember him singing, and we talked about music. I look like myself now, but more awake. I wouldn’t have changed a thing,” DiPaolo explained to The Post.
Alemi said that while patients can get claustrophobic under longer local procedures, since they’re awake but unable to move for a while, he recalls DiPaolo’s surgery being a breeze. “I might have been humming, and I think she had a good time!’’
Tina Gonzalez, a 47-year-old trainer, also seems to have actually enjoyed her surgery. She had an upper lid tightening and a fat transfer into her lower lids, performed by Savetsky. “It felt so comfortable, tranquil and peaceful,’’ she said. “I appreciated being updated by the doctor in the process, and there was a mix of top 40s music. I was awake through the whole thing and it was spectacular. It was a cool option with less planning, and now people actually notice my green eyes.’’
And it’s not just minor procedures like skin biopsies, minor facial surgery and dental work, liposuction is also on the list.
Aliya Sondel, a 27-year-old Upper West Sider who works in tech, and recently had her arms sculpted by plastic surgeon, Dr. Darren Smith, recalls hearing the ultrasound as it melted her fat. “I was definitely coherent enough to ask questions,’’ she said. “He put on a pretty upbeat playlist, it was a cool atmosphere all things considered, and I love the results.’’
