Awake Facelift (Local Anesthesia Facelift)

Conveniently located to serve the areas of Los Angeles and Beverly Hills

Happy black woman with closed eyes touching soft smooth skin stock imageAn awake facelift, or local anesthesia facelift, is a method for performing facelifts that allows for quicker recovery than other techniques. The awake facelift is the safest surgical procedure to achieve a youthful rejuvenation.

Put Your Best Face Forward

Facelifts are a delicate procedure. Most people consider their faces the most sensitive region of their bodies. Facelifts have long been popular among patients looking to refresh their appearance and reverse the effects of aging. However, conventional facelift methods result in a face that looks pulled, stretched, and unnatural. Furthermore, results do not last and patients have to seek revision surgery.

With an awake facelift, you benefit from a safer procedure that leads to more natural results.

Awake Bloodless Facelift Surgery | NO General Anesthesia | Deep Plane Facelift click to see video

Kenneth Kim, M.D., F.A.C.S., specializes in ultra-precise surgeries such as the awake facelift, or awake rhytidectomy. He stays at the forefront of patient safety advances in plastic surgery. With awake facelifts, he offers patients a safer, more effective, advanced alternative to traditional facelift procedures.

Before and After Photos


View More Photos

About Awake Facelifts in Los Angeles

Beautiful smiley Woman stock image

You do not have to be put under general anesthesia or intravenous (IV) sedation to achieve the face of your dreams. With Dr. Kim’s precise awake techniques, you benefit from the most advanced approach in facial rejuvenation surgery. Local anesthesia numbs only the area of the face being treated. Patients continue breathing on their own, which is vital to maintaining optimal safety during a procedure. Dr. Kim performs facelifts in the safest manner possible, protecting you from the risks of general anesthesia and IV sedation.

STAY SAFE WITH AN AWAKE FACELIFT

Dr. Kim’s awake facelifts focus on minimizing all risks and providing patients with the safest means to achieve their goals.

General anesthesia carries some well-known risks, such as blood clots that can traverse into the lungs, also known as pulmonary embolism, which can be life-threatening. Another risk is thrombosis (clot in the heart) that leads to myocardial infarction (heart attack). Another risk is a blood clot in the brain, also known as a stroke, that can cause abnormal brain and body function. A study published in Lancet evaluated patients 65+ years of age. It involved 12 academic medical centers in 9 countries and showed that 7% of patients experienced covert stroke (acute brain infarct), detected by brain MRI, following general anesthesia intubation. One study revealed that 75% of complications that required a transfer to the hospital during a cosmetic procedure occurred under general anesthesia.
Knowing the risks and complications of general anesthesia, patients may opt for IV sedation, also known as twilight sedation. While general anesthesia puts one to sleep by delivering anesthetic gas through a breathing tube from your mouth to your lungs which then travels to the brain, intravenous (IV) sedation involves administering anesthetic through the veins which then travels to your brain. Therefore, both methods involve anesthesia affecting the brain by altering and stopping the brain function. Patients may view IV sedation as being safer than general anesthesia as it does not require intubation. However, IV sedation carries a high risk of respiratory distress as one does not oxygenate properly. This occurs because intravenous sedation depresses the respiratory center of the brain, similar to how a drug overdose can cause someone to stop breathing. An example of this is Joan Rivers, who experienced fatal hypoxia from IV sedation.
Both general anesthesia and IV sedation act on the brain to put patients to ‘sleep.’ However, this is not a natural state of sleep. During natural sleep or rest, a person will wake up in response to a loud noise or physical stimulation. However, under anesthesia-induced sleep, even painful stimuli from surgery (e.g., cutting and dissecting) will not awaken the patient. This forced shutdown of the brain has negative ramifications. It causes permanent neuronal (brain) damage that affects short-term memory and increases the chances of developing dementia.
Younger patients who have had surgery with general anesthesia or IV sedation may not feel the effects of memory loss or cognitive dysfunction after their procedures. However, research has shown that even a single exposure to general anesthesia or IV sedation for 1.5 hours significantly increases the chance of developing dementia, compared to local anesthesia. This means that even if you do not experience noticeable cognitive decline after surgery, it does not mean that you are safe from long-term harm of receiving general anesthesia or twilight sedation.

Dr. Kim’s approach is a true awake facelift. His patients are fully awake, alert, and conscious throughout the procedure. He uses only local anesthesia to numb the face. Following years of research and training, Dr. Kim developed his awake facelift technique that does not alter the patient’s natural physiology and actually protects the brain from the effects of traditional anesthesia. Unlike general anesthesia and IV sedation, local anesthesia does not act on the brain and is localized to the surgical site.
In addition, patients have a significantly lower risk of postoperative complications, such as hematoma (bleeding) and infection with awake anesthesia. This is because general anesthesia and IV sedation lower a patient’s blood pressure during surgery. When operating in a state of low blood pressure, surgeons cannot predict whether cut blood vessels will reopen postoperatively when blood pressure returns to normal (higher blood pressure). This is why patients can develop postoperative bleeding (hematoma) once they are discharged home. There are two types of postoperative bleeding—one is an obvious clinical hematoma that the patient and surgeon can detect, and the second is a subclinical hematoma, which is subtle and cannot be detected. Any bleeding in the face hinders proper wound healing, induces internal scarring, and increases the rate of infection. Therefore, for a clinical hematoma, a surgeon will re-operate to remove the blood in the face. This is a relatively common postoperative complication after a facelift. However, a subclinical hematoma cannot be detected by the patient and surgeon and can induce postoperative infection and internal facial scarring. In contrast, with local anesthesia, the patient’s blood pressure remains the same (before, during, and after surgery). As a result, the risk of clinical and subclinical hematoma with awake anesthesia is significantly lower.

BLOODLESS FACELIFT

The complications discussed above focus on anesthetic risks. There are also surgical risks involved with surgery. Surgical complications occur when a surgeon’s visual field is obstructed by bleeding. One of the main risks of facelifts is nerve damage. Bleeding will obscure the visual field which increases this risk. Inadvertent injury to the nerve most often occurs because the surgeon cannot differentiate the nerves from other facial structures. This inability to distinguish the nerves happens when there is bleeding in the surgical field, as the field is stained with blood. However, if the surgery is performed in a bloodless fashion, a nerve can be clearly visualized and the surgeon can avoid damaging the nerve.

Dr. Kim’s awake technique allows for a precision facelift procedure with no bleeding which significantly decreases complications such as nerve injury. His bloodless facelift preserves maximum blood vessels. Without bleeding, patients experience the fastest recovery with minimal bruising and swelling. This ensures optimal delivery of oxygen and nutrients to cells, which is essential for maintaining healthy skin and achieving long-lasting rejuvenation. Furthermore, antibiotics that patients take after surgery can be delivered more effectively to the surgical site since the vessels are intact and not damaged. This will aid in significantly reducing possible infection.

FULL DISSECTION FOR ULTIMATE FACIAL ELEVATION

Another benefit of the bloodless technique is that Dr. Kim can fully dissect retaining ligaments and adherent tissues in the face. Why is this important? With conventional facelifts that involve bleeding, the obscured surgical field limits how far a surgeon can dissect. As a result, the conventional and commonly-performed approaches, such as SMAS, deep plane and extended deep plane facelifts, do not fully release all the facial tissue necessary for re-draping. Instead, they rely on the pulling method to lift the face.

Dr. Kim’s bloodless approach allows full dissection where the facial tissue is completely re-draped rather than pulled. The full release method also allows access to the midface, which conventional methods cannot address. Therefore, Dr. Kim delivers a comprehensive facelift with lower and midface lifting without the need for fat grafting. Fat grafting is often used with conventional facelifts (such as SMAS lifts, deep plane, extended deep plane facelifts) that cannot lift the midface. Therefore, surgeons inject fat into the midface to project it. However, this does not improve the nasolabial folds. The fat, just lateral to the nasolabial fold, is still present. The added fat grafting in the area just above the fold can cause an unnatural protrusion. Furthermore, fat adds additional weight that can descend over time leading to a more aged appearance.

Dr. Kim’s full dissection facelift that addresses both lower and midface sagging, results in the most natural-appearing results, where the face is smooth and defined. There is no counter-pull or tension since the face is fully re-draped, leading to the most long-lasting results.

Benefits of the Awake Technique

  • Maintains patient’s normal physiology and brain function
  • Provides the safest facelift for patients
  • Results in the fastest recovery
  • Allows for more effective repositioning of facial tissue
  • Sculpts a more refined, smooth, natural result
  • Provides longest-lasting results
Awake Facelift

Candidates

Candidates for an awake facelift include anyone with mild, moderate, or severe facial sagging who wants to lift or tighten the face and neck to restore a more youthful appearance. It is important to completely review a patient’s medical history and evaluate their expectations. The advantage of awake anesthesia is that it is suitable for anyone. Those who are not candidates for general anesthesia or do not tolerate it are well suited for local anesthesia/awake anesthesia. For example, patients may have previously experienced nausea, difficulty waking up, prolonged grogginess and constipation after general anesthesia. For those with medical conditions—such as a history of blood clotting, pulmonary diseases like chronic obstructive pulmonary disease (COPD)/difficulty breathing, sleep apnea, or diabetes—who are at an increased risk of general anesthesia complications can safely have surgery with only local anesthesia. Neurologically, older patients (50 years or above) who are at an increased risk of memory loss, as well as patients with a family history of dementia, may find assurance in opting for an awake facelift, which eliminates anesthesia-induced cognitive risks.

Your Personal Consultation with Dr. Kim

Dr.kenneth kim picture

During your one-on-one consultation with Dr. Kim, he will take the time to get to know you, your aesthetic aspirations, and answer any questions you have about the awake technique for facelifts. He will show various before-and-after photos so that you can see the facial transformation that can be achieved.

An expert in both the artistry and anatomy that contribute to beauty in the face, Dr. Kim has published in scientific and medical peer-reviewed journals on various parts of facial anatomy. He understands the complexities that contribute to an aging face. With his experience he is well-positioned to employ the precise techniques that can correct the undesirable effects of aging. As a Diplomate of the American Board of Plastic Surgery, Dr. Kim is committed to upholding the highest technical and ethical standards. As an Assistant Professor at UCLA’s School of Medicine, he has established himself as one of the most knowledgeable plastic surgeons in Los Angeles and Beverly Hills.

If you’re ready to learn about the benefits of an awake facelift, then schedule a consultation online or call Dream Medical Group’s Los Angeles office at 213-700-4297.

How to Prepare

We will provide you with a comprehensive set of instructions once you schedule your surgery. It is important to adhere to these instructions. In general, you want to avoid any medications or herbal supplements that can thin the blood, including aspirin, ibuprofen, fish oil, and red ginseng concentrates. It is generally recommended that patients arrange for a caregiver to give you a ride home and assist you as needed after surgery.

The Awake Facelift Technique

doctor doing skin check on middle woman before cosmetic surgery stock image

Dr. Kim’s technique repositions your facial tissue to enhance your natural features, rather than making an incision and pulling the skin tighter. His awake bloodless method repositions the sagging tissues of the face to create more natural and long-lasting results than are possible through conventional facelifts. Dr. Kim’s style focuses on creating more slender, youthful results, surpassing the results of conventional methods such as SMAS, deep plane, and extended deep plane facelifts.

Like an onion, the cells in our face are stacked in layers. Operating within the optimal layers allows for more precise surgery. With local anesthesia, Dr. Kim performs ultra-precision bloodless surgery which preserves/maintains maximum blood vessels. This ensures uninterrupted blood flow of oxygen and nutrients to the skin and fat tissue during and after his surgery.

Avoiding blood vessel damage prevents blood from staining the underlying tissues. The advantage of bloodless surgery is the clear visibility of the tissue plane. With a clear tissue plane, the surgeon can visualize the surgical field without any obstructions. This allows critical nerves to be differentiated from connective tissues, compared to a conventional facelift. By keeping the tissue visible during the procedure, an awake facelift greatly reduces the risk of damaging vital nerves in the face. Conventional and commonly-performed facelifts (such as SMAS and deep plane facelifts) cause bleeding that stains the tissue, thereby inhibiting full dissection (due to poor visibility) and increasing surgical risk. As a result, facial redraping cannot be achieved and there is no option other than pulling the face. However, pulling creates counter tension, leading to recurrence of sagging and incisional scar formation.

Beauty portrait of female face stock imageDr. Kim’s awake bloodless facelift using local anesthesia allows for full release dissection to achieve the most optimal and safest facial rejuvenation. His technique creates a smooth and defined jawline, midface elevation, and youthful contoured neck.

Recovery and Aftercare

Recovery after an awake facelift is significantly quicker than with conventional facelifts. Typical facelifts cause bruising and considerable swelling on the face. Dr. Kim’s patients do not experience this bruising, as maximum blood vessels are kept intact. This results in minimal discomfort and a faster recovery. Aftercare is simple—you only need to take Tylenol for any minor discomfort. There will be no need for opioid medications. You will be provided with aftercare instructions, such as avoiding massaging and applying pressure to the face during recovery.

Natural Results

Older styles of facelift pull the skin tighter. This result will come back down in time. Dr. Kim’s precision technique instead repositions the underlying facial tissue and skin. This results in a far longer-lasting result that doesn’t sag as quickly. This precision technique creates a much more natural result that doesn’t look pulled. If you want a facelift that doesn’t look like someone put your skin in the dryer too long, contact Dr. Kim for an advanced awake facelift.

Awake facelifts result in slender and youthful appearances, as opposed to the traditional method which results in a “pulled tight” look that observers may perceive as unnatural looking.

How Much Does an Awake Facelift Cost in Los Angeles?

To provide an accurate price for an awake facelift, Dr. Kim must conduct a thorough assessment of your medical history, hear your goals and expectations, and perform a preliminary examination of your facial anatomy. After he determines what will be required to achieve your goals, he can provide you with an accurate price. You’ll receive a comprehensive breakdown of the costs so you can make an informed decision.

FAQ

What’s the best age for a facelift?

There is no ideal age for a facelift. It all depends on the individual. That said, many of our facelift patients are in their 40s to 70s. However, patients in their early 30s or 80s can also benefit greatly from an awake facelift.t.


Are awake facelifts safe?

Yes. Dr. Kim’s awake bloodless facelift is the safest way to undergo a facelift and provides superior results compared to a conventional facelift (rhytidectomy). Awake facelift does not alter your body’s natural physiology; therefore, there is no anesthetic harm to the body or brain. General anesthesia and IV (twilight) sedation carry many risks, including blood clots, heart attacks, strokes, and respiratory distress (decreased oxygenation to the brain and heart). Both anesthesia types also cause cognitive decline/memory loss and increase the chance of developing dementia in the future. Awake facelift with local anesthesia eliminates these anesthetic risks.


How does local anesthesia work?

You will initially feel the anesthetic being administered and the sensation is that of pressure on the face. This pressure sensation will last around 30 seconds, after which the surgical site will be numbed. The nerves in the face will be anesthetized (numbed) by the local anesthetic.


What if I have anxiety or fear of being awake during surgery?

Much of anxiety stems from the fear that something will go wrong. Patients who feel anxious or fearful often do so because of uncertainty and the possibility of complications. Unlike with general anesthesia or IV sedation, where you are not in control and are unaware of the status of your surgery, an awake facelift allows you to remain aware of the progress throughout surgery. In fact, people with anxiety disorders actually do better with awake surgery because they are in control and know what is happening during surgery. You can breathe on your own. There is no bleeding. You can listen to music and talk to Dr. Kim and his staff during your procedure. Dr. Kim will keep you informed about the progress of surgery. Additionally, you will get a break mid-surgery after one side of the face has been lifted. During this time, you can look in the mirror and see the difference. During the 30-45 minute break, you can see your caregiver, FaceTime family and friends, check your phone, or use the restroom. Dr. Kim has had prior patients who were very busy (executives and professionals) who have used this time to work on their laptops. Dr. Kim has over 18 years of experience performing awake plastic surgery. He understands that patients may feel anxious or concerned about being awake. However, he has successfully operated on numerous patients with severe anxiety disorders. These patients have had no issues during their surgeries and were able to proceed without anxiety. Patients are usually anxious because of the potential risk of complications that may occur during surgery. However, Dr. Kim’s method takes away anesthetic risks and minimizes bleeding, providing a safer and more reassuring experience.


What if I accidentally move my face during an awake facelift?

Dr. Kim's method of surgery allows him to move in sync with the tissue. This means that his hands and instruments respond dynamically to tissue movement. Even if you move one direction, his hands and instruments will move and adjust with your movement. Therefore, you do not have to worry about movement during surgery.


How long does the local/awake anesthesia last?

The anesthetic will last up to 8 hours. Therefore, during and after surgery you will not feel any sensation.


Local vs. General Anesthesia and IV Sedation: What’s the difference after surgery?

The benefit of awake surgery using local anesthesia is that the nerve endings are blocked before incision and dissection are made. In contrast, with general anesthesia or IV sedation surgery, the nerves are not anesthetized but rather the brain is anesthetized. This means that the nerves are stimulated during surgery and become hypersensitive. As a result, once the patient wakes up from general anesthesia or IV sedation, the brain will feel the pain because the nerve fibers at the site of surgery send pain signals to the brain. Therefore, one may be required to take opioid medications to numb the brain again. Once the opioid medications wear off after 4-6 hours, the pain may return and you will need to retake the opioid medications. This can increase one’s chance of developing opioid dependence and has led to the rise of opioid addiction in America. In contrast, local anesthesia numbs only the nerves at the site of surgery. Therefore, the nerves are not triggered. Once the surgery is completed, the nerves should not be sensitized. Ultimately, most patients should be able to manage any discomfort with Tylenol without the need for strong opioid medications.


References

  1. Ratz, J. (2012). Faculty of 1000 evaluation for Determining the safety of office-based surgery: what 10 years of Florida data and 6 years of Alabama data reveal. F1000 – Post-Publication Peer Review of the Biomedical Literature. https://www.doi.org/10.3410/f.14250958.15764058
  2. Kim, H. S., & Kim, K. K. (2020). Subbrow Lift Using Frontalis Sling to Correct Lateral Orbital Laxity. Aesthetic Plastic Surgery. https://doi.org/10.1007/s00266-020-01879-9
  3. Kim, K. K., Kim, W. S., Oh, S. K., & Kim, H. S. (2017). High Double Eyelid Fold Correction Using Wide Dual-Plane Dissection. Annals of plastic surgery, 78(4), 365–370. https://doi.org/10.1097/SAP.0000000000000905
  4. Dejoseph, L. M., & Pou, J. D. (2020). Local Anesthetic Facelift. Facial Plastic Surgery Clinics of North America, 28(3), 409-418. https://doi.org/10.1016/j.fsc.2020.03.012
  5. Linderman, Richard B. (2018). Facelift Under Local Anesthesia With Oral Sedation, Aesthetic Surgery Journal, Volume 38, Issue 12, December 2018, Page NP229, https://doi.org/10.1093/asj/sjy243

Also learn more about Deep plane facelift.

*Results May Vary

Awake Anesthesia

dream medical group