Facelift Anesthesia: Understanding General Anesthesia and TIVA

My deep plane facelift guide covers the operation, the hospital and recovery. This article explains the anesthesia vocabulary, common concerns and the questions worth bringing to your anesthetic assessment, especially if you are traveling to Brazil.

Begin with the concern behind the question

When someone asks which anesthesia I use, the question is often about more than a drug. You might be worried about being awake, losing control, feeling sick afterward or repeating a bad experience from a previous operation. I would rather understand that concern than offer a reassuring phrase that leaves it unanswered.

Tell me what you are afraid of, even without the medical terms. If you were told something went wrong in the past, bring the report if you have it. You do not need to work out what caused it yourself.

Four terms that describe different things

Why I avoid ranking anesthesia by its name

Words such as “light,” “gentle” and “modern” can sound appealing without explaining what will happen. I want you to understand the level of anesthesia planned, who is responsible for it and how your health has been taken into account.

I also cannot judge another team’s care from an advertisement. What matters is whether you understand the plan for your own surgery and have discussed your concerns with the anesthesiologist. If you strongly prefer to avoid general anesthesia, tell us before making travel arrangements, so you do not find out something important only after committing to the trip.

What research can tell us about nausea

A 2018 systematic review and meta-analysis included 229 randomized trials with 20,991 patients and compared propofol maintenance with inhaled agents. The risk of nausea and vomiting was lower with propofol [3]. Two of the authors worked for a company that manufactures propofol, which is worth bearing in mind when reading the result.

I read that result narrowly. The review covered different operations and populations, with a literature search ending in 2016, and did not look specifically at deep plane facelifts. Less nausea does not mean a lower risk of every anesthetic complication, and a group average cannot predict how you will feel when you wake up.

So I do not promise a nausea-free recovery. Tell the anesthesiologist if you have had nausea after previous operations so it can be factored into your plan.

Prepare a history, not just a folder of normal tests

Make a short account of your health and previous procedures. List what you take regularly and occasionally, using the actual medication names rather than “my blood pressure pill”; a brand name familiar in your country may not be recognized in Brazil, so the active ingredient helps.

If you have medical records from home, ask our team which documents are needed and how to send them. I would rather resolve an unclear medication or an incomplete report during planning than after you arrive. Tell us, too, about anything that changes after the first consultation: a new treatment, an illness or new advice from another doctor.

Make medication and fasting instructions easy to follow

The 2024 multi-society guidance published by the ASA emphasizes individual decisions about GLP-1 receptor agonists, taking digestive symptoms and dose escalation into account [4]. In my practice, I ask patients to stop GLP-1 medications three weeks before surgery. That is our team’s protocol, not a universal interval. Plan the pause with the anesthesiologist and your prescribing doctor, particularly if you have diabetes, and confirm when to restart.

My protocol requires no food or liquids, including water, for 8 hours before surgery; blood pressure or thyroid medication can be taken with a small cup of water if that is your instruction. My preoperative guide covers the rest of the preparation, and your individual prescription always comes first.

Write the agreed instructions in Brazil’s local date and time, so travel times and appointment times do not get mixed up. If you have not followed an instruction, tell the team honestly; it lets us make an informed decision about the next step.

Include the whole surgical plan in the discussion

A facelift plan may include the neck, eyelids or fat grafting when appropriate. The anesthetic assessment needs to reflect everything we have agreed to do, because each addition changes the length of the operation.

A combined plan is not automatically the right plan. My article on combining procedures with a facelift goes into that decision. If you are undecided about an additional procedure, raise it before admission: your consent needs to match the final plan.

Traveling to Brazil: logistics are not medical clearance

Our first conversation can take place while you are still abroad. A video consultation helps us discuss your goals and gather information, but it does not replace the in-person assessment before surgery.

I ask you to arrive in Londrina two days before surgery; the in-person consultation and photographs take place the day before. A new concern may still call for further evaluation or a change of plan. Plan to stay at least 12 days after surgery, preferably 14, for follow-up and suture removal. That is not an automatic fitness-to-fly certificate, so do not treat an airline booking as a medical deadline.

Waking up is one stage of recovery

After surgery, you spend about two hours in the post-anesthesia recovery unit before returning to your room. Being awake is not the same as being ready to leave [1]: after a facelift, discharge usually takes place the following morning, after my assessment.

Recovering from anesthesia is different from the healing of the operated tissues. Feeling alert does not remove the need for rest and follow-up. If you feel sick or something seems different from what you expected, tell the team rather than adding medication on your own [5]. My patient journey and the article on pain after a facelift explain what comes next.

Questions worth bringing to your assessment

1. What does the proposed anesthetic plan involve for my operation?
2. Which details of my history should we clarify before I travel?
3. Do you need records from a previous anesthetic or from my current doctors?
4. What should I do with each medication, and what are my fasting instructions?
5. Whom should I contact if my health or treatment changes before surgery?

Questions

Is TIVA the same as sedation?

No. TIVA is a way of maintaining general anesthesia with intravenous drugs. Sedation refers to levels of altered consciousness. Receiving medication through a vein does not, by itself, tell you which of the two is planned [2][3].

Can I ask for a different anesthetic?

You can and should share your preferences and concerns, but that does not make an alternative suitable automatically. For my facelifts I use total intravenous anesthesia with propofol and remifentanil, and I want you to discuss it with the anesthesiologist before deciding.

Does a previous difficult experience rule out surgery?

That description alone is not enough to say. We need to understand what happened and review your current health. Bring any documentation you have; neither dismiss the episode nor assume it was an allergy.

Will the video consultation settle every anesthetic question?

No. It helps organize the first conversation and identify the information to collect, but it does not replace the anesthetic and in-person assessments. A video call or a flight booking is not medical clearance.

Bring the question that matters to you

If anesthesia is what worries you most about a facelift, make it part of our first conversation. Write to us on WhatsApp: Bruna, my AI assistant, handles the first contact and then puts you in touch with Isanna to arrange a consultation with me.

References

1. Royal College of Anaesthetists. You and your anaesthetic.
2. American Society of Anesthesiologists. Statement on Continuum of Depth of Sedation: Definition of General Anesthesia and Levels of Sedation/Analgesia.
3. Schraag S, Pradelli L, Alsaleh AJO, Bellone M, Ghetti G, Chung TL, et al. Propofol vs. inhalational agents to maintain general anaesthesia in ambulatory and in-patient surgery: a systematic review and meta-analysis. BMC Anesthesiol. 2018.
4. American Society of Anesthesiologists. New Multi-Society GLP-1 Clinical Practice Guidance Released.
5. Royal College of Anaesthetists. Risks and side effects – feeling sick and being sick.