The Facelift and Necklift Procedure – The Day of Surgery/Anesthesia

The morning of the surgery, Dr. Portuese will meet with the patient to go over the procedure in fine detail again so that both the surgeon and the patient understand one another. At this time, any last minute minor modifications to the surgical plan for a facelift and neck lift will be discussed. Patients will also meet with the anesthesiologist from Swedish Medical Center during this preoperative visit the morning of the surgery. The anesthesiologist will also verify that the patient has had nothing to eat or drink since midnight. If routine medications need to be taken (such as blood pressure pills, etc.), they can be taken with a small sip of water. The anesthesiologist will ask about certain medications, food allergies, latex allergies, or any other allergic reaction to anesthesia. Patients are then brought into the formal operating room where the intravenous line is started, usually in the right hand, and a sedative is given to relax the patient. The anesthetic given that puts patients to sleep is called propofol. Once the patient is asleep, a small breathing tube is inserted between the vocal cords and is left in place for the surgery. Patients are breathing on their own under a general anesthesia and there is no recollection of the procedure. Anesthesia is now much safer than it was many years ago due to improvements in technology, the anesthetics and the monitoring agents used during the surgery.

There is also a local anesthetic placed in the face and neck to prevent any bleeding. To ensure the patient’s complete safety, the physician anesthesiologist monitors the patient’s vital functions the entire time the anesthesia is being administered in the Seattle Facelift Center. This is a Medicare Certified Ambulatory Surgery Center. While Dr. Portuese concentrates on making the refinements to the new face and neck, the physician anesthesiologist focuses on the patient’s anesthesia and the equipment monitoring heart, breathing, oxygen, and circulation levels. The monitors that are employed are EKG, which is heart tracing, blood pressure cuff to monitor blood pressure during the procedure, pulse oximeter, which measures oxygen concentration in the blood stream and a ventilator monitor, which is usually monitoring the patient’s own breathing and respirations. Carbon dioxide and temperature monitors are also used during the surgery to closely monitor the patient’s safety.


The facelift procedure takes approximately three hours to perform. A mini lift or a neck lift takes approximately an hour and a half to perform. The facelift usually involves re-sculpting and reshaping the face, neck and jaw lines to return them to their youthful state. The goal is to remove the excess skin in the face, which is done after tightening the jowls and removing the fat in the neck. There is no fat removed from the face, only in the neck. The goal for the neck lift is to clean up the neck and jaw line only. The goal for the mini lift is simply to tighten the facial muscles and jowls without any neck lift. The facelift is performing both. The incision for a face neck lift is located in front and behind the ears and into the hairline. Once healed, it is very difficult to see the incision. Care is taken to not make the face and neck lift too tight. Patients will not look like they came out of a wind tunnel. The skin is only pulled very conservatively so that patients look very natural and do not look like they are pulled too tight. The sutures in front and behind the ears are a combination of dissolvable stitches and also some stitches that have to be removed. There are drains that are used with a facelift and a neck lift which stay in for 48 hours after the surgery. There are no facial wraps that are used in the postoperative phase, only drains. The mini lift by itself does not require drains.

When patients awaken in the recovery room, the face and neck are relatively numb from the local anesthetic that was given during the surgery. Most patients experience some form of mild headache and pain in the first few hours during the postoperative recovery phase. This usually subsides with some mild pain relievers. The recovery at the Seattle Facelift Center typically takes two hours and then the patient is discharged to home with their caregiver and a list of instructions on how to care for the drains.

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