For a lot of people booking a facelift, the anaesthetic is the part they think about most, even if they don’t say so out loud. The operation has a clear shape: a plan, a recovery period, and a result you can picture. Being put under is harder to picture. There isn’t a single way it’s done either. What suits you will depend on the technique your surgeon uses, your medical background, and what you work out with your surgeon and the anaesthetist. Below, we go through the three approaches you’re most likely to be offered, how each tends to feel, and what usually drives the decision one way or the other.
Nothing in this guide replaces the conversation you will have with your own anaesthetist before surgery. It is intended as a plain-English starting point.
The Three Main Anaesthesia Options for Facelift Surgery
Facelift surgery is performed under one of three broad anaesthesia approaches, with some overlap between them. Each has a place, and each has limitations.
General anaesthesia (GA)
Under general anaesthesia, you are fully unconscious for the duration of the operation. A specialist anaesthetist (FANZCA) manages your airway, breathing and circulation throughout. You have no awareness of the surgery and no memory of it afterwards. General anaesthesia is delivered in a fully accredited hospital theatre, with monitoring in accordance with the standards set by the Australian and New Zealand College of Anaesthetists.
Twilight sedation (IV sedation, also called conscious sedation)
Twilight sedation is a deeper form of sedation than the kind you might have for a colonoscopy, but lighter than general anaesthesia. The medication is given intravenously by an anaesthetist. You breathe on your own, and you may have brief moments of awareness, although most patients have little or no recollection of the procedure. Local anaesthetic is also injected at the surgical site so the area is numb.
Local anaesthesia with light sedation (the awake approach)
You will see some clinics advertise an awake facelift, done under local anaesthesia with only a little sedation. The patient stays awake and able to respond, and the area being operated on is numbed with local infiltration. For the right person, and for a fairly limited procedure, that can work well. It tends not to suit extended techniques, deep plane work, or anything running beyond a couple of hours, partly because more of the job of staying comfortable falls to the patient.
How the Surgical Technique Influences the Anaesthesia Choice
The anaesthetic plan follows the surgical plan, not the other way around. The deeper and longer the surgery, the more likely it is that a secured airway and general anaesthesia will be appropriate.
Why a deep plane facelift is typically performed under general anaesthesia
Deep plane and extended facelift techniques involve sub-SMAS dissection, retaining ligament release and a procedure that often runs three to five hours. For an operation of that complexity and duration, general anaesthesia (most often delivered as total intravenous anaesthesia, or TIVA) is the standard approach in Australian practice. The airway is protected, the patient is still, and the anaesthetist can fine-tune blood pressure to reduce bruising and bleeding during the lift.
Mini facelift and short-scar facelift: when twilight sedation may be appropriate
Shorter procedures, such as a focused short-scar lift or a mini facelift, can sometimes be performed under twilight sedation with local infiltration. The procedure is shorter, the dissection is more limited, and many patients tolerate the experience well. Whether it is appropriate for you depends on the planned technique, your anxiety level and your medical background, and that is something to raise during your consultation. If you are in the early stages of research, the guide on how to prepare for a facelift consultation is a useful primer on the questions worth asking.
Combined procedures and their anaesthesia implications
Many facelift patients combine the operation with upper or lower blepharoplasty, brow lift, fat grafting, or occasionally rhinoplasty. Combined work lengthens the operation and almost always shifts the plan towards general anaesthesia with a secured airway. There is more information in the article on procedures to combine with facelift, which covers how surgical planning changes when several procedures are performed in one anaesthetic.
Total Intravenous Anaesthesia (TIVA): What It Is and Why It Is Often Used
In modern Australian facelift practice, the general anaesthesia is often delivered as TIVA. The name describes the method: anaesthetic medications are given continuously through a vein rather than as a vapour breathed in through the airway.
How TIVA differs from inhalational general anaesthesia
With older-style general anaesthesia, the patient breathes a vapour through a circuit. TIVA works differently. The drugs, usually propofol alongside a short-acting opioid, go in through the vein, and the anaesthetist keeps adjusting the dose as the operation goes on. You end up just as deeply asleep either way. Where they part company is in how you recover afterwards, and to a degree in the side effects you might notice.
Recovery profile after TIVA: nausea, grogginess, time to discharge
Patients who have had TIVA tend to wake more clear-headed, with less of the heavy, foggy feeling some people associate with older anaesthetics. Rates of post-operative nausea and vomiting are lower with TIVA than with inhalational techniques, although individual experience varies. Time to discharge is determined by your surgeon and your anaesthetist together, based on how you are recovering, not by a fixed clock.
Safety Considerations
Safety in facelift anaesthesia comes down to three things: who is giving the anaesthetic, where the surgery is performed, and how thoroughly you are assessed beforehand.
The role of a specialist anaesthetist (FANZCA)
FANZCA stands for Fellow of the Australian and New Zealand College of Anaesthetists. It is the specialist qualification for anaesthetists in Australia and represents many years of post-medical training in the specialty. Every facelift Dr Hunt performs is conducted with a FANZCA specialist anaesthetist present, monitoring the patient continuously and responsible for all aspects of the anaesthetic.
Accredited hospital vs office-based surgical facility
Major cosmetic surgery in Australia, including facelift surgery, is appropriately performed in fully accredited hospital theatres rather than office-based rooms. Accredited hospitals are subject to strict licensing, infection-control standards, equipment requirements and emergency protocols. Dr Hunt performs facelift surgery only in accredited private hospital settings, with a specialist anaesthetist, and never in office-based or doctor-only rooms. This is consistent with AHPRA cosmetic surgery guidance.
Pre-anaesthetic assessment: what to disclose
At your pre-operative review, the anaesthetist goes through your medical history, the medications you take, any allergies, and how you have responded to anaesthesia before. Conditions like sleep apnoea, reflux, heart disease or a high BMI all matter here, so it helps to be open. Smaller things count too. Herbal supplements, the odd sleeping tablet, and recreational substances can each change the plan, so mention them. For the full run-down of what to bring, what to pause, and the timing involved, see the checklist on how to prepare for face lift surgery.
Comparing the Patient Experience
Patients often want a side-by-side view of what each option feels like, in practical terms. The summary below is general, and your own experience will be shaped by the technique, your health and the anaesthetic plan agreed at the pre-operative review.
Time to wake
How quickly you come round depends on the technique. With general anaesthesia or TIVA, most people are responsive within 10 to 20 minutes after surgery finishes and feel oriented again within the hour. Twilight sedation usually clears a bit faster, and patients tend to be alert within fifteen to thirty minutes. If you have had local with light sedation, there is really no waking-up phase at all, since you stay aware the whole time.
Post-operative nausea and vomiting risk
Nausea is the side effect patients dread most. TIVA is associated with lower rates of post-operative nausea than older inhalational anaesthesia. Anti-nausea medication is given routinely. Twilight sedation also has a low rate of nausea. Your personal history matters here: if you have had bad nausea after a previous anaesthetic, tell your anaesthetist.
Pain control in the first 24 hours
Honestly, most people are surprised by how manageable the discomfort is. It is less a sharp pain and more a sense of tightness and pressure, along with a slightly heavy feeling in the face. To help with this, the surgeon puts in a long-acting local anaesthetic just before closing, so the area stays settled for several hours. After that wears off, paracetamol and similar over-the-counter options usually cover the first few days, and your team can prescribe something stronger if it is needed.
Time to discharge
After a facelift performed under general anaesthesia in a private hospital, an overnight stay is common, particularly for deep plane and extended techniques. After shorter procedures under twilight sedation, day-stay discharge with a responsible adult escort is sometimes possible. The decision is made by the surgical and anaesthetic team based on how you are recovering, not on your preference to get home.
Common Questions Patients Raise During the Anaesthesia Discussion
Will I feel anything?
Under general anaesthesia or TIVA, no. You are unconscious. Under twilight sedation, the surgical field is numbed with local anaesthetic, so you should not feel pain. You may sense pressure or movement, and most patients have little to no memory of these sensations afterwards. Under local with light sedation, you are aware that the area is numb, and pressure or tugging may be felt.
Could I wake up during surgery?
Awareness under general anaesthesia is rare. Australian and New Zealand anaesthetic practice uses continuous monitoring of depth of anaesthesia, vital signs and end-tidal gases where relevant. The risk is low but not zero, and your anaesthetist will discuss it with you if you raise it during the pre-anaesthetic review.
What happens if I have a medical condition?
Heart disease, sleep apnoea, diabetes, high blood pressure and obesity all influence the anaesthetic plan but rarely make surgery impossible. Sleep apnoea, in particular, is worth flagging because it affects how the airway is managed and how recovery is monitored. The pre-anaesthetic assessment exists precisely so that conditions like these can be planned for, not discovered on the day.
Can I refuse general anaesthesia?
You are entitled to discuss alternatives. That said, refusing general anaesthesia may also mean accepting that certain facelift techniques cannot reasonably be offered to you. The technique and the anaesthetic are linked. A deep plane facelift is not a procedure that can be safely performed under local anaesthesia in most cases, and your surgeon will explain why if this comes up.
How the Decision is Made in Dr Hunt’s Practice
In Dr Hunt’s practice, the anaesthetic conversation follows a defined order. The surgical plan is settled first, based on your anatomy and your goals. The anaesthetic options consistent with that plan are then outlined during consultation. A specialist anaesthetist conducts a pre-anaesthetic review in the weeks before surgery, taking a detailed history and ordering any necessary tests. The final plan is agreed between you, Dr Hunt and the anaesthetist. The cost implications of different anaesthetic plans are discussed openly, and the article on how much facelift surgery costs in Sydney sets out where anaesthesia sits in the overall fee structure.
Why Choose Dr Hunt for Face Lift in Sydney
The anaesthetic is only one piece of a facelift. It sits next to the surgical technique itself, the place where the operation happens, and the people looking after you while you heal. In Dr Jeremy Hunt’s practice, that means a proper pre-operative consultation, surgery carried out in fully accredited private hospitals with a specialist anaesthetist (FANZCA), and care that carries on through your recovery. The anaesthetic chosen reflects both the procedure and the person having it, rather than a single default applied to everyone.
Dr Jeremy Hunt is a Specialist Plastic Surgeon (FRACS) with more than two decades of experience in aesthetic and reconstructive plastic surgery. He is a Fellow of the Royal Australasian College of Surgeons in Plastic Surgery, with his profile listed on the RACS register (https://www.surgeons.org/Profile/jeremy-hunt-144103 ). He is a member of the Australian Society of Plastic Surgeons, verifiable at https://plasticsurgery.org.au/doctor/mr-jeremy-hunt/, and a member of the Australasian Society of Aesthetic Plastic Surgeons, verifiable at https://aestheticplasticsurgeons.org.au/surgeon/Jeremy-Hunt/.
Dr Hunt sees patients at his Sydney rooms (175 Edgecliff Rd, Woollahra NSW 2027) and his Wollongong rooms (Suite 6, 174 Gipps Rd, Gwynneville NSW 2500), and welcomes patients from across the Eastern Suburbs, including Double Bay and Bondi Junction, and the wider Sydney metropolitan area. To discuss whether a facelift may be appropriate for you, and what anaesthetic options would be considered in your case, you are welcome to request a consultation.
Under current AHPRA cosmetic surgery rules, a seven-day cooling-off period applies before any cosmetic surgical procedure can be booked, and patients are encouraged to seek a second opinion from a suitably qualified health practitioner before proceeding. Individual results vary, and all surgical procedures carry risks that are discussed in detail during consultation. A broader overview of those risks is available in the article on facelift risks and complications.
Frequently Asked Questions
Is a facelift done under general anaesthetic?
Most modern facelifts in Australia, particularly deep plane and extended techniques, are performed under general anaesthesia or total intravenous anaesthesia (TIVA) with a secured airway. Shorter procedures, such as a mini facelift or short-scar lift, may sometimes be performed under twilight sedation with local infiltration. The anaesthetic chosen depends on the surgical plan, the expected duration and the patient’s medical background.
What is twilight sedation for a facelift?
Twilight sedation, also called IV sedation or conscious sedation, is a form of anaesthesia in which the patient is deeply relaxed and breathing on their own. The medication is given intravenously by a specialist anaesthetist, and the surgical site is numbed with local anaesthetic. Most patients have little or no memory of the procedure. It suits shorter facelift techniques rather than extended deep plane surgery.
Is twilight sedation safer than general anaesthesia?
Both are very safe when administered by a specialist anaesthetist (FANZCA) in an accredited hospital. Neither is universally safer than the other. Twilight sedation avoids the need for a breathing tube and has a lower rate of post-operative nausea, but it has clear limitations for longer or more complex facelift techniques. General anaesthesia provides full airway control and is the standard for deep plane and extended procedures. The right choice depends on the operation and the patient.
How long does facelift anaesthesia last?
Most facelift procedures take three to six hours, depending on whether combined procedures such as blepharoplasty are performed in the same operation. Most patients are awake and oriented within 30 to 60 minutes of the procedure ending. Full clarity, including steady balance and clear thinking, can take several more hours and is influenced by the type of anaesthesia used.
Will I feel nauseous after facelift anaesthesia?
Post-operative nausea is one of the more common concerns, and modern anaesthetic practice plans for it. Anti-nausea medications are given routinely during and after surgery, and TIVA is associated with lower rates of nausea than older inhalational anaesthesia. Individual experience varies, particularly for patients with a history of nausea after previous anaesthetics. Tell your anaesthetist if this has been an issue for you.
What happens at the pre-anaesthetic assessment?
The anaesthetist reviews your medical history, current medications, allergies, previous anaesthetic experiences and any relevant conditions such as sleep apnoea, reflux or heart disease. Blood tests, an ECG or other investigations may be ordered if appropriate. This assessment typically happens in the weeks before surgery and is the right time to raise any concerns you have about being anaesthetised.
Disclaimer: This blog is general in nature and does not constitute medical advice. All surgical and invasive procedures carry risks. Before proceeding with any procedure, you should seek a second opinion from an appropriately qualified health practitioner. Individual results vary depending on anatomy, technique and how the body heals after surgery. AHPRA registration: MED0001151603.
Further Reading
- How to prepare for face lift surgery (dos and don’ts): https://www.drjeremyhunt.com.au/blogs/how-to-prepare-for-face-lift-surgery-dos-and-donts/
- How to prepare for a face lift consultation: https://www.drjeremyhunt.com.au/blogs/how-to-prepare-for-a-face-lift-consultation-questions-to-ask-your-surgeon/
- Procedures to combine with facelift: https://www.drjeremyhunt.com.au/blogs/procedures-to-combine-with-facelift/
- Facelift risks and complications, an honest surgeon’s guide: https://www.drjeremyhunt.com.au/blogs/facelift-risks-and-complications-honest-guide/
Medical References
- Australian and New Zealand College of Anaesthetists (ANZCA), patient information: https://www.anzca.edu.au/patient-information
- AHPRA cosmetic surgery hub and guidelines: https://www.ahpra.gov.au/Resources/Cosmetic-surgery-hub.aspx
- Therapeutic Goods Administration (TGA), cosmetic surgery hub: https://www.tga.gov.au/cosmetic-surgery-hub
- HealthDirect Australia, having an anaesthetic: https://www.healthdirect.gov.au/anaesthesia
- Cleveland Clinic, general anaesthesia overview: https://my.clevelandclinic.org/health/treatments/15788-general-anesthesia
- Cleveland Clinic, IV (twilight) sedation: https://my.clevelandclinic.org/health/treatments/24443-iv-sedation