Benefits of the Awake Facelift

Most facelift patients expect to undergo general anesthesia in an operating room, then wake up hours later in recovery. At his practice in San Mateo, California, R. James Koch, MD, performs your facelift while you remain comfortably awake using twilight sedation and local anesthesia.

This method changes how your surgery feels and how your body responds to it.

How twilight sedation works

Twilight sedation keeps you relaxed and comfortable while remaining conscious. You receive oral medications to help you relax, followed by local anesthesia to numb the surgical area. 

Dr. Koch then uses a tumescent solution — a mixture of lidocaine, epinephrine, and saline — for additional numbing and to reduce bleeding.

You stay awake throughout the procedure but feel drowsy. Most patients can communicate with Dr. Koch when needed, but they remain relaxed during surgery.

Your body functions normally

General anesthesia requires mechanical ventilation because it suppresses your breathing. Blood pressure and heart rate fluctuate, and your circulation changes.

With twilight sedation, your breathing continues naturally. Your heart rate and blood pressure are fully monitored, and remain stable throughout the procedure.

Tumescent technique reduces bleeding

The tumescent solution Dr. Koch injects serves multiple purposes:

• Epinephrine constricts blood vessels to minimize bleeding
• Lidocaine provides extended pain relief that lasts for hours after surgery
• The solution separates tissue layers for cleaner surgical dissection
• Reduced bleeding leads to less bruising and swelling

This technique typically results in swelling and bruising that resolves within one week, compared to several weeks with traditional methods.

Faster immediate recovery

You avoid the grogginess and nausea that often follow general anesthesia. Instead of waking up disoriented in a recovery room, you feel alert immediately after surgery.

The absence of general anesthesia means no breathing tube, no mechanical ventilation, and no residual anesthetic drugs affecting your system for hours or days afterward.

Surgical quality remains the same

Dr. Koch performs his full vertical SMAS imbrication facelift technique using the awake facelift approach. That addresses the deeper muscle layers for long-lasting results that improve:

• Jowls and sagging along the jawline
• Loose neck skin and excess fat
• Marionette lines extending from the corners of your mouth
• Nasolabial folds (smile lines) through indirect lifting
• Overall cheek definition as the lower face becomes tighter and more symmetric

The awake method doesn’t limit the surgical technique; it only changes how you’re kept comfortable during the procedure.  

Furthermore, Awake Facelifts are more cost-effective than those performed under general anesthesia which requires an anesthesiologist. Also they can be performed in Dr. Koch’s procedure room as opposed to an ambulatory surgery center further reducing hospital fees.

Who benefits most from an awake facelift

The best candidates for this approach include:

• People comfortable with the sounds of surgery
• Patients who prefer staying aware during medical procedures
• Those with scheduling constraints who need faster same-day recovery
• Patients with sensitivities to general anesthesia 

Dr. Koch has trained more physicians in awake facelift techniques than any other surgeon in the country, so he can determine if this approach fits your specific situation and comfort level.

The awake facelift delivers the same surgical results as traditional techniques while offering specific advantages related to anesthesia and recovery. 

Contact us for an appointment today at 669-279-3663, text us, or schedule online at drkochfacialplasticsurgery.com to discuss whether an awake facelift is right for you.