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No General Anesthesia

Stay Awake Facelift: The Gerut Lift

Facelifts are more popular than ever. Nonetheless, more and more people balk at going under general anesthesia – even if they are finally getting that long-awaited facial rejuvenation. Experts say being under general anesthesia is fraught with risks – at worst, severe breathing problems can develop while many – if not all -- suffer nausea, vomiting and sluggishness afterwards. Some say the feeling is like being hit by a Mack Truck.

But Long Island, New York, plastic surgeon Zachary Gerut, M.D., wondered if he could skip the general while doing facelifts and use local anesthetics instead, allowing the patient to stay awake and enjoy a much kinder and gentler post-op experience. Dr. Gerut had observed that many liposuction patients remain awake during their procedures, so why couldn’t facelift patients also stay conscious?

One of the key techniques in the patient-friendly liposuction became what is known as “tumescent,” or “wet” liposuction. Surgeons overfilled the area to be suctioned with lidocaine, saline, epinephrine and Marcaine, a type of Novocain often used by dentists. The technique was known to reduce swelling and bruising by greatly reducing bleeding.

About ten years ago, Dr. Gerut began using the tumescent technique – little by little – on his facelift patients who were under general anesthesia or deep sedation. He gradually increased the amount of fluid injected into the face and became very comfortable operating on a face swelled two to three times its normal size. Currently, it takes about five to ten minutes to infuse the medications into a typical face. During those few minutes, the patient is deeply sedated so he or she feels no discomfort. Dr. Gerut says the most difficult part of his procedure was learning how to operate on a face swelled by so much fluid.

“Two and a half years ago, two M.D. sisters came in for a facelift,” Dr. Gerut says. “They knew all about general anesthesia and wanted none of it.”

So Dr. Gerut used the tumescent technique on both. Outcome? The physician sisters hopped off the table and sauntered as merrily out of the building as if they had been at a picnic. With two consecutive successes, Dr. Gerut realized the technique could be a fabulous new offering to people who want all the benefits of a full surgical facelift – but no general anesthesia. Since those two sisters, Dr. Gerut has refined the technique and added special instruments so that now, the vast majority of his patients return to their normal work or social schedule within three or four days.

“Patients today have busy lives,” Dr. Gerut says. “So the beauty of what is now known as ‘The Gerut Lift’ is the three days to recover from a full facelift.”

However, similar patients under general anesthesia can require one to three weeks before returning to normal activities.

Says Dr. Gerut: “While I perform the Gerut Lift,, patients can talk to me while I operate, they can request more or less anesthesia or valium or – like some – just get bored and naturally go to sleep while I operate.”

Even though general anesthesia and deep sedation are not used, an anesthesiologist attends each facelift, just in case a patient wants to go more deeply to sleep or if unexpected problems arise.

The actual facelift operation proceeds like any another. Another technique that makes the operation possible is speed. A Gerut Lift requires about 2.5 hours while many other full facelifts can take up to four hours or more.

“Afterwards, the typical patient leaves my surgical suite with stitches only – no dressing, gauze, ice masks, compression garments nor drains required,” says Dr. Gerut. “Many go out to dinner within 24 hours and report feeling fine.”

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