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For better or worse, the advent of medicare in 1965, led to the death of many in office procedures. In fact, many insurance carriers from that point onwards demanded surgery be performed in an expensive hospital and operating room environment.

Recent economic events, specifically the banking crash related to sub-prime lending, the loss of retirement savings and the California specific 12% unemployment rate with 25% reduction from full the part time employment in the existing work force has led to a rethink in the way that cosmetic surgery should be performed.

Without a question the surgical facility and anesthesia fees have increased by over 20% in the last 3 years despite the economic downturn. Yet, fellow baby boomers want surgery in our look – good – feel – good generation. So in office self – pay procedures are staging a come back.

The question is, can an in office face lift be performed safely and comfortably under local anesthesia and without intravenous anesthesia? And the answer is absolutely yes! Why is this, simply stated, a facelift is a skin operation, in which the thin underlying facial musculature support and facial fat a made readily asensate during the procedure using a dilute subcutaneous anesthetic solution, called tumescent solution. The same anesthesia technique has been previously championed for in office liposuction and laser varicose veinous vein ablation.

In my office, the patients are operated on in the semi – sitting position, looking out the window: across the San Francisco Bay, listening to their favorite music and we make conversation, mean while the face is being operated on, the neck is defatted, the neck muscles corseted, the cheeks suspended, the facial muscle tightened and the excess skin removed through a small ‘S’ shaped, so – called ‘short scar technique’. What is remarkable, is how much happier patients feel and how well they look on their first post operative visit, 2 days after surgery, as compared to patients who have had 4 to 5 hours of general anesthesia. Not to mention, the cost for general anesthesia in a surgical facility more than doubled the overall cost for surgery.

I believe the modern and safe in office face lift supports the concept of “financial necessity is the mother of safe plastic surgical re – invention”.