At a glance
For my hospital-based facelift procedures, I use total intravenous general anesthesia, or TIVA, with propofol and remifentanil. TIVA describes how general anesthesia is maintained; it does not mean light sedation or eliminate the need for an anesthesiologist. Your medical history, medications, and proposed operation belong in an individual assessment. If you are traveling to Brazil, I want those conversations to begin before your flight, with the necessary in-person evaluation completed before surgery.
The accompanying image is an AI-generated illustration. It does not depict a patient, our hospital, or a treatment result.
Begin with the concern behind the question
When someone asks which anesthesia I use, the question may be about much more than a drug. You might be worried about being awake, losing control, feeling nauseated afterward, or having another experience like one you remember from a previous operation. I would rather understand that concern than offer a reassuring phrase that leaves the real question unanswered.
Tell me what you are afraid of, even if you do not know the medical terminology. If you remember being told that something went wrong, bring the report when available. If you only remember feeling unwell, describe that experience without needing to decide what caused it. I do not expect you to diagnose an anesthetic reaction yourself.
This article explains the vocabulary and the conversations I consider useful. My deep plane facelift guide addresses the operation and its goals. Neither page replaces the anesthesiologist’s assessment or the instructions prepared for you.
Four terms that describe different things
Local anesthesia
Local anesthesia acts in a particular area. The term alone does not describe whether you will also receive sedation or general anesthesia. When reviewing a proposed treatment, I suggest asking about the complete plan rather than drawing conclusions from one component mentioned in a description.1
Sedation
Sedation can involve different depths of altered consciousness. Deep sedation may require help with breathing or the airway, and a person can become more deeply sedated than intended. The American Society of Anesthesiologists emphasizes the need to recognize and manage that possibility.2
Total intravenous anesthesia
TIVA is a method of maintaining general anesthesia using intravenous medication instead of inhaled anesthetic agents. In my practice, the medications used are propofol and remifentanil. The anesthesiologist determines the individual anesthetic management; knowing these names is not an instruction to select medications or doses.3
Why I avoid ranking anesthesia by its name
Words such as “light,” “gentle,” and “modern” can sound attractive without explaining what will actually happen. I want you to understand the level of anesthesia planned, who is responsible for it, and how your health has been considered. A shorter or more appealing label cannot answer those questions.
I also cannot evaluate another team’s care from an advertisement. Different operations and individual circumstances can lead to different plans. What matters in our conversation is whether you understand the proposal for your own surgery, including its limits, and have had the opportunity to discuss concerns with the anesthesiologist.
If you strongly prefer to avoid general anesthesia, say so before making arrangements. I use TIVA for my hospital facelift procedures. Explaining that clearly allows you to consider the proposed care without feeling that you learned something important only after committing to travel.
What research can tell us about nausea
A 2018 systematic review included 229 randomized trials involving 20,991 participants and compared propofol-based maintenance with inhaled anesthesia. Nausea and vomiting were less frequent in the propofol groups.3
I interpret that result narrowly. The review covered different operations and populations, with a literature search ending in 2016. It does not establish that TIVA is superior for every outcome in deep plane facelift surgery. Some authors disclosed industry relationships. Most importantly, a group-level finding cannot promise how you will feel when you wake up.
I use this evidence to support an informed discussion, not to advertise a nausea-free recovery. Tell the anesthesiologist about previous postoperative nausea so that it can be considered in your individual plan.
Prepare a history, not just a folder of normal tests
Before we meet, I suggest making a concise account of your health and previous procedures. Include what you take regularly and occasionally, and keep the actual medication names rather than relying only on descriptions such as “my blood pressure pill.” An accurate list gives the team something specific to review.
If you have medical records from your country, ask our team which documents are needed and how to provide them. I would rather resolve an unclear medication name or incomplete report during planning than discover the missing information after you arrive. Do not assume that a familiar brand name will be immediately recognizable in another country.
I also want to know about changes after the initial consultation. Starting a treatment, becoming unwell, or receiving new advice from another doctor should reopen the conversation. A scheduled date does not make that information less important. If two sets of instructions conflict, ask the responsible clinicians to clarify them rather than choosing on your own.
Make medication and fasting instructions easy to follow
For surgery with our team, we ask patients to stop GLP-1 medications three weeks before the operation. This is our practice protocol, not a universal interval for every surgical patient. Coordinate the pause with our anesthesiologist and the clinician who prescribes your medication, particularly if you have diabetes, so that blood glucose management is planned. Confirm when to restart treatment as well. Your fasting instructions are provided individually.
Before the procedure, ask for clarification whenever an instruction is ambiguous. Which medicine does it refer to? Does the instruction apply on the day of surgery or earlier? Who should you contact if you are unsure? I prefer a question asked twice to a misunderstanding discovered at admission.
For visitors from another country, write the agreed instructions using the local date and time for your surgery in Brazil. This is a practical way to avoid confusing travel times with appointment times. If you have not followed an instruction, tell the team accurately; concealing it prevents an informed decision about the next step.
Include the whole surgical plan in the discussion
My facelift planning may include treatment of the neck, eyelids, or facial volume when appropriate. I want the anesthetic assessment to reflect what we have actually agreed to do, rather than a simplified label that leaves part of the procedure out.
A combined plan is not automatically the right plan. During consultation, I explain why I propose each component and which concerns it addresses. If you are undecided about an additional procedure, bring that uncertainty into the discussion before admission. Your understanding and consent need to match the final plan.
It can help to describe the plan back in your own words. You do not need to remember every anatomical term. I want to hear that you understand the areas being treated, what we are trying to improve, and what remains outside the operation’s scope.
Traveling to Brazil: separate logistics from medical readiness
Our first conversation can happen while you are still abroad. A video consultation helps us discuss your goals and organize the information needed, but it does not replace the in-person assessment before surgery. Travel arrangements should support that sequence rather than pressure us to bypass it.
My usual planning request is to arrive two days before surgery. The day-before appointment includes the in-person consultation and photographs. These are my scheduling arrangements, not a promise that every patient who arrives will automatically be cleared for the operation. A new concern may require further evaluation or a change of plan.
I also ask you to plan for postoperative care in Londrina: at least 12 days after surgery, preferably 14 when possible. That time relates to surgical follow-up and suture removal; it is not an automatic fitness-to-fly certificate. Discuss your itinerary with us and avoid treating an airline booking as a medical deadline.
Bruna can help coordinate the consultation and practical questions from abroad. Questions about suitability, medication, anesthesia, or a change in your health need clinical assessment. Keeping those responsibilities clear makes the preparation easier to understand.
Waking up is one stage of recovery
After surgery, the immediate recovery period is supervised. Being awake is not the same as being ready to leave the hospital. The team assesses your condition and explains the next steps.1
I distinguish recovery from anesthesia from recovery of the operated tissues. Feeling alert does not remove the need for follow-up, and a comfortable awakening does not tell us that healing is complete. My patient journey explains the broader sequence of care.
If something feels different from what you expected, describe it to the team. You do not have to decide whether a symptom belongs to anesthesia or surgery before asking for help. Likewise, do not add medicines on your own to manage discomfort or nausea. Ask for instructions that fit the plan already prepared for you.
Questions worth bringing to your assessment
- What does the proposed anesthetic plan involve for my operation?
- Which details of my history should we clarify before I travel?
- Do you need records from a previous anesthetic or from my current doctors?
- Where will I find my individual medication and fasting instructions?
- Who should I contact if my health or treatment changes before surgery?
- What should I expect immediately afterward, and what determines discharge?
I recommend keeping the answers with your preparation documents. This is not a test of how much medical vocabulary you can remember. A useful consultation leaves you knowing what to do next, which questions remain open, and whom to contact for the right kind of help.
Frequently asked questions
Is TIVA the same as sedation?
No. In the facelift care described here, TIVA is a way of maintaining general anesthesia. Receiving medication through a vein does not, by itself, tell you whether the intended state is sedation or general anesthesia.23
Can I request a different anesthetic?
You can discuss preferences and concerns. That discussion does not make an alternative suitable automatically. I want you to understand that my hospital facelift practice uses total intravenous general anesthesia and to speak with the anesthesiologist before deciding to proceed.
Does a previous difficult experience rule out surgery?
I cannot answer from that description alone. We need to understand what happened and review your current health. Bring any available documentation; neither dismiss the experience nor assume it establishes an allergy without assessment.
Will the online consultation settle every anesthetic question?
No. It can help us organize the initial conversation and identify information to collect, but it does not replace the necessary anesthetic and in-person assessments. I do not consider a video call or a travel booking to be medical clearance.
Bring the question that matters to you
If anesthesia is the part of a facelift that concerns you most, make it part of our first conversation. You can contact Bruna to arrange a consultation from abroad and explain what you would like us to address. My aim is for you to understand the plan before making a decision, including the questions that require an anesthesiologist’s individual advice.
References
- Royal College of Anaesthetists. You and your anaesthetic. Patient information. Accessed October 3, 2026.
- American Society of Anesthesiologists. Statement on Continuum of Depth of Sedation: Definition of General Anesthesia and Levels of Sedation/Analgesia. Updated October 23, 2024.
- Schraag S, Pradelli L, Alsaleh AJO, et al. Propofol vs. inhalational agents to maintain general anaesthesia in ambulatory and in-patient surgery: a systematic review and meta-analysis. BMC Anesthesiology. 2018;18:162. doi:10.1186/s12871-018-0632-3.