Most Facial Plastic surgery requires an anaesthetic for your comfort. The safety of your anaesthesia is paramount and Mr Grover works with a regular Anaesthetist, Dr Raman Verma who holds an NHS Consultant appointment at University College Hospital and is a Tutor for the Royal College of Anaesthetists. He has worked in Private practice with Rajiv at The King Edward VII Hospital and The London Clinic for over 20 years. Dr Verma is a specialist in techniques for Facial Plastic Surgery. As an indication of his trust, Mr Grover has personally requested that Dr Verma put him to sleep when he underwent surgery to his elbow for a sporting injury in 2006. Dr Verma is a professional that Rajiv trusts totally, and you can be reassured he will take excellent care of you as a patient just as he did for him. There is no doubt that focus is essential when performing facelift surgery. Mr Grover has a regular team in the operating theatre assisting him and the Anaesthetist. He has worked with this nursing team for over 15 years. They fully understand everything Mr Grover is doing and exactly how he likes it done. This allows Rajiv to make you the centre of his full attention.

What type of anaesthetic is used?

Facelift surgery is carried out by Mr Grover under TIVA (Total IntraVenous Anaesthesia) which is halfway between “Local anaesthesia with sedation” and full “general anaesthetic”. It is if you like, a light form of general anaesthesia, so you sleep through the whole procedure but for safety there is complete control of your airway. It combines a quick recovery with patients usually sitting up, chatting, and enjoying dinner approximately 2 hours after the operation but with the added safety of protecting your airway whilst you are asleep which local anaesthetic with sedation does not. It provides the great benefit that your blood pressure can be very carefully controlled (much more so than local anaesthetic with sedation) and also your carbon dioxide level during surgery can be reduced. Controlling these two factors significantly reduces your bruising and swelling following surgery and accelerates recovery. Mr Grover has personally researched this aspect of facelifting and published scientific papers both in the UK and USA documenting how these effects can improve outcome and safety. He therefore uses TIVA light general anaesthetic as an evidence based choice.

Rajiv has published evidence documenting the advantage of general anaesthetic (especially TIVA) in accelerating recovery after facelift surgery.

What happens when you are taken to the operating theatre?

Most people choose to have an anaesthetic administered by an injection, however if you have a fear of needles occasionally other techniques can be employed. The anaesthetic will drift you off to sleep in a few seconds. The first thing you are likely to remember is waking up in the recovery room. Here you will be looked after until it is safe for you to return to the ward. The anaesthetic team are there to make it as safe and comfortable as possible.

Are general anaesthetics safe?

Although any operation and anaesthetic carries a slight risk, if you are generally healthy this risk is very low indeed. A study performed by The Royal College of Anaesthetists looking at operations in the United Kingdom found serious problems due to elective anaesthesia occurred in only 4 in every million anaesthetics given. To put this in perspective you are many times more likely to have a car accident on the way to the hospital than have a significant problem with the anaesthetic. The Department of Transport estimates the risk of a major injury driving on the motorway from London to Birmingham to be 24 in every million journeys (i.e. many times greater than the risk of having an elective anaesthetic).

The London Clinic has a specialist centre for Plastic Surgery and has facilities in general equivalent to a Teaching Hopsital

Will I need any tests?

Your package at the Hospital includes, in the week preceding admission, a full medical check with blood tests and an ECG for your safety. Prior to your admission the results of these tests are sent to Mr Grover’s Anaesthetist so that he is aware of your medical status before he sees you on the day of surgery.

The pre-admission department carries out a medical check with blood tests and ECG before your admission.

When should I stop eating or drinking before my operation?

Do not eat or drink anything for 8 hours before your planned facelift procedure. This usually means coming to hospital on the morning of surgery having had nothing to eat or drink from midnight before. On the day before surgery, it is wise to be well hydrated so although you can’t eat or drink after midnight prior to surgery, please drink 2-3 litres of water on the day before.

Should I continue my prescribed medication?

Yes, it is important to continue with most medications up to and including the day of surgery. The important exceptions are Aspirin, which must be stopped at least 14 days before surgery to reduce the risk of bleeding. Other drugs such as Non-steroidal anti-inflammatory drugs (e.g. Brufen, Neurofen and Voltarol) along with all vitamins and supplements should also be stopped two weeks before surgery as they all have some blood thinning effect. Mr Grover and his team will be very specific in the lead up to surgery instructing you exactly what to take, and what to avoid before surgery.

If I have had a cold recently, will I be able to have surgery?

Providing you are not feeling unwell and have no productive cough there is usually no cause for concern. If you suffer from chest problems, such as asthma or bronchitis you must discuss this with the team before your operation, ideally before coming to hospital. Ultimately it is the Consultant Anaesthetist, Dr Verma, who will make the decision and he will always put your safety and health before anything else.

I have crowns/ a bridge/ a veneer. Will this be a problem?

Please tell the Anaesthetist about any loose teeth, crowns, bridges, veneers, or dentures. Special instruments used to place breathing tubes can occasionally press on teeth and so extreme care will be taken with loose teeth or crowns. We appreciate how important teeth and dental implants are to you so all the staff will take special care when looking after you.


Will I feel sick after the anaesthetic?

If you have been sick with a previous anaesthetic, please advise the Anaesthetist Dr Verma as specific medications can be given to prevent or reduce the risk of this. The use of TIVA anaesthetic is especially designed to have the lowest rate of nausea, but it can be further tailored to reduce the chance of sickness if you are prone to this.