Thread Lift Anesthesia: Is General Sedation Really Necessary? Pain and Safety Guide

For thread lifting anesthesia, the standard is usually a combination of topical anesthesia (numbing cream) and local infiltration anesthesia (lidocaine injection). This sequence involves applying a cream on the skin first to reduce the sting of the needle prick, and then injecting lidocaine over that to numb the sensation all the way to the layer where the thread passes through. Sedation anesthesia is not mandatory, but an optional choice.

Many people think "you have to undergo sedation anesthesia for it to be painless and safe," but that is not necessarily true. Since thread lifting requires a shallow insertion depth and the procedure time is usually only about 20 to 60 minutes, local anesthesia alone is often sufficient. In fact, sedation anesthesia carries burdens such as respiratory depression, fasting, and recovery time. Therefore, what is important is not 'which anesthesia is stronger,' but choosing an anesthesia that fits my procedure scope and physical condition.

💉 Thread Lifting Anesthesia, How is the Basic Procedure Performed?

The primary anesthesia for thread lifting is local infiltration anesthesia. This is a method where an anesthetic is injected under the skin of the procedure area to block sensation in that spot only. On top of this, topical anesthesia cream is used as an aid to reduce the sting before the injection.

Topical anesthesia creams (such as EMLA) are products containing a mixture of lidocaine and prilocaine, and must be applied 20 to 60 minutes before the procedure to be effective. However, even if applied for 60 minutes, the anesthesia only reaches a depth of about 3 mm, so it is difficult for a cream alone to prevent the pain of the thread entering under the skin. The cream acts merely as a guide to reduce injection pain.

The core medication is **Lidocaine**. Its onset is fast, taking 1 to 5 minutes, and its effect is maintained for about 30 to 60 minutes when used alone. If threads are placed extensively, a long-lasting **bupivacaine (approx. 3 to 8 hours)** may be used in combination, or nerve block anesthesia, which blocks the pathways of nerves, may be used as an aid.

📌 Key Summary: The standard for thread lifting anesthesia is the combination of 'topical anesthesia cream + lidocaine local infiltration anesthesia,' and the cream alone is insufficient for blocking pain.

😴 Sedation Anesthesia, Is It Absolutely Necessary?

To start with the conclusion, sedation anesthesia is not mandatory. This refers to 'conscious sedation' where propofol or midazolam is administered intravenously to cloud consciousness, but for procedures like thread lifting that are not wide in scope, local anesthesia alone is fully tolerable.

Staying awake under local anesthesia also has its advantages. Since you can communicate with the doctor during the procedure, you can check the pulling sensation and the naturalness of your facial expressions, allowing the results to be refined more delicately. Such feedback is impossible while asleep.

If you choose sedation anesthesia, there are many conditions to follow. Since propofol can suppress breathing, oxygen saturation monitoring is essential, and fasting beforehand must also be observed. According to ASA (American Society of Anesthesiologists) standards, fasting is recommended for at least 2 hours for clear liquids, 6 hours for light meals or milk, and 8 hours or more for fatty meals or meat.

After sedation anesthesia, driving on the same day is prohibited, and being accompanied by a guardian is recommended. This is because your judgment and reaction speed remain degraded for some time.

📌 Key Summary: Sedation anesthesia is not 'a safer choice' but 'an option with a greater burden.' Decide upon consultation with your medical staff based on the scope of the procedure and your level of anxiety.

📏 Lidocaine, How Much is Safe to Use?

Even anesthetics become toxic if excessive. Therefore, calculating the dosage is crucial. The maximum allowable dosage of lidocaine is considered to be about 4.5 mg/kg (up to 300 mg) without epinephrine, and about 7 mg/kg (up to 500 mg) with epinephrine (this may vary by guidelines).

Concentration calculation must also be examined together. 1% lidocaine is 10 mg per 1 mL, and 2% is 20 mg per 1 mL. For example, if you use 10 mL of 1% lidocaine, it means 100 mg is administered. You must consider both concentration and total volume to prevent overdose.

This is where **Epinephrine** frequently comes into play. It constricts blood vessels to reduce bleeding and extends the anesthetic effect up to 2 to 6 hours. However, caution is required for patients with uncontrolled hypertension, severe arrhythmia, angina or recent myocardial infarction, hyperthyroidism, and those taking certain antidepressants. This is because it can place a burden on the cardiovascular system.

There are also ways to reduce the pain of the injection itself. Warming the anesthetic close to body temperature before use, injecting slowly with a thin needle, or mixing lidocaine with sodium bicarbonate to ease the acidity are such techniques. This attention to detail makes a noticeable difference in the pain experienced.

📌 Key Summary: Lidocaine must be calculated by both concentration and total volume to avoid overdose, and combined use with epinephrine requires caution in patients with cardiovascular diseases.

⚠️ Anesthesia Side Effects and Emergency Situations, What Should You Know?

Although rare, a risk that you must be aware of is **Local Anesthetic Systemic Toxicity (LAST)**. It occurs when anesthetics are excessively absorbed into the bloodstream, and its initial signs are quite characteristic.

• Numbness around the mouth, metallic taste

• Tinnitus, dizziness

• Unexplained feeling of anxiety

• If it worsens, it can progress from convulsions to arrhythmia and cardiac arrest

If you experience these sensations, do not hold back and must notify the medical staff immediately. In a LAST situation, the administration of the antidote treatment Lipid Emulsion is required, so it is safe to receive procedures at a facility where such emergency medications are stocked.

Meanwhile, there are many who wonder, "Am I allergic to anesthesia?" due to heart palpitations or dizziness after anesthesia, but a true allergy to amide-type lidocaine is extremely rare. If your heart palpitated during dental anesthesia in the past, it was likely an epinephrine reaction, or vasovagal syncope or an anxiety attack caused by a fear of needles. Differentiating this from a true allergy is important, so please describe your past reactions in detail.

There are things you must disclose before the procedure. Anticoagulants and antiplatelet agents such as aspirin, warfarin, and clopidogrel increase the risk of bleeding and hematomas, and allergy history and past reactions to anesthesia are also crucial information that can alter the anesthesia plan.

If the following symptoms appear after the procedure, do not delay and contact the clinic immediately.

• Difficulty breathing or a feeling of chest tightness

• Numbness around the mouth, metallic taste, or convulsions

• Uncontrolled bleeding or rapidly enlarging bruising

• Severe swelling on one side only, with pain that does not subside

• Fever, pus, or spreading redness (signs of infection)

• Prolonged numbness (sensory abnormality)

📌 Key Summary: Initial LAST signs such as numbness around the mouth and metallic taste, as well as symptoms of infection and bleeding, must be reported to the medical staff immediately.

🏥 Anesthetic Environment, Why Does Where You Receive It Matter?

If you choose sedation anesthesia, the key is whether there is personnel dedicated to anesthesia to monitor the patient's condition. According to data, out of 2,777 plastic surgery and dermatology clinics in Korea, only 84 clinics (about 3%) have dedicated anesthesia personnel on duty (as of July 2026).

What this number tells us is clear. If you are receiving sedation anesthesia, it is recommended to check beforehand whether there is someone dedicated to monitoring respiration and vital signs during sedation, and whether emergency medications and equipment are prepared.

Thinking conversely, this also means there is no need to unnecessarily change a procedure that is perfectly fine under local anesthesia into sedation anesthesia. For procedures with limited insertion depth and scope like thread lifting, approaching them primarily with local anesthesia is the way to reduce the burden.

Onlif Clinic aims for non-surgical lifting from a dermatological perspective. In procedures including thread lifting, ultrasound HIFU, high-frequency RF, and All-tight lifting, we handle the skin concerns of sagging and loss of elasticity in a direction of 'clearing away without changing' the face. Operating a system of doctor specialties, where each doctor takes charge of the procedure they perform best in their respective field, also shares this context.

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📌 Key Summary: It is wise to undergo sedation anesthesia in an environment equipped with dedicated monitoring personnel and emergency preparedness, and to avoid changing procedures that are sufficient under local anesthesia to an excessively deep anesthesia.

❓ Frequently Asked Questions

What kind of anesthesia is used for thread lifting? Is local anesthesia alone sufficient?

The combination of topical anesthesia cream and lidocaine local infiltration anesthesia is the standard. Since thread lifting has a shallow insertion depth and takes about 20 to 60 minutes, local anesthesia is sufficient for most cases. If the scope is wide, nerve blocks or long-lasting anesthetics may be used in combination.

Is thread lifting painless if I only apply numbing cream?

The cream alone is insufficient. Even if applied for 60 minutes, it is only effective up to a depth of about 3 mm, failing to block the pain of the thread passing under the skin. The cream plays an auxiliary role in reducing injection pain, while the actual pain blocking is handled by the lidocaine injection.

Is sedation anesthesia safer than local anesthesia?

No, it is not. Sedation anesthesia carries additional burdens such as the risk of respiratory depression, fasting, and recovery time. Local anesthesia also has the advantage of allowing communication during the procedure so the results can be delicately refined. 'Stronger' does not mean 'safer.'

How much fasting is required before sedation anesthesia?

Based on ASA standards, fasting is recommended for at least 2 hours for clear liquids, 6 hours for light meals or milk, and 8 hours or more for fatty meals or meat. If fasting is not observed, the risk of aspiration during sedation increases, so be sure to keep the instructed time.

If I have hypertension or heart disease, will there be problems with anesthesia?

Anesthetics mixed with epinephrine constrict blood vessels and can place a burden on the cardiovascular system. If you have uncontrolled hypertension, severe arrhythmia, angina, recent myocardial infarction, or hyperthyroidism, you must notify us in advance so that the type of anesthetic can be adjusted.

My heart palpitated during past dental anesthesia, is it an anesthesia allergy?

It is unlikely to be an allergy. A true allergy to lidocaine is extremely rare, and palpitations are usually an epinephrine reaction or vasovagal syncope due to fear of needles. Describing the situation at that time in detail helps with differentiation.

What should I do if I feel dizzy or experience numbness around my mouth during anesthesia?

You must notify the medical staff immediately. Numbness around the mouth, a metallic taste, and tinnitus can be early signs of Local Anesthetic Systemic Toxicity (LAST). If stopped and managed early, it is mostly handled safely, so do not hold back.

Can I drive immediately after local anesthesia?

If you received local anesthesia only, you can generally return to daily life and drive. However, if you received sedation anesthesia, driving on that day is prohibited as your judgment and reactions are degraded, and we recommend being accompanied by a guardian.

Does the anesthesia method change depending on the type of thread?

It can change. The required amount of anesthesia and the level of pain differ depending on the thickness, barbs, and insertion depth of the thread. In cases of extensive placement, nerve blocks or long-lasting anesthetics may be combined, so it is recommended to discuss anesthesia according to the treatment plan.

Thread Lifting Anesthesia, Good Things to Check Before Choosing a Clinic

Even for the same procedure, the results and recovery process vary depending on where, by whom, and how it is performed. Directly asking the items below during consultation will help you make a decision.

• Is it a place that performs that procedure frequently? — Every clinic has different procedures they focus on. Check if it is a place that regularly conducts thread lifting anesthesia.

• Can I verify the products and equipment used? — Ask if you can verify the product name and genuineness (whether it is an officially imported product and if there is a process to confirm its unboxing) during the consultation.

• Do they explain the breakdown of the cost? — Rather than just hearing the total amount, you should hear explanations about what product is used, how much, and on which areas to make a proper judgment.

• Do they design after looking at the entire face? — Even for the same procedure, the placement location and amount vary depending on face shape, skin condition, and left-right asymmetry.

• Do they explain adverse reactions and the recovery process first? — It is easier to make a judgment at a place that informs you of possible adverse reactions and coping methods together, rather than a consultation that only speaks of expected changes.

• Is there a way to follow up after the procedure? — Check if the timing for checking progress, the contact method when there is an issue, and the criteria for revisiting are established.

Onlif Clinic Performs Thread Lifting Anesthesia This Way

• We divide responsibilities — With the belief that a single doctor cannot handle all procedures, Onlif divides and assigns responsible doctors by field for medical treatments.

• We check products and equipment together during consultation — We guide you through the products used and the unboxing verification process during the consultation phase.

• Costs are guided along with the breakdown after diagnosis — Since the areas, volume, and scope differ for each person, we explain what costs how much together.

• We design by looking at the balance of the entire face — We view the face through three axes—texture, balance, and signals of youth—and set a plan in a direction of cleaning up parts that cover your inherent impression rather than changing its shape.

• We discuss adverse reactions and the recovery process first — Along with the changes that can be expected, we guide you through individual differences, possible adverse reactions, and coping methods before the procedure.

• We check the progress after the procedure together — If checking is needed during the recovery period, we guide you through the return visits and contact channels.

If you are considering thread lifting anesthesia, it is best to first check what is possible and what is difficult under your current condition. An accurate diagnosis and procedure plan can only be determined through an in-person consultation. Come check it out through a consultation at Gangnam Onlif Clinic.