Evaluating the Time of Maximal Vasoconstrictive Effect of Epinephrine in Facelift Surgery

Abstract Background It remains unclear how long a plastic surgeon should wait for the optimal vasoconstrictive effect of epinephrine as local anesthetic before incision for aesthetic facial surgery. Objectives In this study we investigate the optimal timing for epinephrine-induced vasoconstriction in facelift procedures by measuring cheek skin temperature changes with forward-looking infrared thermography (FLIR). Methods A retrospective chart review was conducted on all patients who underwent facelift surgery by J.E.Z. between July 2023 and June 2024. Skin surface temperature was recorded at baseline and at predetermined time points up to 15 minutes following injection of the standardized epinephrine-containing local anesthetic solution. Additional patient data were obtained from electronic medical record review. Results Twenty-seven patients were included in the study. The median time for each patient to reach the lowest recorded cheek temperature was 5 minutes postinjection (mean 5.1 ± 2.9 minutes). Injected cheeks exhibited the largest median temperature decrease of 2.3°C at 7 minutes, followed by gradual rewarming to baseline. Uninjected nasal skin warmed steadily throughout the observation period. Of the 27 patients, 15 (55.6%) reached their minimum cheek temperature by 5 minutes, 23 (85.2%) by 7 minutes, and all 27 (100%) by 11 minutes. Conclusions These findings demonstrate that the maximal vasoconstrictive effect of epinephrine in facelift surgery occurs approximately 5 to 7 minutes after injection. We recommend that facelift surgeons wait 5 to 7 minutes before initiating incisions and dissection to balance optimal hemostasis with procedural efficiency. Level of Evidence: 4 (Therapeutic)