Awake Facelift in Toronto: How Real-Time Patient Feedback Leads to Better Results

Written By

Dr. Martin Jugenburg, MD, FRCSC

Upload on

February 13, 2026

There is a moment during every awake facelift I perform at SixSurgery in Toronto where the advantage of the technique becomes obvious. I ask the patient to smile. Not after surgery. Not in a follow-up appointment. During the facelift itself, while I am actively repositioning tissue.

I watch how their face moves. I see where the skin falls naturally. I observe how their smile interacts with the work I have just done. And if something needs adjusting, I adjust it right there, in real time, on a face that is behaving exactly as it will behave in real life.

That is not possible during a traditional facelift under general anesthesia. And after performing over 16,500 procedures across almost twenty years, I can tell you that difference matters more than most patients realize when they start researching facelifts in Toronto.

What Is an Awake Facelift?

An awake facelift is a facelift performed under local anesthesia with mild sedation, rather than general anesthesia. The patient remains conscious throughout the entire procedure. The treatment area is completely numb, so there is no pain, but the patient can communicate with the surgeon, respond to instructions, and provide real-time feedback that directly influences the surgical result.

Most of my awake facelift patients in Toronto describe the experience as feeling like they have had a glass or two of wine. They are relaxed. They can talk to me. They can ask questions. And critically, they can follow simple instructions that directly improve their outcome.

For those that opt in and are great candidates for an awake facelift, we find the results are more precise, the recovery is faster, and it is safer.

The Problem With Performing a Facelift on a Sleeping Patient

This is something most patients considering a facelift in Toronto have never thought about, and it is one of the most important factors in facelift results.

When a patient is fully unconscious under general anesthesia, their facial muscles go completely limp. Their skin relaxes in a way it never does naturally. Gravity pulls differently when someone is lying flat and sedated compared to when they are upright and animated.

During a traditional facelift, the surgeon is making every aesthetic decision on a face that does not look the way it normally looks. The tissue is slack. The muscle tone is absent. The natural interplay between skin, muscle, and gravity is gone. The surgeon is estimating how everything will settle once the patient wakes up, sits upright, and starts moving their face again.

That estimation, no matter how experienced the surgeon, is never as accurate as direct observation. And that gap between estimation and observation is the core advantage of the awake facelift.

How Real-Time Feedback Works During an Awake Facelift

During an awake facelift at SixSurgery, I use a series of real-time feedback techniques that are simply impossible during a traditional facelift under general anesthesia.

I ask the patient to smile. This lets me see how the tissue I have just repositioned interacts with their natural facial movement. A facelift is not just about how a face looks at rest. It is about how a face looks when it is animated, expressive, and alive. If I can see the smile while I am still operating, I can make micro-adjustments that translate directly into a more natural result.

I ask the patient to turn their head. Symmetry is one of the most important elements of a successful facelift, and symmetry can only be properly assessed when facial muscles are engaged. A face under general anesthesia is symmetrically slack, which tells me nothing about how symmetrical the result will be once the patient is awake and moving. During an awake facelift, I can evaluate symmetry from multiple angles with the patient's muscles actively engaged.

I ask the patient to sit up. Gravity is a facelift surgeon's constant consideration. How tissue falls when a patient is lying flat on an operating table is fundamentally different from how it falls when they are standing in front of a mirror, which is where they will evaluate their results every day for the rest of their life. During an awake facelift, I can have the patient sit upright and see how my work looks under real gravitational conditions. During a traditional facelift, I am guessing.

These are not cosmetic extras. They are precision tools. Every one of those movements gives me clinical information that no surgeon performing a facelift under general anesthesia has access to, regardless of their skill or experience.

Why Awake Facelifts Produce Better Results

A facelift is about restoring natural, youthful positioning of facial tissue. The key word is natural.

Added precision. During an awake facelift, I can see how tissue behaves under real conditions, which means I can make better decisions in real time. A traditional facelift under general anesthesia does not give the surgeon access to this information.
Faster recovery. A traditional facelift requires the body to recover from two things simultaneously: the surgery and the systemic effects of general anesthesia. That means nausea, grogginess, fatigue, and a longer inflammatory response layered on top of surgical healing. An awake facelift eliminates that second recovery track entirely. The body only heals from the procedure itself. No anesthesia hangover. No systemic inflammatory response from intubation. Healing begins immediately.
Less downtime. My awake facelift patients in Toronto typically experience less bruising and less swelling and are comfortable in public within ten to fourteen days. Not because the surgery is less thorough, but because the body is not fighting anesthesia recovery on top of surgical recovery.
Less risk. The safety case is equally straightforward. General anesthesia introduces risks, including adverse reactions, respiratory depression, and intubation complications, that are entirely separate from surgical risk. They are statistically small. But for a cosmetic procedure that does not require general anesthesia, they are risks I see no reason to accept.

Not for Every Patient

I want to be direct about this. An awake facelift is not appropriate for everyone.

Some patients have anxiety levels that would make a conscious experience counterproductive. Some have medical conditions that make local anesthesia less suitable. At SixSurgery, every patient is evaluated individually. If general anesthesia is the safer or more appropriate choice, that is what I recommend.

Operating on an awake patient is also harder for the surgeon. It requires managing the patient's comfort, communication, and expectations in real time while performing technically demanding work. It demands a different skill set, a team built around the awake experience, and a level of confidence that only comes from thousands of procedures.

Any surgeon who tells you every facelift should be done awake is not being honest with you. Any surgeon who tells you no facelift can be done awake has not kept up with where the field has moved. The right answer depends on the patient.

See It for Yourself

I film my awake facelifts at SixSurgery because I believe patients deserve to see what the experience actually looks like before they make a decision. The footage shows patients who are calm, conversational, and visibly comfortable. It shows a collaborative process between surgeon and patient that is fundamentally different from the traditional model.

Watch awake facelift procedures performed by Dr. Jugenburg at SixSurgery:

If you are considering a facelift in Toronto and want to understand whether an awake facelift is right for you, I am happy to have that conversation. Book a consultation at www.sixsurgery.com.

About Dr. Martin Jugenburg (Dr. 6ix) Dr. Martin Jugenburg is a board-certified plastic and reconstructive surgeon, FRCSC, ASPS member, and founder of SixSurgery. He completed his fellowship at Memorial Sloan Kettering Cancer Center and has performed over 16,500 procedures across 20+ years, earning a 4.9-star rating from 336+ Google reviews and 4.8 stars from 892+ RealSelf reviews. He practises at SixSurgery locations in Toronto, Miami, Dubai, and Kuwait.

‍