About five years ago, Olivia Goldsmith, the author of 'The First Wives Club', went in to have a facelift with a very prominent surgeon in Manhattan," he explains. "As soon as they started anesthesia, she died. The surgeon didn't even get a chance to walk into the operating room. The week after that, in the same hospital, it happened again. It was a coincidence, but it created a major scare. People were calling and canceling their procedures. I had heard about a doctor in California doing liposuction without anesthesia. I started scaling down my anesthesia. Later, I came out to California to learn from the doctor and his technique, and I applied it to the face."

Not having to put a patient under full anesthesia has many benefits, Simoni explains. Patients with heart disease,

diabetes or smokers who would have been considered high-risk candidates for anesthesia can undergo the procedure without fear of complications. And, with the use of just local anesthesia, a patient suffers less bruising and swelling. Because anesthesia increases bleeding, swelling is stimulated as the patient bruises and bleeds underneath the skin. "If you use anesthesia, it will double up the recovery time of the swelling and bruises," Simoni says. Simoni also notes that the timing of the "wide awake" facelift plays a big role in the recovery process. "I can do the same thing that I used to do in five or six hours in one hour," he says. "When the face is open for five or six hours, which is how long it will take for the average facelift, that will increase the swelling and bruising. Now, I’m doing it in an hour, the swelling is significantly reduced, and patients can go back to work in four to six days as opposed to two weeks or three weeks."

While the prospect of having a facelift without being put completely under seems daunting, Simoni says his methods for numbing the face make the procedure about as painful as dental cleaning. "There is a technique to numbing the face that will make sure that the patients do not feel pain," says Simoni, who estimates he does one or two procedures a day, while most cosmetic surgeons only do this type of procedure once or twice a month. "That’s the major selling point of the whole procedure."

Wile the anesthesia may be limited to local, that doesn't limit what Simoni can do for a patient's face. "I can do the full-blown facelift," he says. "It took about five years to perfect this method, but I can do everything – including brow, neck and eyes."

Even during these recessionary times, Simoni says he has seen an increase in facelift patients, which he attributes to individuals wanting to have an edge in today’s job marketplace. According to a recent study by The American Society of Plastic Surgeons, Simoni is right. The ASPS found that 73 percent of the women (ages 18 to 64 they surveyed said they believed that appearance and youthful looks play a part in getting hired, getting a promotion or getting new client. While 3 percent admitted they had already had a cosmetic procedure to increase their perceived value in the workplace, 13 percent said they would consider undergoing a cosmetic medical procedure to boost their confidence and make them feel more competitive in today’s rough job market.

"As the economy is getting worse and the recession is still hanging around our heads, a lot of people are finding that their job is in jeopardy or they’ve lost their job and have to compete with people who have the same skills or even more," explains Simoni. "It’s kind of an untold assumption that if you have two people with the same qualities, the person who looks more youthful and less tired is usually going to get the job. People are realizing that they have to not only rely on their skills but on their looks and a youthful appearance. It’s very difficult to go to an interview and look tired, because it doesn’t make an impression, and people only have 10 to 15 minutes to make an impression, and they want to leave the right impression."

Simoni also points out that because the downtime for a "wide awake" facelift is less, it may be a more attractive option for individuals considering a cosmetic procedure. "Maybe they cannot take two or three weeks off without putting their job at jeopardy," says Simoni. "Employers are more trigger-happy and are quicker to replace a person who is gone for two or three weeks. Using this ‘wide awake’ technique, people can go back to work in four to seven days, so the amount of time they have to take off is not as much, and it’s easier for people to do something about looking better."

And, finally, the price tag on a "wide awake" facelift can be up to $6,000 less, as patients don’t have to pay for the anesthesiologist or a post-op nurse.

From start to finish, this recessionary facelift process can take as little as a week. Potential patients come in to meet with the doctor to discuss their needs. "We have a consideration and go over the things they want and the things I think would be appropriate for them to have," explains Simoni, who estimates that 60 to 70 percent of his business comes from the "wide awake" facelift. "Most people don’t need a lot of pre-operative blood work, because going under local is just like going to the dentist."

On the day of the procedure, patients arrive at Simoni’s office and are given an antibiotic and some relaxing medication, then they lie on the bed in the operating room and listen to music. "My operating room is very softly furnished and doesn’t look like an operating room, so it doesn’t create the anxiety, because once a person starts feeling anxiety, they start feeling more pain," explains Simoni. The doctor notes that he has made an effort to hide away most of his medical equipment, and he uses the smallest needles on the market when he begins the process of numbing the face.

"Once the face is numb, we start doing the procedure," explains Simoni. "We lift up the skin and the muscle and fat underneath and put them up where they used to be 10 or 15 years ago. The patient is sitting up during the procedure so I can see the face in its natural position. When the patient sits up, you see those lines and abnormalities on the face, and you don’t have to guess. That’s why it looks natural. Then I trim the skin and I close."

Simoni does one side of the face at a time, and when he is finished, he says it’s not necessary for the patient to spend hours in recovery,. They can go home and relax. The next day, he says patients can put their hair around their ears and go out. Then, they return to his office in seven days to have their stitches removed, and the process is complete.

Simoni estimates that about 70 percent of his clients are women between the ages of 40 to 80, but he is quick to point out that he’s seen a rise in male clients and predicts that the number of men seeking cosmetic improvements will increase in upcoming years.

As for the future of cosmetic surgery, Simoni believes laser technology will improve greatly in the next couple of years. While minimally invasive laser surgeries have been a popular request in the industry, he says patients are often dissatisfied with the results. "I think we will have some more laser treatments in the future that will be better than today’s technology, because today’s technology is really not there," he says. And, as the technologies improvise, the possibilities for a renewed, youthful appearance will only continue to become less complicated.