Office-based facial plastic surgery involves a wide array of procedures from esthetic surgeries such as facelifting and blepharoplasty to reconstructive procedures including scar revision and local tissue flaps. The cornerstone to a successful outcome is a thorough history and physical examination with an emphasis on assessment of a patient’s ability to tolerate an office-based procedure. Room set-up, equipment, and personnel play an especially important role in these procedures. Anesthetic considerations as well as a heightened attention to safety are paramount in ensuring an excellent patient experience and an optimal result.