I am a healthy female turning 60. I do have mitral valve regurgitation. I take no medicines other than bioidentical hormones. I exercise regularly, am not overweight, do not smoke, and drink at most two alcoholic beverages per month. I am considering doing cosmetic surgery (brow lift and partial neck lift). My concern is the plastic surgeon said the surgery could last up to 6 hours for both procedures. Also, he uses a nurse anesthetist without an anesthesiologist on site, although his office is extremely close to a hospital. He indicated she uses Propofol, Versed, and Fentanyl in local anesthesia. My question is, is 6 hours too long to be under local anesthesia for an elective procedure? Also, how much safer is local anesthesia than general? I know there are relatively serious concerns regarding cognitive impairment for someone 60 and over-, especially in surgery of this length. Maybe I could best put my question this way: understanding that it is ultimately a personal decision weighing costs and benefits, would you be comfortable having anesthesia as described above for an elective procedure?