Can I opt for local anesthesia for my cosmetic procedures?

Hello doctor,

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 that the plastic surgeon said the surgery could last up to six 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.

1. My question is, is six hours too long to be under local anesthesia for an elective procedure?
2. Also, how much safer is local anesthesia than general anesthesia?
3. 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?

Please advise.

Thank you.