AbstractObjectiveThe objective of this study is to provide a state‐of‐the‐art review on the use of anesthetics for in‐office facial plastic procedures.MethodsA search was performed on PubMed, Embase, Web of Science, and Cochrane Review using the keywords “anesthesia,” “office‐based procedures,” “local anesthesia,” “facial plastics,” “oral sedation,” “moderate sedation,” and “deep sedation.”Results and ConclusionsOver the past few decades, the shift toward in‐office invasive procedures has increased patient convenience and decreased hospital resource utilization. Many tools exist to reduce patient anxiety and discomfort in an office‐based setting. With proper patient selection and technique, facial plastic surgeons can adequately anesthetize patients to perform Mohs reconstruction, cutaneous excisions, blepharoplasty, face‐lifts, and other in‐office procedures.