What is the Determing Factor As to What Type of Anesthesia to Use During Lipo Surgery?

I am from VA and I have already spoken to a doc about liposuction on my stomach. After reading more about it since my intinal consutation and actually watching live procedures on line, I noticed the ones I have watched thus far the women were awake whereby the doctor was able to talk to them explaining to them what he was doing as it he was during it. So my question is what determines what type of anasthesia is going to be used on the patient?

Doctor Answers (7)

Anesthesia for Liposuction

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   You can probably use local and sedation for all liposuction, but, if you are going to remove a large volume, some patients cannot tolerate this.  Thus, you should have the ability to convert to general anesthesia if necessary.  Kenneth Hughes, MD Los Angeles, CA


Los Angeles Plastic Surgeon
5.0 out of 5 stars 218 reviews

Anesthesia and liposuction

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There are many determining factors but for the most part it’s amount and location of fat.  If I will be aspirating a very large amount of fat from a patient I will insist on general anesthesia as the procedure itself can be quite painful and uncomfortable for the patient.  If someone will be undergoing minimal liposuction in various areas I’m fully on board with local anesthesia.  I sometimes also leave the patient a choice if I feel that my liposuction procedure can be fully optimized  with the type of anesthesia they select. 

Jonathan Ross Berman, M.D. , F.A.C.S.

Jonathan Berman, MD
Palm Beach Plastic Surgeon
5.0 out of 5 stars 6 reviews

What Type of Anesthesia To Use With Liposuction

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Liposuction can be done with local anesthesia, IV sedation, or general anesthesia.  Depending on the surgeon's experience and the patient's preference, each one has its pros and cons.  The anesthesia that is used is less important than the skill of the surgeon doing the liposuction.  After a couple thousand liposuctions, pretty much any highly motivated and technically skilled plastic surgeon will be able to get the same amount of fat out of any patient's abdomen and do it aesthetically no matter what anesthesia is used. 

There is nothing new under the sun.  Back in the early days of liposuction, many of us stood patients up to be able to do what we thought was the perfect liposuction of abdomen, love handles, and thighs.  After doing that about 100 times, I found that I was able to get as good, if not better, results with the patient under general anesthesia.  Therefore, I can tell you from my own personal experience, anyone who tells you they can get a better, more complete liposuction when you are standing up is selling you a very uncomfortable gimmick. 

I have personally found that when I define what areas I want to liposuction at the beginning of the procedure, I often miss small areas that would do well with some additional liposuction.  These areas are outside the boundaries of where local may be put, requiring more local and leading to more pain. 

Although any of the 3 types of anesthesia will work, I personally feel local anesthesia limits the surgeon's ability to give you the best body sculpting.

S. Larry Schlesinger, MD, FACS
Honolulu Plastic Surgeon
5.0 out of 5 stars 213 reviews

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Liposuction

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One method is not inherently better than the other. Just because a surgeon only does one method or mostly does one method does not mean it is the best for you. Some patients do not respond well to local anesthesia, it just does not work as well on them. Just because a patient can stand up or sit up during surgery does not mean the liposuction result will be better. I have done hundreds without the patient standing up with good results and standing them up would not have changed anything.

If you use a local only method you have to use a smaller cannula and make more holes in the skin because the patient will not tolerate the movement of the larger cannula over longer distances. That does not mean smaller cannulas are better than larger ones or vice versa anymore than smartlipo is better than regular lipo. That may not be a good choice though if the patient is prone to bad skin scarring in which case less larger holes are better than more smaller holes. The surgeon and their experience is more important than the exact modality. The tennis player is more important than the tennis racquet.

What determines the type of anesthesia is surgeon experience, the exact surgery that is to be performed, patient factors like general health, pain tolerance and ability to sit still for long periods of time. I had to do one liposuction surgery in the hospital and after some discussion it turned out that a spinal block was the best option for that patient. He was awake and alert during surgery but his being awake in and of itself did not make it a good choice. The deciding factors were patient condition, amount of fat to be removed, operative time and anesthesia experience.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles Plastic Surgeon

The Best Liposuction Results are usually seen when done under Local Anesthesia

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Tumescent liposuction done under local anesthesia with using the smaller micro canulas usually gives the best results because you are able to stand the patients up and have them move in all sorts of positions to assess the results. Typically the smaller the canula, the smoother the results. If you are stuck under gen anesthesia, you are lying flat on the table with limited positioning available. When you lye down, your tummy goes flatter and shifts to the sides and your thighs get squooshed and out of natural positioning. You really need to sit up, stand up and turn in many ways to see what needs to be further done and how even and symetrical the sides are. This can only be done easily with you being awake during the procedure. You are comfortable throughout the whole procedure and the doc can fine-tune you well. It is much safer and you get to participate in the procedure. Docs who still do the older methods of traditional liposuction under general, also tend to use the larger canulas since it is quick and easy for them but often giving more waviness and dimpling as well. I've done thousands and thousands of lipos and we all did it 25 yrs ago under gen. anesthesia but improvements by the derm surgeons in the different techniques have advanced it a lot over the yrs and especially in being able to adjust the tumescent local anesth. dose to cover more areas safely and comfortable. 

Local anesthesia is easy to undergo and not painful at all when done correctly by an experience lipo doc. Also you can take out just as much fat 3-5 liters under local as you can under general but local is so much safer and you don't have big ugly scars from the incisions and there are NO stitches and a faster more comfortable recovery as well. The downside is that it costs alittle more and more work for the doc but you get much better results.  Sincerely,

David Hansen,MD

David Hansen, MD
Beverly Hills Dermatologic Surgeon
5.0 out of 5 stars 24 reviews

Anesthesia type for liposuction surgery

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Thank you for your question. Liposuction can be done under local anesthesia, intravenous sedation and general anesthesia. The determining factor is the doctor's and/or patient's preference. Some patients do not want to feel or hear anything, obviously local anesthesia is not for them. Some patients are afraid of general anesthesia because they heard "bad things" about it. The truth is, you have to decide with your surgeon which would be best for you. Each has its advantages and disadvantages. Under local, the lidocaine concentration has to be higher to keep you more comfortable, but this means less fat or fewer areas can be done. Under general or IV sedation, the surgeon can cut back on the lidocaine's strength or not even use lidocaine. This allows for more fat removal. If someone had previous liposuction it is more painful awake. I personally do most of my liposuction procedures under IV sedation, but I also have done several hundred cases under local anesthesia only. When I use local anesthesia, I also give the patient some anxiolytic and an intramuscular narcotic shot to help with the discomfort with the tumescent solution administration.

George Marosan, MD
Bellevue Plastic Surgeon
5.0 out of 5 stars 10 reviews

Anesthesia for lipo

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Liposuction can be performed under local anesthesia (you are awake) or general anesthesia (your are asleep).  The decision on which to use is based on many factors including the anticipated length of surgery, the extent of liposuction desired, patient preference, and physician preference.  I would recommend that you discuss which option is best for you with a board-certified plastic surgeon.  Good luck!

Anureet K. Bajaj, MD
Oklahoma City Plastic Surgeon
5.0 out of 5 stars 9 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.