The reason most plastic surgeons use general anesthesia for liposuction and fat transfer is that the put procedure can potentially be very painful. The amount of discomfort with the procedure can be reduced significantly with meticulous use of local anesthesia. All plastic surgeons inject local anesthesia into the areas being treated Whether the patient is asleep or awake. Local anesthesia not only reduces pain during and after the procedure, but also helps control bleeding in a significant way during liposuction. The emphasis or how much time is spent injecting local anesthetic is very different when patients are awake. For full body liposuction with fat transfer it’s not unusual to spend 30 or 40 minutes just injecting local anesthetic. If this is not done meticulously, the procedure will be painful. Even if local anesthetic is injected using good technique using appropriate amounts sensitive patients, although so are easily overwhelmed. May still find the procedure, intense and overwhelming. This is in the hands of the most experienced providers. For that reason some form of sedation is generally needed to do major body contouring without general anesthesiaThe best way I can describe the correct level of sedation for these procedures is that the patient should be able to have a conversation, no where they are, and what’s happening, but may ask the same question three times during the procedure not realizing they just asked the same question earlier. Asking the same question three times during the operation is what I called. Perfect sedation for awake procedures. Overall a BBL can be done with only mild discomfort and as a tolerable procedure. I would say it is equivalent to having a tooth extraction except it takes a bit longer. What makes the procedure possible versus potentially a horrific painful experience is the skill and experience of the provider.During my 13 years of medical training, never did, I encounter anyone doing major body contouring procedures without an anesthesiologist. I’ve been aboard certified plastic surgeon since 2002. The first 15 years of practice was spent doing general plastic surgery and during this time I use general anesthesia for most liposuction and fat transfer cases. 10 years ago I begin focusing exclusively on liposuction and fat transfer and I only perform liposuction and fat transfer. Gradually evolved to doing larger cases without anesthesiologist. There is a very real learning curve and to really master awake. Liposuction takes a few years. Some providers are inherently more talented than others, and some providers are inherently more patient and willing to spend the time necessary to make sure patients are comfortable and get the best results. The answer to question is not yes or no. It certainly can be comfortable and safe to do awake procedures. In regards to pure safety, there are some advantages to avoiding general anesthesia. General anesthesia by itself has some in here to risk. There’s also a safety measure having an anesthesiologist overseeing your well-being why the surgeon focuses on doing surgery. when there is no anesthesiologist, the surgeon has to do both surgery and manage your anesthesia. The process is definitely time-consuming, and it definitely takes longer to do these procedures without an anesthesiologist. Awake surgery can be done in an office setting or in a less formal accredited facility. This means the can be potential cost savings by avoiding a formal operating room. As with almost every plastic surgery procedure, the key is to find the right provider. And the hands of the right plastic surgeon everything will be fine. If you don’t find the right plastic surgeon, then awake, body contouring can be a horrific experience. To get the right outcome an accurate assessment regarding your candidacy and avoid an unpleasant experience or unpleasant outcomes I always suggest having multiple in person, consultations, avoiding virtual consultations whenever possible. During each in person consultation, ask each provider to open up their portfolio and show you their entire collection of before and after pictures of previous patients with similar body characteristics. At that time, you can also ask the provider how many of these procedures they’ve done, including what type of discomfort previous patients have experienced. You can ask for references to previous patients who had the same procedure and see if they can connect you so you can talk to them about what their experience was like. There’s no correct number of consultations needed to find the right provider. Best, Matt Hagstrom, MD