General or Local Anesthesia for Liposuction?

Question

I've heard that more fat can be taken out under general anestesia than under local. Is it true? General anestesia liposuction is a more expensive choice, but I want to take as much fat as possible from my outer thighs. On the other hand, local anasthesia lipo enables a patient to stand up to compare results. Which type is better?

Richard J. Bruneteau, MD · Answer

Tumescent
liposuction represents a significant advance in the management of localized fat
collections.  When this techniques
is utilized with local anesthesia alone the response varies from patient to patient.  The majority of patients appear to do
well and have good results especially when smaller amounts of fat are
removed.  Unfortunately, we
frequently see patients who have had significant pain and discomfort during the
injection process when local anesthesia is used alone.

For
this reason, many surgeons supplement local anesthesia with I.V. sedation or
general anesthesia to minimize pain and discomfort during the procedure.  When utilizing this approach patients
can have more fat removed and avoid multiple procedures.  The procedure is more comfortable and
avoids break through pain which can occasionally occur with local anesthesia
alone.

It’s
important to realize that all surgical procedures and anesthetic techniques
have risks.  This is true whether
local anesthesia, I.V. sedation or general anesthesia are utilized.  Most surgeons who perform tumescent
liposuction agree that the anesthetic technique utilized is less important than
the use of a certified operating room and the presence of an anesthesiologist.  In other words, you don’t want your
surgeon to be your anesthesiologist.

Jeffrey D. Wagner, MD · Answer

For areas that can be treated either way, it probably comes down to patient and surgeon preferences.  For larger areas, general anesthesia is probably better, as deeper anesthesia can be administered and monitored and  better fluid resuscitation can be achieved.  Importantly, if the patient is more comfortable better cross tunneling and gathering of treatment areas can be done to give better results when larger areas are treated or greater volumes are removed  Some of the worst results I have ever seen with liposuction happened when too large a procedure was attempted under inadequate anesthesia, or by relatively inexperienced non-plastic surgeons/practitioners.  There are limits, and an experienced plastic surgery team is very important in either instance.

Jeff Angobaldo, MD · Answer

You can perform local tumescence anesthesia if your planning to liposuction 1-2 areas.  You don't want to be too aggressive in the outer thigh to prevent contour irregularities. Choose a board certified Plastic Surgeon

Hooman Khorasani, MD · Answer

Yes you are right both types of anaesthetic can be used for liposuction. Most commonly however we use a type of anaesthetic called tumescent anaesthesia which is effectively a type of local anaesthesia where diluted anaesthesia is used in safe and tolerable amounts to cover a large area. The advantage of this type of anaesthesia is that it has less side effects and a shorter recovery time in comparison to a general anaesthetic. Liposuction is a day case surgical procedure and is safe in expert hands with the tumescent anaesthetic technique.

Gary Lawton, MD, FACS · Answer

In general, if you are asleep, it is easier to remove more fat because the areas at the edges of the tumescent fluid (which is used for lipo awake or asleep to numb the treatment area) can be more actively suctioned.  General anesthesia will be more comfortable ad the surgery can be more controlled. If you can stand up during lipo, not enough is being taken out.

Ron Shelton, MD · Answer

Local anesthesia is more safe when conforming to the guidelines of tumescent liposuction. There is a limit to how much local anesthetic can be administered, though, so there is a limit to how much fat can be removed at one time. There also is a limit to how much fat can be removed under general anesthesia before the risk of the procedure increases, so it may be that in your case, the amount that can be removed might not be more using general anesthesia. Seek a consultation with a board certified dermatologist or plastic surgeon so that you can be evaluated properly.

David Hansen, MD · Answer

If you are wanting the best results and you are only needing the outer thighs done, then liposuction under local anesthesia is your best choice by far since you can get as much as possible out from your outer thighs under local and do it in the safest way also.

William Bruno, MD · Answer

Liposuction can be performed under either local or general anesthesia depending on the areas that are being treated and the patient.  If the patient is very cooperative you can perform the procedure with local and sedation, however they can occasionally become uncomfortable during the procedure which can prolong the surgery.  If a patient has no medical problems and is in relatively good health, then general anesthesia is very reasonable because the patient does not have to worry about feeling any pain and yes, more aggressive liposuction can be done to a certain extent.
 
Please discuss this with a board certified plastic surgeon prior to scheduling liposuction. You can also discuss this with the anesthesia provider prior to your surgery to see what type of anesthesia is best for your particular case.
 
Best wishes,
 
Dr. Bruno

Matthew Schulman, MD · Answer

The choice of anesthesia for liposuction is quite difficult. Some prefer to perform this under local anesthesia, mostly because the general public has a fear of general anesthesia. The truth is that general anesthesia when done properly is quite safe. Also, there are many different categories within the term "general" so it can be misleading. I prefer to perform liposuction under general anesthesia. This allows my patients to be more comfortable, and allows me to do a better job removing fat and contouring the body. I actually think that this is the safer way to do it. Many of the problems that people hear about in the press are related to trying to do too much surgery, with as little anesthesia as possible. General anesthesia allows the anesthesiologist to properly monitor you throughout the procedure.

Richard Baxter, MD · Answer

There are few topics more confusing than choosing the anesthesia for liposuction. To begin with, there are 3 options: local only (often called "tumescent"), intravenous sedation with local (this may actually be the most common), and general. In my opinion, the choice of anesthetic does not relate specifically to how much fat is removed, though sometimes with local only it can be a less than completely comfortable experience, so most of the time we do IV sedation + local.
What makes it confusing is that there are a lot of doctors doing lipo under tumescent only, because they may not have the type of accredited facility in which to do other types of anesthesia. They may go to great lengths to emphasize the dangers of general anesthesia. Tumescent has its own risks, though if guidelines are adhered to lipo is a safe procedure regardless of what type of anesthetic is used. Just keep in mind that it isn't either local only or general only, and my recommendation is to make sure the facility where the procedure is to be done is accredited.

General or Local Anesthesia for Liposuction?

Answers (19)

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