General or Local Anesthesia for Liposuction?

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?

Doctor Answers 19

"Removing as much fat as possible" should not necessarily be the goal of a liposuction procedure

We perform liposuction under tumescent anesthesia in the office as well as under general anesthesia, depending on several factors. These include the anticipated amount of aspirate, number of areas to be liposuctioned and patient preference. I would caution you however that excellent liposuction results can be obtained with either technique, and that the fat left behind is as important as the fat removed to obtaining excellnt contours after liposuction.

Liposuction under local anesthesia is by far much safer

Dear Innam

It is important to understand that the mortality rate for liposuction under general anesthesia continues to be much higher than the mortality rate for liposuciton under local anesthesia. It is thought that this higher rate of death is related to several factors including the drugs needed for the anesthesia. The mortality rate for liposuction under general anesthesia varies with the reporting study but is somewhere between 1 in 40,000 cases to as high as 1 in 5,000 cases. The mortality rate when liposuction is performed under local anesthesia is approximately 1 in 300,000 cases.

Even the rate of 1 in 5000 cases is rare enough that a single surgeon is not likely to experience an operative death from liposuction in their career. Your plastic surgeon can look at you straight in the face and tell you the complication has never happened to them and be telling the truth. That is why in medicine we look at what happens when large numbers of case are pooled together so we can learn from the experience of others. Another way of looking at this issue is that 98% of malpractice lawsuits regarding liposuction stem from liposuction performed under general anesthesia, although this data is now about 10 years old.

Why do doctors continue to do liposution under general anesthesia despite the higer risk of death? It is partly cultural. General plastic surgeons are accustom to having their patients out. However, there is a financial reality. The liposuction that has to be done slowly and gently with microcannulas by the dermatologist in their office operating room and may take several hours can be accomplished under general anesthesia in 45 minutes. So, it is much more profitable to perform liposuciton under general anesthesia even when you factor in the economic cost of paying for the increase liablity caused by surgery related death and illness. On average, I am going to guess that you will pay more for the liposuction under local simply because more contact time is spent with the surgeon even considering the extra cost of the anesthesia and the more expensive operative setting.

Can more fat be removed having liposuction under general anesthesia? Absolutely this is true. However, it is also true that if you need a 5 liter liposuction, it is also likely that liposuction is not appropriate to address your actual concerns. The fat removed will be coming back. Individuals with morbity obesity need lifestyle changes not liposuction and if these fail and it is appropriate evaluation for measures like lap band surgery.

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon
5.0 out of 5 stars 22 reviews

Liposuction and anesthesia

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.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
5.0 out of 5 stars 38 reviews

Liposuction under local vs general anesthesia

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

William Bruno, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 282 reviews

Anesthesia options for liposuction

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.

Richard Baxter, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 42 reviews

Local Vs. General Anesthesia for Liposuction

                  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.

Liposuction anesthesia depends on what has to be done

Liposuction is different for each patient. I see patients that need just a little bit of fat removal and skin tightening around the hips or thighs and that can be done nicely under local anesthesia. Use of the SmartLipo laser can cause less trauma because the canulas are smaller. The patient has to be somewhat cooperative, though.

However, for more extensive liposuction, anesthesia, whether general or IV sedation should be used so that the surgeon can be more aggressive to give the best result possible. Under local, if the surgeon gets too aggressive, it is often quite uncomfortable which in turn causes the surgeon to be more gentle. We certainly want to give the patient the best result possible. Good luck.

Dr. Cuber

Outer thigh liposuction by local anesthesia gives far superior results

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. 

David Hansen, MD
Beverly Hills Dermatologic Surgeon
5.0 out of 5 stars 35 reviews

Liposuction and anesthesia

I find that patients do not tolerate aggressive liposuction under straight local. With general anesthesia, the patients are more comfortable, and not moving around while I am doing the liposuction. This allows me to concentrate on the procedure and the results as I am working. I can also be more aggressive because the patients are not "feeling" the procedure occurring.

Steven Wallach, MD
New York Plastic Surgeon
4.0 out of 5 stars 23 reviews

Not exactly

It is often said that it is not what you remove, but what you leave in with liposuction that is important. Also, you really don't want ALL the fat removed anyway, just enough to give a pleasing result.

That said, lipo can be safely and comfortably done while awake. It is best not to do large volume liposuction this way, so you should ask your doctor to evaluate and give his honest opinion as to what would be best/safest for you.

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.