When having lipo, can a doctor remove more fat under sedation/local or general anaesthetic?

Question

I’m considering lipo to my outer and inner thighs. What are the pros/cons of local (sedation) Vs general anaesthetic for the procedure? Is there a difference in the amount of fat that can be removed?

Jason Emer, MD · Answer

I find Its much easier to remove more fat and get more tightening when someone is asleep. It apperas you may have laxity that could use a thigh lifting or modified hidden scar thigh lift or internal heating along with liposuction and fat grafting to the buttock and hips. this is more complicated procedure than you think so please see an expert.  Best, Dr. Emer.

Daniel Barrett, MD · Answer

Dear Imaginative443736,
generally speaking, local anesthesia can be used for treatment of smaller area. In case of thigh, liposuction, general anesthesia is probably a better option. If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Damien Grinsell MBBS, FRACS (Plast) · Answer

Hi  Theoretically the amount of fat that can be removed is the same however I nearly always do this procedure under a General anaesthetic As it is way more comfortable.  My advice is that you should have a Brazilian buttlift because it is s much better vslue gor money proposition.RegardsDamien

Kenneth Hughes, MD · Answer

Limited liposuction can be done under local anesthesia.   You do not want to be in pain during the procedure so that the surgeon must stop the procedure or do less than what is necessary.   For this reason, general is a better option for my patients.   I do not use local exclusively unless a small area of liposuction is planned.

Felix Omar Márquez, MD · Answer

Hello. Thanks for your question and photos. You can go to the operating room for liposuction under local or general anesthesia. It depends on several factors, including the extension of the area where the Lipo will be practiced. If you will have a Lipo just for thighs, local anesthesia may be enough. Consult with your doctor. Best luck!

Connie Hiers, MD, FACS · Answer

Yes, there is a difference between the two types of anesthesia--local and general. Both can safely be used to do liposuction. With local anesthesia, the amount of fat removed and the number of sites treated is dependent upon how much local anesthesia can be used. This amount is calculated specifically for each patient based on weight. Under general anesthesia, more areas can be treated. There is a limit on how much fat should be removed per case. Local anesthesia does take longer to allow time for the anesthesia to be effective. Some surgeons, like myself, are very comfortable doing both, and some prefer general or local. With general anesthesia, an anesthesiologist or nurse anesthetist is also present in the room, and administering IV drugs to keep you asleep.

Arian Mowlavi, MD, FACS (license on probation) · Answer

Local vs. general anesthesia typically depends on the extent of the operation. You would benefit from a consultation with a board certified plastic surgeon. Overall a maximum of 5L of fat can be removed in one procedure. If an extensive amount of fat needs to be removed you will likely need general anesthesia. A Skype or FaceTime consultation with a board certified plastic surgeon will help you get an accurate recommendation for your procedure and for pricing. 
Respectfully, 
Arian Mowlavi MD, FACS
Realself 100 Hall of Fame Inductee

Mats Hagstrom, MD (license on probation) · Answer

I’ve been a plastic surgeon for over 20 years. About mid career I switched from using general anesthesia for Liposuction to doing this as an awake procedure using local anesthesia with mild sedation.
There’s a learning curve and getting patients through this procedure comfortably. It takes time and the surgeon needs to learn how to work properly with local anesthesia including understanding safe limits of both lidocaine and epinephrine.
The procedure can get more uncomfortable as more fat is removed.
That said, I  routinely do 5 L Liposuction cases with patients awake on a weekly basis. I follow recommended safety guidelines and do not remove more than 5 L of fat aspirate during a single procedure. 
The goal is not to remove as much fat as possible. Doing  so regardless of form of anesthesia will leave someone disfigured.
The goal is to do the procedure correctly and that includes getting good aesthetic outcomes, keeping the procedure safe and comfortable for the patient. It is never about getting the most amount of fat out.
Lower extremity Liposuction is not particularly difficult to do with patients awake if the surgeon has plenty of experience doing local anesthesia Liposuction. 
For the first 10 years of practice I have the same view that most plastic surgeons do.  I simply questioned why anyone would do Liposuction in the office or using local anesthesia when it’s so easy to have patients put to sleep with an anesthesiologist.
Mid career I had friends who were plastic surgeons doing awake Liposuction who did cases with me and showed me what they were doing.
I slowly evolved my practice to now doing all my Liposuction with patients awake.
The procedure can be uncomfortable.
Most patients find it similar to having a tattoo or having a dental procedure.  Uncomfortable parts of the procedure are usually very brief and if the surgeon is gentle it’s really not that bad.   Most of the procedure is not nearly that bad but at its worst it can be slightly uncomfortable for some people. With  the use of appropriate pain medication and anti-anxiety medication the whole experience becomes quite tolerable.  
I review the experience with each one of my patients during my follow up visits. it’s extremely rare that someone wish or would have chosen general anesthesia. most people realize you’re going to have a medical procedure and anticipate some discomfort.   If the surgeon doesn’t have enough experience the patients could have pain and the procedure becomes intolerable. This is a highly undesirable position to be in.  I can’t emphasize enough how important it is for the surgeon to learn how to do awake Liposuction for patients to not be put in pain.  
There is a very real learning curve to doing this procedure using local anesthesia.
Typically extremities are fairly easy and should not be perceived as painful. If you’re having only two areas treated and staying within a general local anesthesia safety guidelines of keeping the procedure to under 50 mg of lidocaine per kilogram should easily allow the patient to be very comfortable through the procedure.
The biggest advantage to keeping patients awake is the ability to do the procedure with patients in different anatomic positions. In particular when working on both inner and outer thighs it is an amazing advantage to keeping patients laying on their side while doing this procedure.
When working an outer thigh a foam wedge should be put between the legs extending the leg that’s being worked on. This technique was developed by Dr. Jeffrey Klein.  It helps protect the patient from getting contour irregularities in the hip dip region.
Plastic surgeons who have plenty of experience doing liposuction on patients while awake will absolutely prefer this for working on extremities especially inner/outer thighs. 
In the end I suggest finding the most qualified board certified plastic surgeon regardless of what form of anesthesia they use.
Personally I now rarely use general anesthesia for liposuction.   I find it difficult for me to get the best results that way. 
To date I have performed over 7000 liposuction procedures. The great majority of these were done with patients awake. I typically perform about 400 awake Liposuction procedures per year.
I specialize exclusively in liposuction and fat transfer procedures. 
Inner thigh Liposuction can be tricky and if not done correctly contour irregularities are not unheard of.
I suggest consulting with numerous local board-certified plastic surgeons.
I recommend having in person consultations.
During the consultations you should ask to see as many before and after pictures of inner and outer thigh results as possible.
You’re not looking for the best outcome but would average results look like.

Best, 
Mats Hagstrom MD
Certified by the American Board of Plastic Surgery.

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