Can you be awake during a tummy tuck?

Question

I've heard of some plastic surgeons around the country performing awake tummy tucks; Is this a legitimate procedure that can give you good results if you need a full tummy tuck, or is this considered dangerous with minimal results?

Otto Joseph Placik, MD · Answer

Due to many factors and the length of the procedure, you should not do it under anything other than general anesthesia. It is better for both you and your surgeon. You don't want to be awake for a tummy tuck, it may sound like a good idea but it is not.

Richard Baxter, MD · Answer

Paramount in planning surgery is the patient's safety and comfort. With modern methods for general anesthesia, it is extremely safe and I frankly see no benefit to trying to do it under local. What ever the choice you make, be certain that the surgery will be done in a fully accredited facility.

Vishnu Rumalla, MD · Answer

Some surgeries can be performed under sedation and local anesthesia without a breathing tube. I prefer not to with a tummy tuck becasue 99% involve some form of muscle repair. I think it is hard to achieve comfort with this procedure and the muscles often need to be relaxed with medicine to help facilitate the best repair. The more important point is that many surgeons who have not completed formal training in plastic surgery and are not board certified plastic surgeons are usually unable to get priveleges to perform a tummy tuck in a certified surgery center or hospital. Thus, they perform "awake" tummy tucks in their office as an alternative. See my website for videos discussing the operation and best of luck.

Jeffrey M. Darrow, MD · Answer

Surgery procedures can be done with patients awake but the proper choices of patients and procedures must be considered. A patient must feel comfortable during surgery with being awake or perhaps with a slight amount of sedation. The area to be operated on must be able to be numbed completely by a safe level of local anesthesia. If the patient has no pain, a safe level of local anesthesia can be used and the patient can feel relaxed during the procedure then it could be accomplished. The patient must understand that the local anesthesia must be injected into the areas to be worked on and this can be momentarily uncomfortable. I would think this would work best for people with small amounts of tissue to remove. The larger the area, the more local anesthesia would be required and this could lead to dangerous levels of anesthesia in the blood.

Paul Gill, MD · Answer

The thought of an awake tummy tuck makes me very nervous.   One main difference between an average and outstanding tummy tuck is the amount of muscle plication.   It is impossible to get an equivocal muscle repair with a patient awake.   I use general anesthesia for all my tummy tucks and always ask my board certified anesthesiologist to give a medication to relax the muscles prior to repair.  This allows me to tighten the muscles very effectively while knowing the patient is safely monitored, comfortable, and stable due to the general anesthesia.  

	Awake Tummy tuck requires very high doses of local anesthesia that can have significant cardiac effects even hours after administration.   In addition, it is important to ask your surgeon performing awake tummy tuck, if they have privileges to perform this same procedure in any hospital or accedited surgery center.   I would be very skeptical of any physician who does not have this.

	I wish you a safe and healthy recovery

Barry L. Eppley, MD, DMD · Answer

Certain very limited forms of tummy tucks may be able to be done under local anesthesia with IV sedation. The removal of a little pooch of skin can be done this way but this would really be a 'micro-tummy tuck'. More significant forms of tummy tucks, whether they be a mini- or full tummy tucks, can only really be done under general anesthesia. When it comes to tummy tucks, do not be deceived into thinking that awake or seemingly simple approaches will make for significant changes. One example thaty I have seen recently is the 'Scarless Tummy Tuck'...meaning liposuction only. This is hardly a real tummy tuck.

Steven Wallach, MD · Answer

To me an awake tummy tuck would be something from the times of the Inquisition. I do not think you would want to be fully awake during a tummy tuck. I think you may be better off having general or deep sedation.

Steven Turkeltaub, MD · Answer

Although tummy tucks can be performed awake (that is sedation) with or without an epidural, you would be far more comfortable to have general anesthesia - and it would make your plastic surgeon's job less trying. Most board certified plastic surgeons do perform tummy tucks under a general anesthetic.

	Make sure that you do have your surgery performed in an accredited center such as an outpatient center associated with a hospital. For the administration of the anesthesia, I would also recommend that it is a doctor performing it (anesthesiologist) versus a nurse anesthetist.

C. Bob Basu, MD, MPH, FACS · Answer

"Awake" anesthesia can mean different things to different people. Since a tummy tuck involves both removing excess skin and fat and tightening of your abdominal wall muscles, I generally recommend either IV sedation/MAC anesthesia or general anesthesia. However, I recommend you have this procedure done in an accredited surgery center/facility/or hospital. Please visit with a board certified plastic surgeon to learn more about your options. Based on your anatomy, surgical needs (procedures), and overall health status, your surgeon will make the safest recommendations for you.

Karol A. Gutowski, MD, FACS · Answer

It depends on what "awake" means. A tummy tuck done with sedation and tumescent anesthesia (injection of large amounts of fluid containing an anesthetic under the skin such as used in liposuction) is reasonable for some patients. Pure tumescent anesthesia without sedation may be hard for most patients to tolerate.

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