Can I get a BBL under twilight anesthesia?

The simple answer to your question is yes.

This procedure can be done with everything from just local anesthesia to full general anesthesia.

Starting with the least to the most I’ll try to explain what the advantages and disadvantages are as well as the implications for the patient.

Local anesthesia alone is insufficient for most people to get through the procedure comfortably. It can be done for those who are tough but I don’t recommend it.

Instead local anesthesia with sedation whether twilight or not is my preferred method and is a very good approach.

Sedation is typically described as mild moderate or deep.

With mild sedation the patient is fully aware of where they are the procedure being done and can have a clear conversation at all times. With light sedation patients are not at risk for having respiratory collapse or risks from sedation. Light sedation is typically the kind of medications the doctor could write a prescription for that you could take it home. This includes medications like Xanax, Valium, hydrocodone or oxycodone.

Moderate sedation the patient has slurred speech, is responding to commands but may not necessarily remember the procedure.

This type of sedation requires continuous monitoring with a minimum of one committed registered nurse who is focused on monitoring the patient only.

This is typically what most people call twilight anesthesia.

Deep sedation the patient is minimally responsive but may respond to painful stimulus. The patient will not remember the procedure. This type of sedation should be done with full monitoring in a fully accredited facility Preferably by an anesthesiologist or anesthetist.

When doing the BBL procedure the biggest advantage to keeping patients awake is the ability for the patient to hold different positions throughout the procedure.

Light sedation with lots of local anesthesia is perfect for this.

With moderate or deep sedation the patient becomes too intoxicated to follow commands and finds it difficult to stay in the same position.

The patient continues to not recognize where they are and body contouring becomes more difficult.

With general anesthesia the patients need continuous airway support with a breathing tube of some type.

With general anesthesia there is risks involved with moving the patient.

Getting a BBL procedure while awake and being cognizant of what’s happening can include some discomfort.

This is the great juggle or debate between general anesthesia versus awake body contouring.

Managing pain to the point of being acceptable or tolerable Is a fine art. It takes practice and experience and it can’t be rushed.

I’ve done thousands of awake liposuction and fat transfer procedures over the last decade successfully.

Patients often ask how painful is it?

There are certain moments throughout the procedure that can be bordering on intense.

Aggressive Liposuction of the lower abdomen has a burning sensation even with proper use of local anesthesia. Patients often described as similar to getting a tattoo.

This is were using sedation appropriately makes all of this tolerable and Appropriate

I typically give most patients Xanax and Demerol as the sedatives.

I take a pretty thorough history of our patients have reacted to sedating drugs including alcohol in the past as well as in nausea and vomiting history.

For those patients who have a hard time or use nitrous oxide or laughing gas to help them through those few parts of the procedure that can be challenging.

It takes experience to get good at doing awake surgery.

I spent the first 10 years of my career doing all of these procedures under general anesthesia.

Are you to believed that it was inhumane and inappropriate to do large liposuction and fat transfer cases with patients awake as office based procedures. I had colleagues who I begin working with one on one doing these procedures with patients awake. I am lucky that I had good mentors showing me the ropes and guiding me. They taught me how to get patients Through the procedure with minimal pain.

There’s nothing wrong with using general anesthesia, epidural anesthetics, deep sedation or whatever form of anesthesia each surgeon feels is best for their case.

If the surgeon has most experience doing these procedures under general anesthesia and that’s how it should be done in the hands of that surgeon.

In my case my preference is to use local anesthesia with mild sedation. That is how I currently treat all my patients but I have privileges in the hospital to do these procedures under general anesthesia should I choose.

Twilight or deep sedation is not preferable in my opinion because the patients can’t follow commands clearly.

Local anesthesia alone is not sufficient to be comfortable enough through the procedure.

My preference is local anesthesia with mild sedation or general anesthesia.

Avoiding general anesthesia has the following advantages.

The ability for my patients to hold different positions multiple times throughout the procedure greatly enhances my ability to contour their body.

Personally I believe it’s safer to not do these procedures under general anesthesia.

For example should the surgeon penetrate the chest or the abdomen the patient will let you know something is wrong if they’re awake. While general anesthesia is overall very safe there are some inherent risks with just having general anesthesia.

When doing body contouring on patients awake every area has to meticulously be flooded with tumescent or numbing solution.

This is also done under general anesthesia but the attention to detail isn’t nearly as important.

Tumescent solution doesn’t just allow us to do the procedure with the patient being numb. It also decreases bleeding substantially.

If not every area is properly treated with numbing solution including giving the numbing solution sufficient amount of time to be affective the patient will have more bleeding and more bruising after surgery. It’s certainly possible to mimic the same Efforts of placing to messenger solution under general anesthesia but my observations has been that patients don’t nearly focus enough time and effort on this part of the procedure when patients are under general.

Obviously general anesthesia or deep sedation requires an anesthesiologist or anesthetist.

It requires a formal operating room.

While costs vary from facility to facility an average cost of $1000 an hour is probably not a typical.

When you add up the cost savings, improve safety, easier recovery and in my opinion better results Doing these as awake procedures simply makes much more sense.

Having been on both sides of the aisle I feel I can answer this question objectively.

Best,

Mats Hagstrom MD