Liposuction on flanks; How reasonable is it to do under local anesthesia?

Question

No matter how hard I work out I’ve always had these love handles that I absolutely cannot get rid of. So it’s just flanks, no abdomen. I was thinner than I’d like to be, they were still out there. I’ve reached out to two highly regarded plastic surgeons in the area. One said they can do local or general anesthesia, but recommend local because it’s less costly and less recovery. Other says no way would would ever do anything other than general. What’s the deal?

Harry T. Haramis, MD, FACS · Answer

In my experience, some patients can tolerate liposuction of flanks under local, but I usually recommend anesthesia so the procedure can be properly and thoroughly performed with best results and patient comfort. Anesthesia also will give intranet fluids.

Under local, some become uncomfortable, especially if treating flanks from back and front, some must return to finish liposuction under anesthesia at another time- which no one wants.

You can have further discussions with your/a plastic surgeon. If you absolutely do not want anesthesia, you can try local, it’s a personal decision.

Emmanuel De La Cruz, MD · Answer

Liposuction of the flanks (also known as love handles) under local anesthesia is a common procedure and can be quite reasonable for many patients. However, the suitability of local anesthesia for liposuction depends on various factors, including the extent of the procedure, the patient's pain tolerance, and the surgeon's expertise.

Here are some considerations:

Extent of Liposuction: Local anesthesia is often suitable for smaller to moderate areas of liposuction, such as the flanks. However, if the procedure is extensive or involves multiple areas of the body, general anesthesia or sedation may be more appropriate.
Patient Comfort: Local anesthesia numbs the targeted area, but patients may still feel some pressure or discomfort during the procedure. Patients with a higher pain tolerance may find local anesthesia sufficient, while others may prefer sedation or general anesthesia for a more comfortable experience.
Safety and Monitoring: Under local anesthesia, patients remain awake during the procedure, allowing them to communicate with the surgeon and move as needed. However, safety measures must be in place to monitor the patient's vital signs and ensure their well-being throughout the surgery.
Surgeon's Expertise: The surgeon's skill and experience play a significant role in the success and safety of liposuction under local anesthesia. A board-certified plastic surgeon with expertise in liposuction can assess the patient's suitability for the procedure and ensure that it is performed safely and effectively.
Patient Preferences: Some patients may prefer local anesthesia because it avoids the risks associated with general anesthesia and typically involves less downtime. However, it's essential for patients to discuss their preferences and concerns with their surgeon to make an informed decision.
Overall, liposuction of the flanks under local anesthesia can be a reasonable option for many patients, but it's essential to consider individual factors and consult with a qualified plastic surgeon to determine the most appropriate approach for your specific needs and preferences.

J. Timothy Katzen, MD, FACS · Answer

Hi LIPOQS312,

Thank you for reaching out with your query regarding the use of local anesthesia for flank liposuction.

Both local and general anesthesia have their places in the realm of liposuction. Some plastic surgeons feel comfortable and achieve excellent results using local anesthesia, especially for smaller procedures. On the other hand, other surgeons opt for general anesthesia, particularly for more extensive liposuctions.

Choosing the type of anesthesia often depends on several factors:

Extent of the Procedure: If you're considering a minor liposuction, where less than 1 L of fat is expected to be removed, local anesthesia might be sufficient. However, it's essential to understand that you may experience some discomfort during the process.

Amount of Fat Removal: Local anesthesia typically has limitations when it comes to pain management, especially if removing larger quantities of fat. In situations where over 2 L of fat is anticipated to be extracted, I usually recommend considering general anesthesia. Under general anesthesia, you'll be unconscious and won't feel any pain, allowing for more substantial fat removal without causing discomfort.

From your description, it sounds like your procedure might be on the smaller side. If your plastic surgeon feels confident performing the liposuction under local anesthesia and you're comfortable with this approach, it could be a suitable choice.

However, always ensure that you are well-informed and comfortable with the planned approach. Open dialogue with your surgeon is crucial to achieving the results you desire while ensuring your safety and comfort.

Thank you for your question, and I wish you the very best with your upcoming procedure.

Sincerely,
Dr. Katzen

Kyle Summers, DO · Answer

Great question. In general, the decision, whether to use general anesthesia or local anesthesia comes down to a couple of factors. Firstly, some surgeons may not have access to general anesthesia as not all physician offices are equipped with a surgery center. So many times the choice of anesthesia comes down to surgeon preference and what the surgeon is comfortable with. Secondly, if you have a small area that you want treated, or if you do not need an aggressive amount of liposuction, then it may be worth considering doing this under local anesthesia. The local anesthesia is mixed into the tumescent solution, which is the solution injected under the skin for the liposuction. Third, some patients may not be able to tolerate general anesthesia for a variety of reasons. If that is the case, then sometimes local anesthesia is the only option. Fourth, some patients just do not want to undergo general anesthesia, again for a variety of reasons. In that case, then we would just offered to do the surgery under local anesthesia. However, in general, both options are very safe and both options provide adequate anesthesia and satisfactory. Patient results. Hope this helps.

Anuj Purbey, MBBS · Answer

Vaser Liposuction on flanks can be done under local anesthesia, although many practitioners prefer to do this procedure under either IV sedation or general anesthesia as people have different pain tolerance levels. I have done many under local anesthesia as post surgery recovery is much quicker and patient can go home quickly.

Vincent Gardner, MD · Answer

Hi lipoqs312, You could do either. From my perspective it depends on the comfort level of the surgeon and patient. I’ve done it both ways and they each have advantages/disadvantages. Local is safer but takes longer and can be uncomfortable. General anesthesia means no pain during the procedure and typically a faster procedure but theoretically involves more risk from an anesthesia standpoint. Cost is sometimes a wash because with local anesthesia the OR time is longer and OR time is very expensive. With general anesthesia OR time is shorter but now you have the added anesthesia cost. Again talk with your surgeon and go with your comfort level. Good luck!

Navjot Singh, MD, FACG · Answer

Your concerns about love handles are common, and it's understandable to want a targeted approach. Liposuction under local anesthesia, often called "awake lipo," is a great option. When done by a skilled and experienced cosmetic surgeon, it can provide the precision needed while minimizing trauma. The benefits of awake lipo under local anesthesia include a faster recovery, minimal downtime, and often a more cost-effective procedure. Every surgeon has their preferred methods, but local anesthesia can be an optimal choice for treating specific areas such as the flanks. Always ensure your comfort and safety by discussing your concerns and preferences with your surgeon.

Mats Hagstrom, MD (license on probation) · Answer

Not all plastic surgeons have training or experience doing awake surgical procedures without general anesthesia. Doing awake liposuction without an anesthesiologist is a skill that needs to be mastered in order for patients to be comfortable. There’s a learning curve involved. In my own case during my training in early in my career, all liposuction cases, other than minor touchup procedures were done in an operating room with an anesthesiologist generally giving general anesthesia about midway through my career. I was working with other plastic surgeons who were keeping patients awake using local anesthesia with mild sedation without an anesthesiologist, at that point, I learned through guidance of other experienced surgeons how to do the procedure with patients awake. There was probably slightly more discomfort earlier in my career and there still can be some discomfort doing the procedure using only local anesthesia with sedation. Today I do all my cases without an anesthesiologist. Using only local anesthesia with mild sedation. Most patients tolerated just fine, but the procedure can be uncomfortable for patients who are very sensitive, especially those who have anxiety disorders.
The type of anesthesia used should be guided by the surgeon since they are the ones who either have or don’t have experience doing the procedure without an anesthesiologist relying on local anesthesia with sedation. This is not some thing all plastic surgeons are taught.
What you don’t want is to be awake having surgery that’s unbearably painful.
I generally view the torso as a single anatomic unit, and generally don’t encourage people to spot treat the problem area, but treat the entire torso. Treating a single area on the torso will leave an unnatural fat distribution that doesn’t look natural.
There are always exceptions, but generally speaking, my preference is to treat the torso as one single anatomic unit treating the entire torso.
Choose providers based on their proven ability to deliver quality results. This should entail, reviewing a lot of before, and after pictures. During each consultation, ask each provider to open their portfolio and show you their entire collection of before, and after pictures of previous patient who had similar body characteristics to your own, and had just those areas treated. an experienced provider should have no difficulty showing you at least 50 sets of before and after pictures. 
Being shown a handful of pre-selected images, representing the best results of a providers career is insufficient to get a clear understanding of what average results look like in the hands of each provider or how many of these procedures any one surgeon has actually done. Doing liposuction well on a consistent basis is more difficult than most people realize. Being board-certified and plastic surgery with years of experience and overall good reviews does not mean somebody has mastered anyone single procedure especially not Liposuction.
I recommend you find the right provider, then follow their recommendations in regards to what form of anesthesia to use.
I don’t suggest telling the surgeon what form of anesthesia they should use.
Best,
Mats Hagstrom, MD

Liposuction on flanks; How reasonable is it to do under local anesthesia?

Answers (8)