Can you be as aggressive with liposuction when you are under local anesthesia as when you are under full sedation?
Doctor Answers 2
Local anesthesia va general for liposuction
Thank you for asking about your liposuction.
- Local anesthesia is fine for liposuction but it is not entirely pain free and that can limit what is done.
- Local anesthesia with iv sedation is the riskiest anesthesia - you may stop breathing.
- General anesthesia with you asleep and your breathing controlled is safer than iv sedation.
- It is not necessary for small area liposuctions but for larger ones, is faster to do than local anesthesia and you feel no pain.
Always see a Board Certified Plastic Surgeon. Best wishes - Elizabeth Morgan MD PHD FACS
Local vs general anesthesia for liposuction
This is one of the best questions I have answered on Real Self. So, let's talk about anesthesia. There are 3 basic methods to undergo an operative procedure:
- Local anesthesia, wide awake and talking
- Local anesthesia with sedation, usually IV medication, awake but sleepy
- General anesthesia, totally asleep and unaware of surroundings
Liposuction can be performed under any of the 3 choices above. Shorter time and smaller areas of liposuction are OK with just local or sedation. Longer cases and multiple areas of treatment need either sedation or general anesthesia. Procedures with the patient prone (lying on their stomach) need general anesthesia and airway control (intubation).
The final choice will depend on the patient and the surgeon's choice. Some patients want to be wide awake and others want to be put to sleep. Likewise, some surgeon's are more comfortable with general anesthesia and some with local anesthesia.
There is no question that you will "feel" pain and discomfort with a local anesthetic and the surgeon may have to reduce the amount of liposuction or even stop if the pain is overwhelming. If during a local with sedation the discomfort is too much then the procedure may need to be converted to a general anesthetic or stopped.
Here is the most important advice: ALWAYS, ALWAYS, ALWAYS have a board certified anesthesia person in the operating room during the procedure, no matter which of the 3 choices are made. There are several reasons for this. This person is trained to manage airways, vital signs, drugs and emergency situations, not the surgeon! Even with a local anesthetic the patient may incur an allergic drug reaction or have cardiovascular collapse that the anesthetist can manage. Also, the anesthesia person can convert between any of the 3 choices. As an example, let's say we start the procedure with a straight local anesthetic for liposuction of the abdomen, and the pain is so great that the surgeon has to stop. The anesthesia person can then give medication to sedate the patient to complete the procedure. Or, let's say our patient is a professional singer and does not want to be intubated (breathing tube placed in the trachea or vocal cords). The anesthesia person can use just a mask or a LMA to prevent damage to the vocal cords during the course of the procedure.
The recovery for the straight local is quick and easy. Recovery for the sedation and general anesthesia is about 1-2 hours. The newer drugs used do not make our patients groggy and sedated for hours on end. The vast majority of my patients who undergo liposuction with a general anesthetic are wide awake, talking and are discharged within an hour after the procedure is completed. One of the newer medications, Diprovan, wears off very quickly and does not leave our patients dopey or nauseated.
Please, always make sure your surgeon is Board Certified by the Board of Plastic Surgery, the anesthesia personnel is Board Certified and the facility is nationally accredited. This is easy to check and if any of the 3 are not in order, I would suggest finding another surgeon. There are plenty of physicians offering liposuction surgery, why not choose the best trained and safest, it is your health we are talking about!
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.