Would you recommend a patient having Vaser to flanks and abs to have twilight sedation/general anaesthetic rather than local?

Question

I'm about to book my surgery date. The procedure I'm having is vaser liposuction on my flanks and upper and lower abs. The first surgeon I approached offers local-anaesthetic only; the second offers local, twilight (IV) and general anesthetic, but has warned against going local-only. The twilight and general are priced the same. I should mention I'm also on a high dose of Lyrica. When questioned further, both surgeons would be happy to prescribe a Valium as a mild sedative.

Jerimiah Mason, MD · Answer

Vaser lipo can be done awake with good carefully placed local (tumescent) anesthesia with good results. There is always a small risk with general anesthesia, but in an otherwise healthy patient it's probably the preferred option when they have the capability to provide it.

J. Timothy Katzen, MD, FACS · Answer

Thank you for your query about Vaser Liposuction anesthesia. I strongly recommend general anesthesia due to its painless nature. Using local anesthetics like lidocaine has dosage limits, restricting the extent of liposuction. In contrast, under general anesthesia, more extensive liposuction is possible due to pain elimination. This makes it the preferred option among many plastic surgeons.

I hope this addresses your concern about Vaser Liposuction anesthesia. Always consult with a board-certified plastic surgeon for the best individual advice.

Sincerely,
Dr. Katzen

I hope this addresses your concern about Vaser Liposuction anesthesia. Always consult with a board-certified plastic surgeon for the best individual advice.

Sincerely,
Dr. Katzen

Dennis Wolf, BScHons, MBBCh, MRCSEd · Answer

I would suggest IV/twilight sedation and local. General is not really required.Local alone is not recommended for abdomen.

Mark H. Tseng, MD · Answer

Hi Sincere758501,
Local anesthesia is a type of anesthesia that numbs only the specific area of the body being treated. It is often used for minor surgical procedures such as dental work or minor skin procedures. The advantage of local anesthesia is that it avoids the risks associated with general anesthesia, such as breathing difficulties, nausea, and other side effects.
Twilight anesthesia, also known as conscious sedation, is a type of anesthesia that combines local anesthesia with intravenous medication to produce a state of deep relaxation and sedation. You may be awake and responsive during the procedure, but you will not feel pain or discomfort.
General anesthesia is a type of anesthesia that puts you into a deep sleep during the procedure. It is usually reserved for more complex procedures or when local or twilight anesthesia would not provide adequate pain relief or relaxation.
Lyrica is a medication used to treat nerve pain and seizures. It may interact with anesthesia, so it is important to discuss your medication with your surgeon and anesthesia provider. Your surgeon may also recommend that you stop taking Lyrica before the procedure.
The decision to choose the type of anesthesia for your procedure depends on several factors, including the complexity of the procedure, your medical history, and your personal preference. It is essential to have a detailed discussion with your surgeon and anesthesia provider to weigh the risks and benefits of each type of anesthesia and make an informed decision.
With the extent of your surgery, I will recommend twilight sedation/general anesthesia for best efficacy and safety for your surgery.
Sincerely,Dr. Mark Tseng

Giuseppe Fiore, MD · Answer

Hi, thanks for your question. 
The decision to use local anesthesia, twilight sedation, or general anesthesia during a Vaser liposuction procedure is a personal one, and this decision should be made between the patient and the surgeon based on several factors, such as the extent of the procedure (number of areas treated), the patient's medical history and medications, and their level of anxiety or discomfort.
In my clinical practice, I use local anesthesia for Vaser liposuction in limited areas such as the neck, arms, and flanks. However, I commonly use general anesthesia when I perform Vaser liposuction in several areas of the body, especially the upper/lower abdomen, flanks, and back (known as the 360-degree approach). In my opinion and experience, when a surgeon uses local anesthesia, they can remove fat but cannot perform body contouring very well due to the level of discomfort during the procedure.
Vaser liposuction with twilight sedation or, better yet, general anesthesia, allows the surgeon to perform fat removal and also body contouring and middle to high definition Vaser, as the patient is completely asleep, and the consultant anesthetist looks after the patient's vital signs and respiratory support.
It is important to discuss the anesthesia options with your surgeon and anesthetist and ask any questions you may have to ensure you understand the risks and benefits of the different options. I hope this helps.

Best wishes,
Dr Giuseppe Fiore

Anuj Purbey, MBBS · Answer

Choosing the right type of anesthesia is a significant decision, and I'll provide some guidance to help you make an informed choice:Local Anesthesia:Generally, local anesthesia is suitable for smaller areas or less extensive procedures.It allows you to be awake during the procedure, and recovery is typically faster.It might be appropriate for individuals who prefer to avoid the potential side effects of sedation or general anesthesia.Twilight Sedation (IV Sedation):Twilight sedation provides a moderate level of sedation, and you may not be fully unconscious.It can be a good choice for longer or more complex procedures, enhancing comfort without the deeper effects of general anesthesia.Recovery might take a bit longer compared to local anesthesia.General Anesthesia:General anesthesia renders you completely unconscious during the procedure.It's often recommended for more extensive surgeries or for patients who may be uncomfortable or anxious about the procedure.Recovery time is longer compared to local or twilight sedation.Considering your case and the involvement of Lyrica, here are some suggestions:Inform both surgeons about your Lyrica dosage to ensure they are aware of any potential interactions with anesthesia.Discuss your anxiety levels and comfort preferences with both surgeons.Since the cost is the same for twilight sedation and general anesthesia, consider factors such as your comfort, anxiety levels, and the surgeon's recommendation.Lastly, if you have any specific concerns or questions about the anesthesia options, don't hesitate to ask your surgeons for clarification or further details.

Mark A. Schusterman, MD, FACS · Answer

Thank you for your question.  Although most patient get adequate anesthesia with Tumescent solution (local) I would definitely opt for twilight or general if you can.  In my experience most patients are happier with general than straight local.  Hope this helps.

Hamid Mirzania, MD · Answer

It depends on a few factors including your BMI your cooperation and your anxiety levels.If you send a few pictures I may be able to help you better.

Mats Hagstrom, MD (license on probation) · Answer

Choose providers based on finding the most talented and experienced provider.
Doing liposuction of major areas using only local anesthesia can be painful to the point of being intolerable.
I perform all my liposuction procedures without general anesthesia. Small areas can be done using local anesthesia alone but major procedures are far better done using some form of sedation as well.
Doing awake liposuction procedures has a Learning curve.
Make sure your surgeon has done at least 500 a week liposuction cases and preferably several thousand before signing up.
Delivering consistent quality liposuction results is more difficult than most people believe.
The results are permanent and if done poorly they are irreversible and disfiguring.
Being a board-certified plastic surgeon with overall good reputation is insufficient to confirm that somebody has mastered Liposuction.
I would not consider anybody other than a board-certified plastic surgeon for this procedure.
To have this be a good experience and end up with quality results they’re consistent with your expectations I recommend first getting an accurate assessment and secondly focusing and finding the most talented and experience provider.
Start the process by getting a set of quality pictures of your body the same way plastic surgeons take before and after pictures.
Bring those pictures with you and use them as a reference during each consultation.
Schedule multiple in person consultations with local board-certified plastic surgeons who seem to be good at liposuction.
During each consultation ask each provider to open up their portfolio and show you their entire collection of before and after pictures.
Providers may be apprehensive to do this and will instead want to show you only the best results of their career. this is however insufficient for you to get a clear understanding of what average results look like in the hands of each provider or what results would look like on someone with your candidacy for the procedure.
Ask providers to only show you before and after pictures of previous patients who had very similar body characteristics to your own. Bring printed pictures of your own body of the areas you’re interested in having treated. For the abdomen or torso the pictures should include your body from your neck to your knees standing in an upright straight position showing your front, side and backside.
Ask providers to show you examples of excellent results, average results and results that did not turn out as well as they had hoped. everybody has a variety of outcomes at fair game for patients to ask to see them.
If there show me a pictures of people who have very different body characteristics to your own then remind them to only want to see pictures of patients who look like you.
The same amount of skin laxity, similar amounts of body fat, similar age, similar pregnancy related changes if applicable etc. etc.
You need to understand if you’re a good candidate for this procedure or not.
Most patients get liposuction are not ideal candidate. Some are and they should get the best results. Patients who are not perfect candidates may still get good results and it may still be justified to have a procedure. Patients who are poor candidates should consider not having the procedure or choosing a more appropriate procedure based on what their underlying ideology or diagnosis is.
For reference an experienced surgeon should have no difficulty showing you at least 50 set a before and after pictures of commonly performed procedures like Liposuction.
A board-certified plastic surgeon should have privileges in the accredited institution and have access to doing the procedure using different forms of anesthesia. any provider who can only offer local anesthesia should be a big red flag with the provider is not a board-certified plastic surgeon or does not have proper privileges.
Doing full body liposuction without any form of sedation is not a very good idea. The procedure can be uncomfortable but it becomes tolerable in the hands of sufficiently experienced providers with sufficient use of local anesthesia and appropriate amount of sedation.
Personally I believe keeping patients awake and avoiding general anesthesia is a better option but that requires the surgeon having the experience of doing sufficient number of Liposuction cases with patients awake to have learned how to do these without causing significant discomfort.
This is important but even more important is choosing a provider who has the skills to deliver consistent quality results and has the ability to make an accurate assessment.
Look very carefully at all before and after pictures making sure there are no contour irregularities anywhere on the treated areas.
Ask surgeons to review the pictures with you and ask them to point out exactly what areas were treated and what areas were not treated. you should then look very carefully a transition zones between treated and untreated areas to make sure they look completely natural.
In regards to the abdomen I generally recommend treating the entire torso in order to maintain an even natural been fat distribution.
At full torso technically includes upper abdomen, lower abdomen, love handles all the way down to the top of the hip dip, waist, fall back and under arms all the way to the side of the breast. 
There is no right number of consultations someone needs to find the best provider. The more consultations you have the better you’ll get at having plastic surgery consultations. You’ll also get more insight into your candidacy and it will eventually get better at vetting plastic surgeons regarding their skill and experience.
Simply being a board-certified plastic surgeon with overall good reputation and years of experience it’s not sufficient to confirm that somebody has mastered Liposuction.Doing liposuction well on a consistent basis with the ability to make an accurate assessment and accurately predict what results will look like it’s far more difficult than most people believe. Most plastic surgeons think they’re far better at Liposuction and they actually are.
The number of providers who truly mastered this complex procedure is relatively small and intelligent patient to want to minimize having any negative experience should be adamant about provider selection and go through a rigorous vetting process.
Take notes during each consultation specifically regarding both quantity and quality of before and after pictures. take a note about what percentage of before and after pictures where a previous patient who had similar body characteristics to your own.
You should also take notes about the overall thoroughness of the procedure regarding all aspects of a plastic surgery consultation like medical history, physical examination, assessment, recommendation of treatment including alternatives, what the treatment experience will be like, preparation for surgery, recovery, revision rates, complications including the rate of complications and how each one is managed etc. etc. 
The type of equipment used for liposuction is not particularly important.
The type of anesthesia is important if someone does not have sufficient skill and experience to get patients through the procedure comfortably.
If you have doubts then you’re probably not in the hands of the right provider.
You should also be able to ask to talk to previous patients who went through the procedure and had similar areas treated to talk to them candidly about what their experience was like.
Considering the permanence and potential negative impact of Liposuction patients should probably be far more selective and careful with these decisions than they think they need to be.
In the end there are only two variables that matter. They are patient candidacy and surgeon skilled.
Continue having consultations until you feel very comfortable you found the right provider for your needs.
Avoid virtual consultations whenever possible.
I do not recommend anybody travel long distances for elective surgical procedures unless absolutely necessary.
Good luck,
Mats Hagstrom MD

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