Safety of 'awake' lipo? Would it be safe to undergo 'awake' lipo on the calves and knees? What are the pros & cons of awake lipo

I find results to be better when people are asleep especially for the calves although for 8+ years I did it all awake, see the video I attached. get a formal consultation with an expert as this area for liposuction requires an expert and someone very experienced.
You need a formal evaluation by an expert in body shaping and contouring to determine what is best.  Traditional liposuction awake and smart liposuction are old methods and do very poorly for tightening skin or significant skin tightening or contouring.  Small problem areas can be improved slightly by these methods.  The best in body contouring not only removes fat with energy devices like VASER ultrasound but also internally heat the skin with radio-frequency devices such as J PLASMA/RENUVION, InMode BodyTite, ThermiRF to heat the under surface of the skin and tighten it at the same time as fat removal. These combinations are called 4D HIDEF VASER contouring and can only be done by a well . trained body contouring specialist. At the same time fat should be harvested, PRP and stem cells added and injected into muscles or indentations/cellulite to get body shaping and contouring.  This is known as a Brazilian butt lift when you inject the fat to the buttock for contouring and lifting, but fat can also be used in areas such as the chest/breast, arms/shoulders, calves and face.  Cellulite should also be treated with cellfina, sculptra, subcision and/or fillers such as bellafill, renuva synthetic fat, or sculptra.  If skin is very loose before surgery then it will need to be removed such as lower abdominal skin (tummy tuck/abdominoplasty), breast skin (breast lift), arm skin (brachioplasty).  Overall you need a full assessment, but simple liposuction alone will not tighten skin and needs a combination of various methods -- fat removal, skin tightening, defining, fat grafting, skin removal -- to get the best in body contouring and body sculpting.  Dr. Emer.

Hello, thank you for your question. Your issue is very common and can usually be treated as an outpatient with local anesthesia and oral sedation,  with very little time needed for recovery. You can drive yourself home. I recommend you to schedule a consultation with a board certified plastic surgeon for proper evaluation. 

Liposuction under just local anesthesia may be an option if the areas treated are smaller and very well-defined. When more fat needs to be removed from different areas with significant volume, IV sedation or general anesthesia  is a much better option for patient comfort and safety. Some doctors who are not board certified plastic surgery perfom  Liposuction without Anesthesia because their facility is not certified And local laws prohibit it. Consult with a board-certified plastic surgeon in your area to explore the best options for you.

Dear Ferrarifeast,
the choice of anesthesia will depend on type of surgery, body area, length of procedure, etc. If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon and anesthesiologist. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Liposuction of small areas or limited liposuction (which includes touch-ups) can be performed under local anesthesia in an office setting. Because so much local anesthesia is required to provide satisfactory anesthesia for liposuction of the calves and knees, it may be safer and more comfortable for you to perform the procedure with light general anesthesia or sedation. It can still be performed as an outpatient but you should not plan on driving yourself home after the procedure. 

Awake certainly means different things to different people.  Whether general or IV sedation, you should be unconscious such that you don’t move or respond to stimuli.   Awake is a phrase used in NY, where is it a basis for loss of license to orally sedate a patient to create an alteration in consciousness except in an accredited OR facility.  Some surgeons cross this line using oral meds but the patient isn’t monitored by an anesthesiologist. It definitely makes the procedure less costly to cut out the anesthesia services, but isn’t as safe. The notion of presenting it as a positive is troubling and a marketing ploy.

This is something you should discuss with your board certified plastic surgeon. A lot of factors can influence local vs. general anesthesia. For example, the areas being operated on and the extent of the operation. Typically, the longer the operation, the more anesthesia, the more expensive the operation will be. A Skype or FaceTime consultation with a VASER specialist will help you get an accurate recommendation and pricing.
Respectfully, 
Arian Mowlavi MD, FACS
Realself 100 Hall of Fame Inductee