Can a mini tummy tuck be performed under local sedation?

Tumescent liposuction tightens the skin significantly if the Plastic Surgeon is aggressive with Liposuction. Smart Lipo is just a Hype and there is nothing smart about it.
Considering that you have had two c-sections, there is a high likelihood that you have poor skin elasticity, especially in the lower abdomen. Therefore, doing a mini-tummy tuck along with lipo is a very good idea. Otherwise, you will most likely have some redundant and wrinkled skin in the lower abdomen.
Although all these procedures can be done under local anesthesia, the extent of surgery would be very limited. Meaning that what a doctor can accomplish under general anesthesia is usually more dramatic than under local anesthesia.
The risks of either method are not different as long as you have an anesthesiologist. Often times, patients who are have liposuciton under local aneshtesia don't have an anesthesiologist monitoring them, and this can be a risky thing, especially that during local liposuction patient do also recieve intravenous sedative and other medications.

Liposuction is focused on removing fat from pockets of excess.  It is most successful when these areas are limited and prominent, such as saddlebags on the thighs or prominent flanks.  Tummy tucks tighten loose skin and muscles.  If your skin is loose, removing excess fat will only make the laxity more apparent.  Although Smart Lipo is heavily promoted, its results can be heterogeneous with regard to skin tightening, resulting in some areas that are tight and others that are looser.  This yields a cellulite-type appearance that is extremely difficult, if not impossible to correct.  A consultation with a board-certified plastic surgeon will allow you to determine the pros and cons of different combinations of liposuction and skin tightening.

I understand your frustrations with your stomach contour but the first question I would ask is if you intend to have children again. Having children again can undo your results. I would also ask if you’re breastfeeding. If you are, then it’s best to wait a few months after you’ve stopped before considering surgery.Your photo shows very little sagging skin. This may make it difficult to remove the stretch marks with a tummy tuck, since you don’t have much skin that can be removed. You may want to consider nonsurgical options to treat your stretch marks and see if you have success with them. As for your scars, a scar revision can be performed to reduce their visibility.

Liposuction is less invasive and quicker to recover from than a Tummy Tuck (abdominoplasty). This is because liposuction only involves removing fat from beneath your skin. Your body will cause the overlying skin to contract only to the degree it is capable, often leaving redundant skin which can be unsightly. In other words, you need good elasticity to get a good result. A Tummy Tuck involves removing redundant skin and tightening the underlying muscles. Sometimes liposuction is combined as needed with a Tummy Tuck for the best possible result. The question is whether the shape of your abdomen is affected by an excess of fat, skin, muscle separation or laxity, or some combination thereof. This can only be determined by examination, so go ahead and consult with a board certified plastic surgeon. Some of my patients elect to have liposuction first, and then opt for a Tummy Tuck if the results are not satisfying.

Great question and one we deal with every day in the office. Skin quality can range from normal to very lax and redundant. It can retain much of it's elasticity or it can be stretched and have lost the ability to retract. We see this loss of elasticity after considerable weight gain then loss or often after pregancy. The telltale signs of lax skin are stretch marks (stria). Simply put, these stria are tears in the deeper layer of the skin called the dermis. Also, your surgeon can assess the skin elasticity on physical examination.  If there are a lot of stretch marks and the skin is loose, then there are few options other than to remove the excess skin. If we remove the fat beneath, the skin will not retract and will simply hang loose. Skin excision is required when the skin is loose and has lost it's elasticity. If this loose skin is mostly below the belly button then a mini tummy tuck is a great option. For those with loose and lax skin that extends above the belly button, a full tummy tuck would be a better option. Many patients in your situation are "on the fence" and it is not entirely clear whether liposuction alone or liposuction with mini tummy is appropriate, even for the surgeon. There are three ways to approach this. First you can choose to do the liposuction and mini tummy tuck together. This will almost certainly give you an excellent result in the right hands. In my opinion, the only real downside is the scar, but this should not be much greater than the c-section scar you already have. The risk of adding a mini tummy tuck incision is quite low. Another option is to do only the liposuction based on the surgeons determination that the skin elasticity is good. The risk of this approach is the possibility of a poor result that then would require the mini tuck later. Ultimately, this is much more costly than the first option. Finally, you can agree to leave the decision to your surgeon to make intraoperatively (during the procedure). Of course this requires a great deal of trust that you hopefully already have with your chosen surgeon. Both liposuction, mini tummy tuck and the combination can be very safely performed under sedation with local anesthesia. I hope this helps.BRK

If you don't have too much saggy skin, then you may benefit from liposuction alone. There is a bit of skin tightening that occurs with Smartlipo. However I would have to see you in person to make sure you would be a suitable candidate. Local may be admininstered if you don't have too much fat to be removed.

Which procedure you choose depends on what is wrong. Consultation with your plastic surgeon will involve a full physical examination to identify the amount of loose skin, the quality of your skin and whether you have any abdominal wall laxity.Most woman who have had a pregnancy will have some laxity of their abdominal wall and may have excess skin and fat. By fully relaxing your stomach muscles in the mirror, and watching whether your tummy bulges out, you can get a sense of how lax the abdominal wall is and how much fat is behind your abdominal wall.Abdominoplasty: Uses a low incision on the abdomen to remove excess skin/fat and will tighten the abdominal wall above and below the belly button. Mini-abdominoplasty uses a slightly smaller incision in the same location, but removes less skin/fat and only tightens the abdominal muscles below the belly button. Both can be good options for patients with loose skin and laxity of their abdominal wall. Liposuction: Liposuction is used to remove fat from areas that are prominent compared to the surrounding tissues. It relies on good skin quality to work properly because the skin needs to be able to rebound after the underlying fat is removed. Liposuction performed in patients with loose skin may leave them with skin that appears even more loose, saggy, and uneven.Limited incision abdominal wall tightening: In patients who have have abdominal wall laxity, but not much excess skin, a limited incision abdominal wall tightening can be performed. The abdominal wall can be tightened using an incision that is placed low on the abdomen so that it is concealed by a bathing suit or underwear. This incision is about half the size of a full tummy tuck incision. In some situations, the abdomen above and below the belly button can be tightened. Abdominal wall tightening can lead to dramatic improvements in the waistline and the flatness of the tummy. Consultation with your plastic surgeon will help determine exactly what issues need to be addressed to help you choose the right operation.

The best procedure and surgical setting will depend on your exam.  If there is a large muscle separation then the best setting will be with a general anesthetic.  If it is more a scar revision and liposuction then that can be done in the office.  Another option is to start with liposuction alone and reserve the mini-tummy tuck option as a backup plan if the skin is looser than you would like.

The appearance of the abdomen can
be dramatically impacted by pregnancy. 
Pregnancy can result in redundant skin, weakened muscles, stretch marks,
C-section scars and fat accumulation. 
When evaluating the abdomen following pregnancy all of these factors
should be considered.  The best
results are obtained when treatment is individualized based on physical
findings.

When patients have localized fat
collections with tight skin and muscles, liposuction will usually provide an
excellent result.  When patients
have excess skin and muscle weakness, an abdominoplasty is usually
necessary.  Depending upon the
location and magnitude of loose skin, either an abdominoplasty or mini
abdominoplasty will be necessary. 
When the excess skin is confined to the area below the umbilicus mini
abdominoplasty is usually necessary.

Without being able to perform a
physical examination it’s impossible to know whether liposuction or mini
abdominoplasty would be best for you. 
Although your consulting surgeon felt that both options would be
beneficial, liposuction might not be quite as effective in addressing loose
skin.  In light of the fact that
you’ve had two C-sections, scarring shouldn’t be an issue.   It may be helpful to obtain
multiple opinions, but the final decision will need to be
yours.

Which procedure would work best for you depends on your goals.  It sounds like you do have some extra skin, so the mini-tummy tuck is the only thing that will address that.  Don't buy the hype about smart-lipo really tightening your skin.  Visit with your board-certified plastic surgeon, and they can help guide you to what will work best.

In my experience, it is an extremely rare post partum patient that will obtain the best result simply with liposuction. Usually some version of a tummy tuck gives a much better result. If you choose not to have the tummy tuck, you may want to consider Coolsculpting rather than liposuction which can give considerable improvement without the need for anesthesia and with far fewer risks and also, less expensive.