IV Sedation or General Anesthesia for Liposuction and Fat Transfer?

Don't be scared of general anesthesia. General anesthesia actually give the anesthesiologist the most control over your body, which can lead to a smoother surgery. However, in many cases IV sedation is appropriate as well. The anesthesia decision should be made between you, your surgeon and your anesthesiologist. Good luck with your surgery.

Dear Itecdh
The safest form of liposuction is pure tumescent liposuction.
The key is dilute local anesthetic that is slowly infiltrated into the tissue. Then tiny cannulas are used to remove the fat. Fat transfer can be performed in exactly the same way with great results. However, this procedure is time consuming. The same liposuction that can be done in 45 minutes under general anesthesia could take about 3 hours to perform under local simply because doing the procedure more slowly makes it more comfortable.
This means in a single day performing tumescent liposuction, a surgeon will do two cases. Under general anesthesia, 5 cases can be done in the same time. This creates a huge financial incentive to perform liposuction under general anesthesia. However, the rate of death from liposuction is about 1 in 5000 cases when it is performed under general anesthesia. Compare this to the much lower mortality of liposuction performed under local which is estimated at about 1 in 500,000 cases. This is why I stopped performing liposuction under general anesthesia.
In looking at IV sedation versus general anesthesia, it is unclear from existing studies whether IVsedation is safer than general anesthesia for liposuction. What is clear is that the act of intubation is stressful and causes a catecholamine release. These are the chemicals responsible for the fight or flight response. The stress created by these drugs at the time of intubation for general anesthesia is measurable even two years later in the form of an increase rate of mortality.
So, is general anesthesia safer than IV sedation? This is a more difficult question. IV sedation is much more difficult to perform than general anesthesia. Patients can be placed on auto pilot with an anesthesia machine reducing the opportunity for errors in human judgement. IV sedation requires constant vigilance on the part of the anesthesiologist. However, I believe that almost any cosmetic procedure can be done better with a great IV sedation. The key is to recognize that a great IV sedation is an art form.
If your anesthesiologist has ADD or needs to read the Wall Street Journal or Twitter during your surgery, you are probably safer having a general anesthesia by such a character.

IV sedation can be very ight or deeper, usually performed with an anesthesioogist for greater safety.
Beyond the excellent safety concerns about having a half asleep patient on their stomach, patient tolerance for discomfort and awareness of the surgery are important. For a larger case (and for many patients even for a smaller one), do you really want to be awake and experience the surgery?