Is Local Anesthesia for Smartlipo Pain Normal?

I agree wholeheartedly with Dr. Blinski.  As a board certified plastic surgeon I generally prefer my patients to have some sort of sedation when having liposuction.  It is too difficult to get a patient completely comfortable under straight local anesthetic.  Having said that, on one small localized area I will occasionally offer local as an option provided the area again is small and the patient is adamant about having local only.  Theoretically, any surgery can be performed under straight local anesthetic but it's not always wise.  It's in the best interest of the patient to be comfortable during the surgical procedure so the doctor may do what is necessary to give the patient the results they desire...often times that simply can't be achieved without some type of sedation. 

Unfortunately, I do not think that your experience is entirely rare. You are not the first patient I have heard describe their experience this way. While Smartlipo is highly touted as being comfortably done under local anesthesia, that has not always been my experience. I think that for some smaller areas the use of local anesthesia can be reasonably comfortable. But when it comes to larger areas, particularly those that extend around the waistline and into the back, getting the patient adequately numb can be difficult and can be a limiting factor in getting the best result. This is an important issue that I discuss with any potential Smartlipo patient and I usually strongly advise patients to consider sedation or general anesthesia. The most important benefit of a Smartlipo procedure is the final body contouring result, not whether it was done under local anesthesia.   

Liposuction, with or without a laser, can be done completely with local anesthesia without the need for general anesthesia or intravenous sedation. There will be some discomfort during the placement of the local anesthetic, but it shouldn't be more than just that, discomfort, not extreme pain. I've done over 5000 local anesthetic-only liposuction procedures, and it is very rare for the placement of the fluid to be more than the level of discomfort, usually a stinging or pinching sensation that quickly subsides. To achieve a comfortable placement of the fluid requires skill, a skill that not all practitioners have. It also requires time and patience. It may take more than the 30 minutes per area that you describe to slowly place the fluid at a pace that is comfortable for you. Everyone is different and it's important to tailor what we as surgeons do to the needs of the individual patient. 

Ways to make the placement of the fluid more comfortable include:


going slow

using very small diameter cannulas

using the right strength of fluid (this is a variable that can be adjusted)

using mild pain medications (not intravenous sedation) to take the edge off the process

using Body-Jet for fluid placement is a huge advance in comfortable placement


The Body-Jet technology has made the placement of the local anesthesia fluid significanly more comfortable compared with the typical means of placing fluid. The advantage to Body-Jet is that the time required for placement is greatly reduced. What may take 30 minutes or more can often be achieved in about 10 minutes with a much greater degree of comfort.