Under Local Anesthesia, is the Tumescent Fluid Injection Painful?

Liposuction when done by an experienced doc who knows how to inject the tumescent anesthesia is almost totally painless.  He/she should use a 30 g. needle to do the tiny skin injections slowly which numb up the skin and which don't hurt. (Derm Surgeons are especially adapt at this but any specialty can do a good job if trained well at it).  Then he would go through these spots to inject the fat layers under the skin and that is also almost painless.  Your experience should be a pleasant one.

We have our patients all watching Blu Ray 3D- DVD movies on a fancy headset which makes it seem so cool IMAX during the whole liposuction procedure. We make it a fun experience for all our patients. You are also to be commended for choosing the safest liposuction and hopefully will get the best results possible since your doc can stand you up and put you in all sorts of positions to fine tune the results. Hopefully he will be using the micro canulas which give the best and smoothest results possible and is staying away from some of those laser lipo machines which can have a tendency to cause dimpling, puckering and burns of the skin. Most docs do a little oral sedation or very light IV sedation with their tumescent anesthesia which is fine and often helpful in larger cases.  We all want you to have a great experience and tell all your friends!  Sincerely,

David Hansen,MD

                  Tumescent liposuction represents a significant advance in the management of localized fat collections.  When this technique is utilized with local anesthesia alone the response varies from patient to patient.  The majority of patients appear to do well and have good results especially when smaller amounts of fat are removed.  Unfortunately, we frequently see patients who have had significant pain and discomfort during the injection process when local anesthesia is used alone.

                  For this reason, many surgeons supplement local anesthesia with I.V. sedation or general anesthesia to minimize pain and discomfort during the procedure.  When utilizing this approach patients can have more fat removed and avoid multiple procedures.  The procedure is more comfortable and avoids break through pain which can occasionally occur with local anesthesia alone.

                  It’s important to realize that all surgical procedures and anesthetic techniques have risks.  This is true whether local anesthesia, I.V. sedation or general anesthesia are utilized.  Most surgeons who perform tumescent liposuction agree that the anesthetic technique utilized is less important than the use of a certified operating room and the presence of an anesthesiologist.  In other words you don’t want your surgeon to be your anesthesiologist.

The local anesthesia injected into the skin prior to making the incisions is, for most patients, minimally uncomfortable. These injections do nothing to blunt the sensation of the tumescent anesthesia as it anesthetizes the fatty tissue. How much feeling you have is a function of the ingredients of the tumescent formula, how quickly it is injected and what your pain tolerance is. I have experimented with different formulas for anesthesia and have found that no matter what is done to minimize discomfort, some patients are very uncomfortable and others find it minimally bothersome. The real stimulation comes from the liposuction and based upon my experience most patients will have intermittent discomfort in varying degrees of intensity. The more fat that is removed or the more fibrous the patient's fat - the more likely they will experience pain. Dr Harrell

Dear Enzo1226,  In most patients, the injection of local anesthesia into the skin is the most painful part of the procedure though you may at times feels pressure and/or a small bit of pain as the tumescent solution is being injected.  Once the tumescent fluid has been injected, waiting a short period of time for it to take full effect will help decrease or eliminate any pain you may experience from the liposuction in most areas.  Some regions are harder to numb with just tumescent fluid and may required more anesthesia in order for the liposuction to be performed comfortably and safely.  Like so many other things in surgery, choosing the right technique and how it is applied is what makes the difference in obtaining a comfortable experience for the patient and obtaining a good result.

Realistically, you can expect some discomfort with procedures done under local anesthesia only. At the minimal, this would be similar to going to the dentist and having local anesthesia injected.

Be very careful about promises made that sound too good to be true...

Best wishes.

While local anesthetic can be used during liposuction, I think patients are still uncomfortable and if they are uncomfortable, then I can not do my best work. It is usually best to be performed at least with sedation.

Patients frequently refer to "local" anesthesia for what we refer to as intravenous sedation.  Obviously, straight local into the incision sites is different than IV sedation.  You cannot expect a pain free experience.  The local anesthesia injections do hurt for a brief period of time and may not completely numb the underlying area.  Before undergoing any liposuction under straight local, I'd encourage you to speak with your surgeon in greater detail about expectations and also to see another plastic surgeon in consultation for an independent evaluation.  If it sounds too good to be true, it is frequently too good to be true!