Extended TT w/lipo - sedation question

Thank you for your question about the type of anesthesia for your extended tummy tuck with liposuction. It’s great that you’ve consulted with multiple surgeons to explore your options and find a doctor you’re comfortable with. Your concern about the choice between twilight anesthesia (sedation) and general anesthesia is valid and worth exploring.

Some doctors prefer to perform procedures like tummy tucks and liposuction under twilight anesthesia with spinal blocks. This approach can be effective and safe when performed by an experienced surgeon and anesthesia team. Twilight anesthesia typically costs less than general anesthesia because it requires fewer resources and may allow for quicker recovery immediately after surgery. Additionally, it can avoid some risks associated with general anesthesia, such as the need for intubation.

However, there are limitations to twilight anesthesia for larger procedures like an extended tummy tuck with extensive liposuction. Twilight anesthesia may not provide the same level of relaxation and comfort as general anesthesia, particularly for longer surgeries or those requiring muscle repair. Under general anesthesia, the patient is completely unconscious, which allows the surgeon to work without concern for patient movement or discomfort, especially during complex procedures like muscle plication.

In my practice, I only perform large surgeries such as tummy tucks and liposuction under general anesthesia. This ensures the patient’s comfort throughout the procedure and allows me to achieve the best possible results without interruptions or limitations. While general anesthesia carries some risks, these are minimized when it is administered by a board-certified anesthesiologist in a fully accredited surgical facility. The benefits of a completely relaxed and controlled surgical environment often outweigh the slightly higher cost of general anesthesia.

Ultimately, the choice comes down to the surgeon’s preference and comfort level, as well as your confidence in their approach. If you are uneasy about having your procedure done under twilight anesthesia, it’s worth discussing your concerns with the doctor you’re considering. Trust and comfort in your surgical plan are essential for a positive experience and outcome.

Sincerely,
Dr. Katzen

Thanks for your question! I prefer GA for the comfort of the patient and the advantages to me as your surgeon. However, everyone has a different reason for doing what they do. If you have met with 15 people and finally found one you like/trust, I'd go with your gut. Best of luck!

It is impossible to numb enough for a tummy tuck to be able to do a good job with the muscle tightening and control it's safety.
Liposuction can be done under local anesthesia and a bit of sedation.

Dear BKNY718,
tummy tuck is a major surgery and it requires adequate sedation and relaxation. Most surgeons would recommend general anesthesia. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

if done by a board certified anesthesiologist general anesthesia is extremely safe. almost all board certified plastic surgeons would use general anesthesia. First, this is a BIG procedure and needs to be done safely and correctly. One crucial component is repair or tightening of the abdominal muscles. This is best done if you are completely relaxed. This requires the use of a paralytic which requires general anesthesia. Not using general anesthesia would compromise your final result in my opinion.

During an abdominoplasty, the muscle fascia often is getting plicated/ tightened. With general anesthesia, patients get muscle relaxation allowing the surgeon to complete the plication during the tummy tuck. Under twilight anesthesia/spinal, patients breath on their own. While with general anesthesia, the airway is protected. Patients are often nervous about anesthesia. Patient safety is so importand. With a good medical history and family history most patients tolerate GA.

I don't know any great surgeons that use 'twilight' or spinal anesthesia for body contouring surgery, both of which can be as or more dangerous than general anesthesia. The bottom line is general anesthesia is thousands of times safer than driving in a car (not an exaggeration) if you have no premorbid conditions, so there is no reason not having a board certified anesthesiologist administer general anesthesia in a fully accredited ambulatory surgery center.

Thank you for your question about tummy tuck and liposuction under sedation. Your consultation experience shows how slow the process of change is in surgery and surgical anesthesia. In residency training, all major cases in plastic surgery are done under general anesthesia. Surgeons in private practice continue that practice because that is all they know. It is a misconception that it is safer, and surgeons who are only familiar with this approach are suspicious of those who do not do the same (are they plastic surgeons? are they board certified? and so on). As a board certified plastic surgeon for over 30 years, I have been doing ALL my major surgeries including tummy tucks, VASER Hi Def Lipo 360, all breast surgeries, arm lifts, thigh lifts and others under deep (not twilight) intravenous sedation ( the patient is breathing on their own, no tube in the windpipe, not paralyzed) and tumescent anesthesia. I used to use spinal or epidural anesthesia in the past, but I abandoned that practice many years ago due to the extra time it took before surgery and after for the patient to regain feeling and strength in their legs. Deep intravenous sedation is safe, less issues with postoperative nausea, no brain fog for 24+ hours and patient does not have to spend 2-3 hours in post surgery recovery room. Matter of fact, my patients are ready to leave the office 20-30 minutes after surgery. It is encouraging to see, that now some of the training programs are teaching this method to their residents. It's all about patient safety and don't be dissuaded by entrenched rigid thinking. Good luck with your surgery.

Spinal anesthesia can cause vasodilation and can lead to excessive bleeding, if liposuction is done. It may be possible to do the tummy tuck but I do not recommend spinal anesthesia for liposuction, particularly circumferential.

Best Wishes,

Gary Horndeski, M.D.

As the last consultation you had was the only one out of 15 consults that you’ve had who stated that they do not use general anesthesia, this should make you realize that the vast majority of people who have a tummy tuck with associated liposuction of the flank and back, have the procedure done under generally anesthesia for safety reasons and so the experience is good for you. Small procedures, such as a mini tummy, tuck or small areas of liposuction can be done under locally anesthesia with sedation quite easily. However, as you’re having an extended abdominoplasty with associated extensive liposuction, I believe your best experience would be under general anesthesia. Best wishes.