Hello and thank you for your question. It is always an advantage to do a surgery under a local anesthetic instead of general anesthesia when possible. However, for successful placement of fat cells into the buttocks, the patient should be placed under deep sedation. Harvesting the fat cells with liposuction is easily done with just a local anesthetic with minimal discomfort. During the fat transfer to the buttocks, I always place the fat on top of the bone, in between the muscle and under the skin. Unfortunately, it is not possible to get all of those areas numb. The deep placement of the fat, on multiple levels is necessary for a quality result and for as many fat cells to survive as possible, but it is not comfortable with local anesthetic. At my practice, I have a Board Certified Anesthesiologist there to place the patients under deep sedation, not general, for the transfer part of the surgery. This allows the patient to get through the surgery without pain, as well as allows me to successfully place the fat and create the best outcome. Always seek the advice from a plastic surgeon certified by the American Board of Plastic Surgery. Good luck!