Tummy Tuck w/ lipo using IV sedation and a local?

Question

I'm scheduled for TT with lipo to hips back flanks using IV sedation and a local. I'm scared I will wake up during surgery. Is IV sedation enough? And what is the local?

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question.   In my practice I perform tummy tucks using general anesthesia with a board-certified MD anesthesiologist administering anesthesia.  I frequently perform muscle plication during this surgery and general anesthesia is needed for this.  A tummy tuck can be done through a low and short
incision, all completely below the bikini line. 
The belly button can be designed to look natural and have no scars on
the exterior.   Your muscles can also be
plicated resulting in a flat abdomen. 
Make sure you specifically look at before and after pictures of
real patients who have had this surgery performed by your surgeon and evaluate
their results.  
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Kenneth Hughes, MD · Answer

You should be monitored very closely during surgery by a board certified plastic surgeon, and board certified anesthesiologist so do not worry about waking up.  Although the TT can be performed under local anesthesia, this procedure can be extraordinarily painful for the patient.  The patient's pain threshold and anxiety level should be taken into consideration.  You want the most dramatic transformation possible, and you also do not want to be in pain during the procedure so that the surgeon must stop the procedure or do less than what is necessary.  If you move or tighten your abdominal muscles, you may compromise results.Kenneth Hughes, MD, Board Certified Plastic SurgeonLos Angeles, CA

Rohit Jaiswal, MD · Answer

I have only done this combination of procedures under general anesthesia. That being said, as my colleagues below have mentioned, it is possible to do this under IV sedation and local anesthesia safely and effectively. If your surgeon has performed this before, is comfortable with doing it through sedation, and most importantly is board certified or board eligible by the American Board of Plastic Surgery, then this should be a safe procedure. 
However, it is also important to inquire about the board certification of the anesthesiologist as well as the accreditation of the facility where the surgery is being performed. It should be an accredited outpatient surgical facility that is either part of a hospital, has AAAASF certification, be certified by the Joint Commission, AAAHC certified, or be certified by the state department of health you live in. 
The "local" that is typically used in liposuction procedures is called a tumescent fluid or wetting solution. It is a mixture of saline solution, a local anesthetic such as lidocaine or bupivicaine, and epinephrine to help limit blood loss.

Christian Subbio, MD · Answer

I think the answer depends upon who was performing the procedure.  If it is a board certified plastic surgeon (american board of plastic surgery)  with extensive experience in this technique, then it is likely okay.  If it is a "cosmetic Dr. " certified by some bogus "cosmetic operating" board, then you could be in trouble.Look into this!
Dr. SubbioBoard-Certified Plastic SurgeonNewtown Square/Philadelphia, PA

Ricardo L. Rodriguez, MD · Answer

Although tummy tuck surgery can be performed under either IV or General Anesthesia, I prefer the use of IV anesthesia (administered by board certified Anesthesiologists) because patients experience much less nausea and a quicker recovery. A ‘tumescent solution’ numbs the area, the tissues will be really numb and there will be very minimal blood loss. See the web reference to learn more.
Best wishes!

Steven Wallach, MD · Answer

Well, depending upon how much sedation is being given, it can be considered general. Good luck. I prefer general for a Tummy tuck.

Kris M. Reddy, MD, FACS · Answer

The first step is understand why iv sedation is recommended for you. If it is simply because that is the highest level of anesthesia that a Center can do, then you should be cautious. The surgery should only be performed Board Certified Plastic Surgeon with anesthesia performed by an MD Anesthesiologist. Consult in person with an experienced and expert board certified plastic surgeon to understand your options.

Paul C. Dillon, MD · Answer

This combination would be acceptable for my practice if the area to be excised is small.  I would discuss your concerns with your physician.  With the proper combination local with iv sedation can be very effective.  In my experience if I need to do muscle plication, I have to use a general anesthetic. I am giving you my personal experience.  The experience of your surgeon may be different so make sure you discuss your concerns with your doctor.

Stefan Rene Adair, MD · Answer

Abdominoplasty is always performed under general anesthesia in my experience. One requires an absolutely sterile environment and the ability to deal with unforeseen problems should the abdominal cavity be entered. I would seek consultation with a board certified plastic surgeon (ABPS) and be sure to review credentials and before/after photos.

Andrew Gear, MD · Answer

The use of IV anesthesia (typically Propofol) along with tumescent anesthesia (lidocaine + salt water) placed into the soft tissues is a valid technique for abdominoplasty.  Like Dr. Rodriguez, it is my preference for a litany of reasons including reduced nausea and vomiting, faster recovery and a theoretical reduction in the rate of thromboembolic events.  That aside, general anesthesia is safe.  It is dealers choice honestly.  You do not have to worry about waking up.

Tummy Tuck w/ lipo using IV sedation and a local?

Answers (12)

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