I do 95% of liposuction and fat transfer, including Brazilian butt lifts, without general anesthesia. Learning how to keep a patient comfortable is an art, and there's a real learning curve. During my training, we put everyone to sleep with general anesthesia for all liposuction. It is simply not necessary once you learn how to keep people comfortable with local anesthesia.Conscious sedation is the ideal.As plastic surgeons, we often preach seeing board-certified plastic surgeons. Some of the biggest improvements in liposuction have come from our dermatology colleagues.Dermatologists can generally not get privileges in formal operating rooms. In order to do liposuction, they figured out how to successfully do it while keeping patients awake.The greatest contributor to this has been Dr. Jeffrey Klein.Once I converted away from general anesthesia, I am convinced that this is a procedure better done with patients awake.There are many many reasons.The patients can move and hold different positions during the procedure. This is of great benefit in order to obtain better results. Think of us using straight instruments on curved bodies. Patients have less nausea and vomiting after the procedure when general anesthesia is not used. It's safer. It's less expensive. I have done over 2,000 liposuction procedures including fat transfers on awake patients.The ideal is conscious sedation.Using only pain pills can be insufficient for sensitive people.Technically, the procedure becomes more difficult when done in multiple sessions.That said, there are limits to how much fat can successively be transferred into any one area during a single session.When patients need a substantial improvement in size to get their ideal shape, I often tell patients they may need to have a second procedure. At times, this make sense. Other times, it doesn't. Best of luck,Mats Hagstrom, M.D.
