Is Oral Valium Good Sedation for Tumescent Liposuction?

Question

I am considering tumescent liposuction with oral valium sedation. I don't want general anesthesia because I am a lightweight and it takes forever to wear off. Will this be enough?

Armando Soto, MD, FACS · Answer

Hi there-

	As I find myself saying on this site and others all too often, it is very important that you maintain focus on the context of these decisions and constantly remind yourself of the goals you had when you set out on your plastic surgery journey....

	When the idea of improving your body contour first sparked in your mind, you immediately had an impression of what you wanted your experience to be like and your outcome to approximate- you want to be safe, and you want to look your very best. 

	If we can agree on this point, what I am going to say now will be easy for you to understand.

	Is it possible to perform even larger amounts of liposuction under local with a bit of sedation? YES. 

	Would I let my wife, sister, or mother do it this way? Unless it was a tiny area (like under the chin), ABSOLUTELY NOT.

	Why?-

	
		Larger volumes of local anesthetic (like those required to numb larger areas like an abdomen or thighs) will approach TOXIC levels. The fact is that the vast majority of women who have died during or after liposuction over the past ten years died because they received too much local anesthetic.
	
		In an attempt to limit the amount of local given during the procedure, the doctors who prefer to do it this way (more on them later) offer to treat one area per day, having the patient return for multiple treatments. Aside from the inconvenience of this, treating area 2 while having to see through the swelling that has formed in area 1 will compromise your doctor's ability to deliver the best outcome...
	
		There is no way to give you enough sedation or local that you are pain free. In other words, it's still going to hurt. And when it does, especially if you are sedated, guess what happens? I can no longer do my best for you- because you are moving, because you are expressing pain, and because the knowledge that I am hurting you causes stress and keeps me from concentrating on doing what you paid me to do- my best work. So what ends up happening is that you have a negative, painful experience, and then don't even look as good as you hoped because I couldn't do my best work for you.
	
		For all of these reasons, you should stay away from doctors who are ONLY able to offer you the procedure under local. The majority of doctors who tell you that local is the way to go do so because it is quite simply the only option they can offer you. Why? Because they are not surgeons and therefore do not have privileges to do the operation under anesthesia at a hospital or accredited surgery center. The best way to weed these people out is to simply ask them- if I wanted to do it under general, could you do it? Where would it be done? What if you've given me all the local you can safely and I'm still in a lot of pain?


	Again- to summarize, if your goals are to be safe, and to have the very best outcome possible, you are much better off dealing with a little hangover from the more safe general anesthetic so that your Board Certified Plastic Surgeon can do his best work for you.

	Remember- Board Certified Plastic Surgeons have the credentials and ability to do liposuction under any kind of anesthesia known to man- there is a reason that the vast majority of us still think it's in our patient's best interests to do all but the smallest of areas under more than local with oral sedation.

Ronald J. Edelson, MD · Answer

Liposuction can be done under either general anesthesia or local with sedation. Tumescent liposuction does a very good job of numbing the areas to be treated and some oral Valium might be sufficient particularly if you are having a few small areas done as opposed to large volume and multiple areas. You should discuss the matter with your surgeon to determine whether this is a good option in your case.

David Hansen, MD · Answer

Liposuction under local tumescent anesthesia has become the golden standard now and is the safest liposuction with usually the best results for obvious reasons. You want to be able to stand and rotate and put the patient in all positions to fine tune the liposuction results. And since you are comfortable, it is easy to do. Oral sedation with valium or lorazepam is routinely given in most cases and is enough to have a good experience during the procedure.  Some patients will benefit by tiny doses of IV sedation of demerol and versed.  You are still fully awake and comfortable and able to do anything the surgeon requires of you without the risky and sometimes scary recovery of general anesthesia. A good tumescent injector can make sure you have a great painless experience.  Sincerely,

	David Hansen,MD

Robert L. Kraft, MD, FACS · Answer

Oral sedation is not as effective as intravenous sedation. In NY, any kind of sedation, whether oral or IV, which affects consciousness can only be performed in an accredited facility. You haven't specified which body area you propose for liposuction. There is certainly a distinction to be drawn between a small liposuction of the chin and jowls and a full suction of the abdomen. As a board certified plastic surgeon, I do not want a patient standing under the effects of valium or another sedative!! See a plastic surgeon with an accredited facility who can provide you with various options, all within the standard of care and legal requirements rather than a practitioner who is limited to no or minimal sedation to get the full picture.

Steven Wallach, MD · Answer

This is always a question that comes up. Yes, liposuction can be done under straight local, however it can take alot of time to slowly inject the local and then perform the liposuction which still may be uncomfortable for you. Valium is sometimes used in this setting to ease anxiety. However, if my patient is at all uncomfortable and I have to manage their discomfort at the same time as perform a meticulous procedure to give the patient the best result, I think that in some ways the procedure results may be compromised. I prefer the patient to be completely comfortable using a board certified anesthesiologist while I perform the procedure. I look at it like a race team, there is a driver and the pit crew. The dirver does not service his car in the pit he is focused on the race.( or something like that?)

Samir Shureih, MD · Answer

It all depend on your tolerance to pain, and the amount of liposuction to be taken out and the number of sites that need liposuction.

	Remember liposuction is a major procedure that needs to be done by a board certified plastic surgeon, in an accredited facility. That ensures safety of the patient, and fluid management.

T. Wayne Day, MD · Answer

Yes you should do fine with Valium or something like it for sedation during tumescent liposuction. I prescribe lorazepam which is like Valium. Also, I have my patients take one at bedtime the night before. Otherwise, most people are so keyed up, they can't get a good night sleep otherwise. Plus, it gives them a chance to see how benign and safe the medication can be.

Is Oral Valium Good Sedation for Tumescent Liposuction?

Answers (7)

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