What's the pros and cons of liposuction under general anesthesia and local?

Question

Is it true that local is worst and you end up with holes in your body and not proportionate? Are the results of both procedure equally good?

Emmanuel De La Cruz, MD · Answer

Hello andreamillanblando, 
I appreciate your questions! Depending on the volume of fat to be removed, cosmetic surgeons may performed liposuction with either local or general anesthesia. I typically use general anesthesia when performing large volume liposuction procedures (beyond 4-5 Liters). Overall, general anesthesia is very safe for most patients. Under general anesthesia, the anesthesiologist or nurse anesthetist remains with the patient throughout the procedure and carefully checks the patient's heart rate, electrocardiogram, blood pressure and oxygen delivery (pulse oximetry) at a minimum of five-minute intervals. On the other hand, limited volume liposuction can be performed local using tumescent anesthesia. Contour irregularities (such as indentations, and/or fibrosis) are not associated with local nor general anesthesia. Among other factors, the risk for contour irregularities depends on the liposuction technique utilized. In this respect, VASER Liposuction is clinically proven to cause 53% more skin retraction and the risk for contour irregularities is significantly lower with the use of the VASER liposuction machine relative to other traditional liposuction methods. Request an in-person consultation with an experienced plastic surgeon to assess your candidacy for VASER Liposuction and discuss your specific needs and cosmetic goals. Best regards! Dr. De La Cruz.

Jason Emer, MD · Answer

General anesthesia allows for more fat removal and body contouring. For best results, I recommend a hi definition procedure like VASER liposuction. I use VASER HI DEF with ThermiRF and fat grafting to get the most fat removal, skin tightening, contour and definition. This combination will give you the most toned result. I recommend getting a formal evaluation with a hi definition physique expert. Best, Dr. Emer

Kenneth Hughes, MD · Answer

Limited liposuction can be done under local anesthesia.   You 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.   For this reason, general is a better option for my patients.   I do not use local exclusively unless a small area of liposuction is planned.
Kenneth Hughes, MD, Board Certified Plastic SurgeonLos Angeles, CA

Brad M. Gandolfi, MD · Answer

As with all things, there are trade-offs.
Local-only liposuction allows patients to avoid any side effects of general anesthesia (nausea, blood pressure swings) and the cost of an anesthesiologist. So what are you trading? Comfort and likely results. First, comfort can be a challenge with local anesthetic only. More numbing fluid must be administered and it must be administered slower, which can increase the operative time. Although most people can tolerated the procedure, some cannot, and I do not know anyone that has enjoyed the procedure. Additionally, I cannot be as "aggressive" with my fat removal with an awake patient. 
For smaller areas or targeted liposuction, local can be used effectively. For larger liposuction procedures it is my preference to have general anesthesia or at least IV sedation.

Tim Sayed, MD, MBA, FACS · Answer

Lipo can be done under local (often with some oral sedation) or general anesthesia, depending on the areas being treated, surgeon technique, and other factors. The general advantages of local are:1. No need for general anesthesia, with less risk of blood clots in theory2. Patient can move around and change positions (including being upright in some circumstances) to allow the surgeon to see possible differences with gravity3. Recovery is faster in terms of not needing to overcome side effects of general (nausea, drowsiness, etc.)However, there is a risk of lidocaine toxicity which requires a clear understanding of maximal volume of local anesthetic that can safely be used, and this may limit how many areas can be treated in one surgery. This in turn may result in needing more than one operation. The surgery also may take longer because the surgeon may not be able to be as aggressive and may need to stop periodically to assess your comfort and add more local. I find this tedious for large areas and believe that general anesthesia is preferable for large areas and BBL/fat transfer cases for sure. With general anesthesia, I can be very aggressive and get a more impressive change. Some dermatologists and other specialists who are not actually plastic surgeons may not have facilities/resources for general anesthesia and in such cases, local will be the only option.

Ethan Philpott, MD · Answer

There is no question that you can do a better job with general anesthesia.  You should probably be concerned about places that only offer local anesthesia for liposuction.

Susan Buenaventura, MD, FACS · Answer

Be sure you are seeing a BC plastic surgeon and that you have the choice of the hospital or office operating room for you surgery.   If you are only offered office and local anesthesia, you may not have an ASPS certified plastic surgeon.  Limited liposuction can be done under local anesthesia and I usually recommend general anesthesia to allow maximal results with maximal patient comfort.

Ronald V. DeMars, MD (Retired) · Answer

General anesthesia on a healthy patient is extremely safe when administered by a board certified MD anesthesiologist. We do not perform liposuction under local anesthesia. I have found most facilities that use local do so because they do not have the ability or staff to give the patient a general anesthesia.

What's the pros and cons of liposuction under general anesthesia and local?

Answers (8)

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