Hello and Great Question. I appreciate the time you are spending researching this procedure. My name is Dr. Matthew J. Nykiel. I am a Board Certified Plastic Surgeon, a Fellowship Trained Cosmetic Surgeon, and a Butt Augmentation Specialist.
I think there are pros/cons: the pro of local anesthesia is that you are "awake"; this can also be a negative if you don't want to hear/see the surgery. The con is that the anesthesia is not as deep and the fat grafting portion can not be as aggressive.
Best of Luck! Please reach out if you have any further questions or concerns.
Matthew J. Nykiel, MD
Butt Augmentation Specialist
Board Certified Plastic Surgeon
I perform these types of procedures under general anesthesia. You are undergoing multiple areas of high volume liposuction along with injections deep into the gluteal muscles. This can be alot for a patient to tolerate while awake. You also run into the issue of pain control - if its too painful then the surgeon will need to injected more local anesthesia medication and there is an upper limit of how much you can inject before it becomes toxic. You should speak with your doctor and ask about his experience with local vs general, but the safe bet is general if you are healthy enough for it.
Thank you for your question and photos. The answer depends on your final goal. Do you want a sculpted look with a large amount of fat transferred into the buttocks or you want minimal results? For a sculpted look, you need intravenous sedation or general anesthesia. In my practice, if I do a "debulking" fat removal procedure, I can do that under local anesthesia only. If I want to sculpt someone's torso and place large amounts of fat into the buttocks, then I use intravenous sedation with tumescent local anesthesia. About 15% of my body sculpting practice (and this is growing) now comes from the two branded, chain liposuction facilities in my city. These are patients who thought they will save some money by not having some sort of anesthesia (they were told local is safer!), and with suboptimal results and many times disappointing results they show up in my office for correction. The unfortunate situation is that these people are very hard to correct, might need multiple procedures and they missed the best chance for a good result; first time surgery done appropriately. I do not use general anesthesia in my accredited office surgery suite, not even for abdominoplasties. I do all my surgeries under local tumescent anesthesia and intravenous sedation by an anesthetist. See a board certified plastic surgeon for an in person consultation/evaluation. BTW, the type of anesthesia should be discussed during the consultation. Good luck.
Everything is balancing risks and complications with result. Local anesthesia may be appropriate for smaller areas or in areas where less is to be removed or in patients who cannot undergo general anesthesia due to one reason or another. The more areas that are done, the more that is harvested and injected, the more likely that general anesthesia will be necessary.Kenneth Hughes, MDLos Angeles, CA
You will find that different surgeons prefer different forms of anesthesia for these procedures.
A little bit of background information.
Liposuction was initially always done under general anesthesia except for a small limited areas.
This was when almost all liposuction was done by board-certified plastic surgeon's in operating rooms.
As other medical specialties especially dermatology wanted in on the action they began experimenting doing more and more liposuction without General Anastasia.
Dermatologist as a general rule do not qualify to obtain privileges in operating rooms and I'm not recognized as surgeons at most hospitals or surgery centers.
Dermatology has evolved to wear dermatologist now call themselves dermatologic surgeons though they still for the most part cannot get privileges to do surgery in hospitals or surgery centers.
One dermatologist, Jeff Klein in Southern California did some pioneering research showing that very high doses of lidocaine can be used safely to perform high-volume liposuction with patients awake.
Once this research was published and Dr. Klein began giving instruction during weekend courses teaching doctors from various backgrounds how to do liposuction.
This open the doors to the doctors for many specialties now feeling they could do liposuction.
As medical reimbursement has been cut down to the point where it's difficult to make a living practicing medicine more and more doctors see the opportunities to make a better living doing cosmetic procedures.
So why do some doctors still use general anesthesia?
The truth is that awake liposuction relying on local anesthesia, liposuction especially high volume liposuction with fat transfer, can be painful.
The amount of discomfort varies greatly depending on the skill of the surgeon in how to place local anesthesia properly, how sensitive the patient is, what areas are treated and the adjuvant use of medications to give light or moderate sedation.
Except for small areas liposuction done with local anesthesia generally always requires some form of sedation to make it tolerable.
Even then some patients find a procedure painful and more difficult than they had anticipated.
My practice is exclusively devoted to liposuction and fat transfer.
These procedures represent 95% of all surgical procedures I perform.
I perform almost all my liposuction and fat transfer procedures using local anesthesia with mild sedation.
During my training and during my first 10 years of private practice I used to General Anastasia for these cases.
Once I began sub-specializing in liposuction and fat transfer only I saw and learned the advantages of using local anesthesia.
I now much prefer using local anesthesia over general anesthesia.
The reasons are better aesthetic outcomes, faster recovery, increased safety, less bruising, less postoperative pain and lower cost.
The best way I can describe the ability to perform proper liposuction without limiting of the procedure in anyway using local anesthesia and mild sedation is that it's an artform that takes hundreds of cases to master.
The learning curve to keeping patients comfortable throughout the procedure without General Anastasia is fairly steep.
My first hundred liposuction cases done without general anesthesia were definitely more difficult then how my procedures are now.
I was lucky to have excellent mentors and experts teaching me the subtle techniques needed to get patients through these procedures.
The local anesthesia has to be placed very precisely in all areas that are to be treated. There are safety limits of how much local anesthesia can be used.
It can be a balancing act staying within safety parameters and still keeping patients comfortable.
People perceive the procedure very differently.
Some people find it easy and aren't phased by it while other patients find it almost intolerable.
For those who are challenged by the procedure the ability to give adjuvant sedation is critical.
The doctor has to have the appropriate drugs available in the skill to admin of them safely in order to get these patients through the procedure comfortably.
There is an appropriate dose of narcotic pain medication that will get all patients through this procedure.
The balancing act as maintaining safe levels of both lidocaine and sedatives.
Awake liposuction becomes more challenging as more areas are treated during a single procedure.
Often the worst of discomfort comes towards the end of the procedure when liposuction it needs to be done on a more aggressive level to get the best results.
It's imperative that the doctor does not compromise your static outcome but rather manages the patient's discomfort appropriately throughout the entire procedure.
I have personally seen doctors limit how much fat was removed because of patient's discomfort.
This is a very unfortunate situation because patients results are compromised and this would not happen if the patient had exes to general anesthesia or deep sedation.
One of the absolute prerequisites to doing this type of work without a general Anastasia is patience.
It simply takes time to get to patients through the procedure correctly while minimizing discomfort.
This technique is not the best for doctors who are impatient and simply want to get the procedure over with.
The benefits of avoiding general anesthesia are great.
Particularly the ability to sculpt bodies properly.
I personally find it technically difficult to properly contour bodies when they're asleep and cannot hold certain anatomic positions.
The ability to have my patients move and hold certain positions during the procedure greatly enhances my ability to get the best results.
Each doctor figures out their own way and overtime figures out what works best for them.
I don't think you can say that local anesthesia is better than general anesthesia for liposuction.
It simply comes down to what each doctor prefers and how they best to do the procedures.
I have many patients come to see me because they like the fact that we don't use general anesthesia.
I would not choose your surgeon based on what type of anesthesia they use.
I would rather pick the surgeon based on their inherent skill and talent.
I would also recommend staying with doctors who have the ability to offer patients both.
For those who have very high anxiety or are very sensitive to discomfort General Anastasia may be a much better way to go.
It's generally always best to pick the surgeon not the equipment or form of anesthesia used.
Staying with board-certified plastic surgeon is generally gives patients more alternatives and an assurance of some of the most thorough training in any medical specialty.
Plastic surgeons are also uniquely qualified in not only doing the procedures, alternative procedures but diagnosing and handling any and all potential complications related to liposuction and all other procedures we perform.
While these are considered fairly safe procedures complications do you happen and it's unfortunate when a doctor performing liposuction has to just tell the patients to go to the emergency room I let someone else take care of a complication.
I apologize about my own personal bias in these statement but I believe them to be accurate and correct.
Mats Hagstrom M.D.
Both general anesthesia and local anesthesia are reasonable options for your Brazilian Butt Lift … With one caveat. Local anesthesia should be done in combination with IV sedation to make you as comfortable as possible without using general anesthesia. I offer both options of general anesthesia or local anesthesia with IV sedation to my patients. All of my patients have opted for local anesthesia with IV sedation. My patients have been quite pleased with this type of anesthesia as they like the fact that they do not have to "go under." Just as important, they've enjoyed their final results and commented they were comfortable during their procedure. I'm sure it is possible, but it will be more difficult to get you comfortable using local anesthesia alone for all the areas of liposuction you want done plus the fat injection into your buttocks. If you're the type who does not want to know what's going on during your procedure, opt for local anesthesia with IV sedation or general anesthesia. Best of luck.
That is too much to do under local anesthesia. If you're in pain, the doctor can do what he or she needs to to give the best result. You should split it up into manageable segments or have general anesthesia. If your doctor dcan not offer general anresthesia, there might be a problem
I believe you will be so much more comfortable with general anesthesia. It is certainly possible to to have it done under local anesthesia, but it will be tough on the patient due to pain, and also the procedure tend to take a lot longer. I would not recommend to have it done local. Best, Alex Kim MD