I can appreciate your frustration and how hard it is to decipher different variables when choosing to either have a procedure or not, which provider is going to serve you best including decisions like Anastasia. My answer is going to be a bit indirect at first then I will address your question spot on. Most people spend a significant amount of time learning about procedures before having surgery and wisely so. Nobody would discourage someone for getting educated about a procedure that will change your life forever. That said, the problem is where the stores of information comes from. Most patients rely on Dr.'s personal opinions, websites, posts on real self etc. to get educated. These sources are biased and sometimes highly biased based not only on the doctors opinion but often based on self promotion on behalf of the physician. I've never seen a doctor not say that the best way to perform the procedure is by using the equipment that they just purchased. I've seen this over and over with the use of VASER, laser liposuction, power assisted liposuction, closed canisters for fat transfer, processing the fat, centrifuging the fat, postoperative massage, postoperative radiofrequency treatments, compression garments and secondary compression garments etc. etc. etc. As you see and are probably aware of there are many many variables. The type of anesthesia is just one of them The question becomes which ones are important and which ones can you ignore or leave up to doctors discretion. As far as I'm concerned you can leave all of these after the doctor and focus your effort 100% I picking the best plastic surgeon you have access to. I cannot emphasize enough how important the provider is and how in relationship unimportant the other factors are. Of course for you before you've had the procedure the type of anesthesia is very important. However, three months later the type of anesthetic you had is irrelevant. This is such an important concept that it it's worth saying twice. The most important decision or variable is who does the procedure. A brief note on how to find the best plastic surgeon. In general the best plastic surgeons are busy in the operating room doing surgery not on the computer posting on social media. The best plastic surgeons have less reviews but better reviews. Being talented does not make people write more reviews. Encouraging patients to write reviews directly or indirectly with or without incentives creates more reviews. Doctors with the least manipulation of reviews will have even distributions of reviews among the different websites like real self, yelp, health grades and vitals etc. Doctors who have five reviews on yelp but 100 reviews on real self or manipulating the reviews. Now let's talk about Anastasia. Anesthesia options are general anesthesia, spinal or epidural and aesthetics, deep sedation, light sedation, or just local anesthetic. It's worthwhile mentioning that local anesthetic is used with every type of anesthesia regardless. The first question to ask yourself is does the doctor have access to all forms of Anastasia? If they don't then they are going to recommend what is available. This happens when doctors who do not have appropriate training or performing these procedures which is becoming more and more common. Hospitals and surgery centers will not grant operating room privileges to doctors who do not process qualifications to do surgeries. It is within the law for any doctor to perform any surgical procedure. Doctors were not board-certified and plastic surgery may have a difficult time getting access to an operating room with a board-certified anesthesiologist. This is one of the more common reasons doctors will recommend avoiding General Anastasia. They simply don't have access to General Anastasia. There are also board-certified plastic surgeons, like myself who have access to accredited operating rooms including the use of general anesthesia but prefer to do the procedures without General Anastasia. Earlier in my career and during my training we did these procedures only with general anesthesia. About 10 years ago I began doing liposuction procedures with my patients awake avoiding general anesthesia. There's a very real learning curve to how to keep patients comfortable for the procedure. I had excellent mentors who were hands-on teaching me these skills. To date I have performed over 7000 liposuction and fat transfer procedures. The great majority of these were done with patients awake including many many Brazilian butt lifts. You do not want a Doctor Who does not have extensive experience performing these procedures using local anesthesia doing it this way. Learning how to do these procedures without general anesthesia takes time and the something that needs to be worked on gradually starting with small areas of liposuction until the art has been mastered. The reasons I prefer to keep my patients awake for the procedure is that my results are substantially improved without general anesthesia. It is also safer, has a faster and easier recovery, gives less bruising and serves as a cost savings for my patients. The first thing to ask yourself is is your provider a board-certified plastic surgeon? Does the provider have the option of using different forms of anesthesia and has privileges to perform this procedure in a formal operating room in a local hospital. If the answer to these are no then continue your search. If you find an experienced board-certified plastic surgeon who has access to general anesthesia and privileges in the hospital to perform these procedures and chooses to keep patients awake for the procedure then that is an option and may be attractive if you were in particular do not want a general anesthetic. The procedure can be moderately uncomfortable. This varies greatly from patient to patient but as stated earlier it is highly dependent on the surgeon taking their time and having experience. The level of discomfort can easily be controlled using moderate doses of narcotic pain medication. Other medications often used are antianxiety medications and occasionally laughing gas. That was a fairly lengthy response to a simple straightforward question. I believe the information is relevant not only to the choice of anesthesia but the decision making process as a whole. Hopefully that answers your question and may perhaps serve you in the decision-making of what can be a complex and daunting task. Best, Mats Hagstrom MD
