Is general anesthesia a must when getting a BBL?

It is not a must, but local anesthesia alone is not very effective in allowing the patient to remain pain free and calm during the procedure.

Many surgeons do use a traditional general endotracheal anesthetic to perform a BBL. This means you are asleep, with a breathing tube, usually on a ventilator, and many surgeons position you prone (face down) on the operating table. This is a traditional method used by many plastic surgeons including experts in the field. My own practice is to have patients asleep, but using an IV infusion, avoiding paralysis, an endotracheal breathing tube, gas, and avoiding prone positioning in surgery (my patients start off positioned on their back and are then turned from side to side during surgery). I consider this a "goldilocks" type of anesthesia because you are asleep for the surgery but are still breathing on your own. It is even safer than a traditional general anesthetic because mechanical ventilation (breathing machine), gas, and most importantly, paralysis are eliminated. You can read more at my website if you wish. You are wise to be concerned about the type of anesthesia because this is a very important consideration when having surgery of any type.

Yes, BBLs are generally done under general anesthesia. In these procedures, general anesthesia is usually safe and best with regards to patient comfort.