Is liposuction under local anesthesia painful? Is it safe? Why have there been death incidents in the past year using local?

Thank you for your question.  To make a liposculpture  there is some many  ways to apply anesthesia, can be  local with  sedation, general or BPR, this can be determined in the anesthesiology  evaluation.I hope my answer will help you to your question.Before undergoing any surgical procedure, please seek a board certified plastic surgeon.

Liposuction can be performed with local anesthesia, local anesthesia with sedation, or general anesthesia. Patients have to be properly selected. Patient death as a result of liposuction is extremely rare when performed by a properly trained board-certified plastic surgeon.

When using tumescent techniques, there is a formula used with calculates how much local anesthetic can be used.  If epinephrine is used then the amount of local can be increased.

Liposuction is a very safe procedure so long as one has ensured that the procedure and patient have been properly selected.Liposuction of small areas can be safely done with local anesthesia.  IF one is considering large or multiple areas to be liposuctioned it will be safer and easier for the patient to consider a general anesthetic.  Your plastic surgeon can asses and suggest what is right for you.

It takes a very specific patient to be able to tolerate liposuction under local anesthesia. This procedure can be lengthy, because the surgeon needs to inject the tumescent solution very slowly. Tou need a very patient patient. Deaths have occurred when overdoses of lidocaine were administered or too much fat was removed without regard to changes in fluids and electrolytes in the body. Most if not all board cerrtified plastic surgeons should be aware of these risks and know how to prevent these complications.

Liposuction under local is safe. I have performed several hundred over the past few years with a lot of success. Good luck.

Thank you for your question. Many plastic surgeons believe that liposuction using local anesthesia, called "tumescent" anesthesia, plus a light sedative medication given by a pill, can be far safer than using a general anesthetic. It really comes down to choosing the right patient, and limiting the number of areas to be treated. I have had a lot of success in keeping patients very comfortable and essentially pain-free during the procedure with this approach. Of course, nothing is without risk, so please ask a nearby Board-certified PS for advice. Best wishes.

Dear foreveryoung908,

Thank you for your clinical post. Liposuction is the most common cosmetic
plastic surgery performed in North America.
Last year well over 1,000,000 liposuctions were performed. Liposuction can also come with some complications
if proper patient selection and safety is not applied to the procedure. You are very fortunate in the Province of
Ontario only certified surgeons generally plastic surgeons are allowed by law
to perform liposuction surgery. A
certified plastic surgeon is trained in both surgery and the principles and
application of plastic surgery.
Liposuction needs to be administered judiciously and not as a weight
loss technique but as body contouring.
The use of tumescent local anesthesia is very safe when administered by
a certified plastic surgeon and a milligram per kilogram per dosage is
well-known to those plastic surgeons that are certified and trained in the
science and art of liposuction.

All liposuction surgeries are performed in certified surgical
facilities licensed by the Province of Ontario and are performed by certified
plastic surgeons. Having said that, even
liposuction has complications and a very experienced and certified plastic
surgeon will tend to minimize that by ensuring you have enough intravenous
replacement for the combined aspirate that is removed and ensuring that no more
than 5 litres of combined aspirate is removed at any one session if the
procedure is to be performed as an outpatient.
In my plastic surgery practice I’ve been performing liposuction for over
20 years. Any time I’m removing more
than 2 litres of fat I will keep patients overnight for 24 hours for constant
monitoring, anticoagulation, thinning the blood and use of sequential compression
garments which keeps the venous blood moving at all times. One of the rare complications of liposuction
is deep venous thrombosis and pulmonary emboli and your certified plastic
surgeon will know the techniques to minimize this. Local anesthetic is common for a small zone
or multiple small zone liposuction, but when large or multiples on liposuction
is performed many plastic surgeons will advise use of an anesthesiologist to
administer IV sedation or general anesthesia.
And, again, when larger volumes are removed overnight 24 hour stay with
constant monitoring IV replacement and blood thinning is common.

I am not aware of any deaths in Ontario in the last several
years. The last death was unfortunately
multiple zone liposuction performed under general anesthesia with an
anesthesiologist present, but was performed by a non-plastic surgeon, in fact,
a family physician. It was a result of
this case that the Province of Ontario and the College of Physicians and
Surgeons of Ontario instituted astringent laws and regulations about who can
and cannot perform liposuction and plastic surgery.

Your concerns around safety are valid. You should articulate these in your
consultation discussions with your operative certified plastic surgeon. Select a physician with lots of liposuction
experience and I think you should be able to achieve an excellent aesthetic
result safely and effectively.

When tumescent local anesthesia is administered in the right
dosage and enough time has elapsed for it to anesthetize the area usually 8-10
minutes then the liposuction procedure itself is usually painless.

All of these issues and concerns will be raised in your
consultation and thorough research and selection of your upper plastic surgeon
is critical.

There are several types of liposuction. The more modern versions deploy energy to
gently liquefy the fat and stimulate skin contraction, these more modern
liposuction techniques include SmartLipo (the use of internal laser
coagulation), Vaser Lipo (the use of gentle ultrasonic waves) and BodyTite (the
use of electrical radio frequency energy).
These more modern techniques will coagulate and liquefy the fat prior to
aspiration, seal off small blood vessels to minimize risk of bruising and
generally have less swelling and pain and enhance skin contraction for better
contour. I would definitely recommend
seeking out practices with more modern approaches to liposuction than older
microcanulla tumescent techniques.

I hope this information has been of some assistance and best
of luck.

For more information, please review the link below.

R. Stephen Mulholland, M.D.

Certified Plastic Surgeon

Yorkville, Toronto