Yes, a full vaginal reconstruction (consisting of deep vaginoplasty + perineoplasty) can be performed under awake, purely "local" anesthesia (different from "conscious sedation" which basically is "...mostly asleep..."). First designed by Dr. Red Alinsod around 2010 and adopted by myself (Dr. Michael Goodman) the same year, for many years only Drs Alinsod and Goodman performed these vaginal tightening surgeries on awake patients, under "local." Now there are several other surgeons in the U.S. and Europe, many trained by Dr. Goodman or Dr. Alinsod in our surgical training programs. Personally, I have not anesthetized ("asleep") a patient for a vaginal tightening in 10 years. WHY LOCAL? Several reasons: 1. The surgeon can do better work, tightening ideally, as (s)he can communicate with the awake patient as to optimal tightening. 2. "Local" is safer. 3. Recovery is easier, with no "general anesthesia" to awaken from. 4. Much less expensive, as no hospital/surgical center "facility fee" to pay, and no separate anesthesiologist's fee. In my case, the fees I charge are "out-the-door" fees, and include facility and local anesthesia. Hope this helps! Michael P Goodman, MD, FACOG, IF, AAACS Sacramento, CA, USA