Dr. Marwan Khalifeh: Patient is now lying down. He's still wide awake. We're not showing his face, but can you just tell us you're wide awake?

Male Voice: I'm wide awake.

Dr. Marwan Khalifeh: Okay. So first thing obviously he would feel that. You would feel a little stick here. This is my first incision point right at the armpit. I chose this location because it's very hidden, with the arm folds and it's also a thin skin that heals very well. Because we're doing direct excision, I'm going to also make an incision here which we can use for the numbing portion. So right now, we've numbed up the skin. Did this hurt sir?

Male Voice: No, not at all.

Dr. Marwan Khalifeh: Okay. All right. Now the next step, you'll feel a little puke here, a little puke there. I'm making tiny little incision in the skin. This is the numbing process for liposuction and gynecomastia. This is a tumescent cannula. It's not a needle. It's not sharp so it's very hard to penetrate anything important, okay. So it would go through my blood if it were sharp. I put it under control. I'm going to puke through that little skin, little puke. You're going to feel a little. Here we go. Now, I'm going to touch his muscle. Right now, I'm going to touch his muscle and I'm going to slide it right over the muscle and you can see me here pushing through the skin. Let's see here. Here, it hurts a little bit, and go.

Now you can see this area starting to blow up, okay this area. You will see it better in a few seconds. Pressure rise up to 400 please, okay. Okay. So this little ball is a ball of fluid on the inside. So we're going to numb up the track. So right now, I'm just moving the cannula back out and my assistant is keeping the fluid going at 400, right?

Female Voice: Mm-hmm.

Dr. Marwan Khalifeh: Okay. We're just going to blow up the air. Now, one last point. I think that a lot of patients come here and think it's going to be one shot. It's not, it's a few because each time I'm moving the cannula, I'm numbing up a little area. So obviously I'm going to have to move the cannula a few times before I can numb up the whole area. So it's not like you can just make one shot and infiltrate all the fluid. The fluid has to be placed by the instrument and the instrument can place fluid to an area of that wide. So if you want to know how many shots, it's not really a shot because it's blunt. It's just going to be numbing up little tracks like that so we're going to do one like that, one like that, one like that and one like that so about four times.

This is what he'll need for an area. Obviously if you'll get into the stomach, it would be more than four times because it's going to take about six or seven times. We're about to start the laser. This is the SmartLipo Triplex Pro. This here is the temperature pro. This is unique about the SmartLipo machine and that the SmartLipo Triplex would monitor the patient's temperature and prevent burns or help prevent burns and we're going to go through our first incision. At this one, we waited a good 10 minutes so the patient is numbed.

Laser Liposuction Requires Special Local Anesthesia

Dr. Marwin Khalifeh walks us through the anesthesia process preceeding a laser liposuction procedure.