There are lots of patients who are afraid of general anesthesia and would very much prefer to have procedures done under local anesthesia. I have been a big proponent for a long time of doing Liposuction under general anesthesia to achieve the desired results and still maintain that for the most part. This becomes especially relevant, in my opinion, when you have to do fat transfer in cases such as BBL. When the patient is completely asleep, you have the most control and can get really aggressive with your Liposuction.
Another important aspect is that when you are doing fat transfer, it is really important to stay subcutaneous to ensure patient safety and minimize any risk of fat embolism. When the patient is awake, it is possible for them to move either due to slight discomfort or just inadvertently, which can be challenging at times. However, it is possible to perform Liposuction and even fat transfer under local anesthesia in appropriate patients.
With an adequate pre-operative cocktail that includes multiple pills such as Valium/Xanax, Demerol/Percocet and use of ancillary products such as nitrous oxide, it is possible for the patients to get to a point where the tumescent solution can be injected with minimal to no discomfort. Since the tumescent solution has numbing medication (lidocaine) inside it, it does generate anesthesia in the required field.
Moreover, depending on the amount of tumescent solution needed – it’s possible to have additional lidocaine in the tumescent solution to further the anesthesia effects. In such a set up, Liposuction and fat transfer can be performed under local anesthesia. One additional advantage of local anesthesia is that the patients can aid the procedure by positioning their bodies in a certain way that would facilitate the surgery.
So, my practice and thought process have evolved over a period of time. I believe that these two options complement each other rather than competing with each other. In an appropriate patient, Liposuction and fat transfer under local anesthesia can be a very effective procedure. My Liposuction and fat transfer practice is now a mix of general anesthesia and local anesthesia. If you are interested in discussing these options further, please feel free to schedule a consultation.