LIPOSUCTION is the most common plastic surgery procedure performed in the United States. It’s the removal of fat from the body using suction often with the addition of energy based systems, such as ultrasound (VASER) with the goal of creating a more aesthetically pleasing body contour.
Anesthesia makes the procedure possible and is designed to minimize discomfort and even treat anxiety. The surgeon & patient should mutually decide on the method of anesthesia.
All liposuction procedures should use cardiac monitoring with blood pressure, continual pulse, oxygenation, electrocautery (ECG) and temperature measurement. If one is removing more than 100 cc of fat, an intravenous line should be placed in case medication administration or fluid resuscitation is needed.
It may be easier to understand different anesthesia methods as Awake or Asleep. All liposuction procedures use a wetting solution administered to the body sites being treated. The wetting solution (referred by some as tumescent solution) contains salt water (lactated ringers or normal saline) containing lidocaine, epinephrine and bicarbonate. Lidocaine in the tumescent solution is the anesthesia to minimize discomfort. Epinephrine or adrenaline constricts blood vessels to minimize bleeding and bruising. Bicarbonate reduces the burning solution when the fluid is administered.
List of Types of Anesthesia:
- True Tumescent liposuction only uses the wetting solution to reduce discomfort in the surgical treated areas of liposuction. This is the safest technique, however, provides no sedation, only local anesthesia. It limits the amount of fat that can be removed and the number of body sites that can be treated. If multiple body areas are desired to be treated, than a second surgery or staged procedure may be necessary.
- Tumescent Anesthesia adding Oral Sedation & Analgesia allows the procedure to be performed with sedation, which most patient prefer. When less than three anatomical body areas are treated in patients with a fair pain threshold, this technique should be considered.
- Tumescent Anesthesia Combined with both Oral & Intravenous Sedation (Conscious Sedation) is our preferred anesthesia method. The vast majority of patients (>90%) prefer this method after the preoperative discussion on the surgery and anesthesia options. Compared to the above options: more fat can be removed, more anatomical areas can be treated, and high-definition liposculpting can be achieved. Most patients have limited recall due to the effects of Versed (Midazolam) that is an amnestic. The risks of general anesthesia are avoided.
- General anesthesia is when the patient is unconscious with their airway protected by an artificial airway. The advantages are that the patient has no perception during the procedure, more fat can be removed, more anatomical areas treated, and high-definition liposculpting is easier to perform. Another advantage is that a Tummy Tuck or Avelar lipoabdominoplasty can be performed simultaneously, frequently used in “Mommy Makeovers”. The drawbacks of this technique is more postoperative pain and bruising, higher risk of a blood clot forming in the lower extremities (deep venous thrombosis or DVT) embolizing to the lungs (pulmonary embolism or PE). There is a higher risk with general anesthesia of airway obstruction and pneumonia with an overall mortality rate of about 1:20,000 surgery cases.
All surgical procedures have three main variables affecting the outcome, the type of liposuction performed with VASER ultrasound-assisted high-definition liposculpture arguably achieving the best athletic body sculpting, the type of anesthesia with either general anesthesia or the combination of oral and intravenous sedation with Tumescent anesthesia, and a well-experienced and superior trained liposuction surgeon.