Sound Plastic Surgery specializes in body contouring surgery in Seattle WA. A substantial portion of our cosmetic surgery practice is liposuction. Over the years, the cosmetic surgery industry has generated a number of corporate organizations that provide liposuction services. The medical equipment industry has crowded the market with a variety of liposuction devices. These corporate marketing programs and medical devices have created a lot of confusing jargon and unsubstantiated claims about liposuction.

This is the first in a series of short articles designed to clarify and dispel some of the misunderstandings about liposuction surgery.

We encounter many patients that have questions about the type of anesthesia used for liposuction surgery. There are a couple of ways to think about this question. The first type of anesthetic that many people associate with all types of surgery is a general or dissociative anesthetic. With a patient completely asleep under general anesthesia, surgery can be performed safely without the perception of pain, until the patient wakes up. At that time, pain will be felt and the post-operative experience is less than ideal. The second option is to keep the patient totally awake and aware during the procedure, but produce profound 'numbness' (anesthesia) in the regions being treated. This second option is highly effective, and is termed 'tumescent anesthesia', referring to the large amounts of very dilute local anesthetic solution used to 'tumescent' the region to be treated with liposuction.

The ideal anesthetic plan for most patients is a combination of moderate sedation (for patient comfort) and tumescent anesthesia of the body zones being treated with liposuction. Patients can be lightly sedated with Xanax and an oral narcotic like Percocet about 30 minutes prior to the liposuction procedure. The treatments zones are then fully infiltrated with a very dilute local anesthetic solution (tumescent) solution, rendering those body zones totally numb and insensate.

Liposuction is then performed, removing fat in a painless process. Because the patient is awake during the procedure, the patient can reposition during surgery to ensure the cosmetic result is as smooth as possible. 

It is possible to perform liposuction for patients asleep under a general anesthetic. A tumescent anesthetic is also used, because the volume of fluid that is infiltrated with the treatment zones helps to remove substantial amounts of fat. We frequently add liposuction of the waist and hips zones from both the front and back of the patient during a tummy tuck procedure. Since the patient is completely asleep during these combined procedures, extra assistants are used in the operating room to reposition the patient on her back and on her abdomen. 

My strong preference is to offer patients a light sedation with Xanax and Percocet, and rely on the tumescent anesthetic to keep the treatment zones completely numb during the procedure. Since the patient is awake, repositioning is easy. For those patients that prefer to be completely asleep, a general anesthetic with tumescent treatment is also available.