With a boosting variety of people embracing liposuction surgery or lipoplasty, enhancing person safety and security is a concern for cosmetic surgeons. Modern plastic surgery technology is particularly created to improve client safety and security.
Standards of Safety
Two Standards: Their Basic Difference
The tumescent technique for liposuction has evolved into two distinct but similar procedures, with two distinct standards of safety. The basic difference between these two standards is “the amount of liposuction that is considered to be safe”. The term “amount of liposuction” refers to both the volume of fat removed and the number of areas treated by liposuction on a single day or week. When compared to liposuction by general anesthesia, liposuction totally by local anesthesia is usually done more gently, with fewer areas treated and smaller total volumes removed, and fewer unrelated surgical procedures attempted on the same day. When liposuction is done under general anesthesia there is a temptation to maximize the total volume of fat remove, to treat too many areas, and to do other unrelated cosmetic surgical procedures on the same day.
The Dangerous Aspect of General Anesthesia
This is not the anesthesia but the use of general anesthesia to permit 1) excessive volumes of liposuction, 2) multiple unrelated cosmetic procedures on the same day resulting in excessive surgical trauma and prolonged exposure to general anesthesia. There are safety limits on the total amount of local anesthesia that one can use on a single day, which in turn limits the amount of liposuction on a single day. There are no clear limits on the amount of general anesthesia that can be used. The use of general anesthesia makes it easier to attempt excessive amounts of cosmetic surgery on a single day. Surgeons and anesthesiologists are both responsible for insisting on optimal patient safety and avoiding excessive cosmetic surgery on a single day. A patient who consents to doing “everything on a single day” might be exposing herself or himself to unnecessary risks and dangers. The real danger of general anesthesia is that it permits both patients and surgeons to foolishly attempt too much surgery on the same day.
Drugs Used for General Anesthesia
General anesthesia produces unconsciousness and insensibility to pain. A systemic anesthetic is any parenteral drug that can be expected to impair the patient’s respiration, impair protective airway reflexes, and impair the ability to communicate verbally at commonly administered doses. Systemic anesthesia includes general anesthesia given by inhalation of anesthetic gases such as halothane or isoflurane, intravenous (IV) drugs injected into a vein such as propofol (Diprivan), midazolam (Versed), ketamine (Ketalar) and narcotics such as meperidine (Demerol), or fentanyl (Sublimaze). All of these drugs are commonly used to achieve general anesthesia.
Which Form of Anesthesia is Safest?
If a routine surgical procedure can be done using either local anesthesia or general anesthesia then the choice of anesthetic technique depends upon several factors including safety, and convenience. Although dentists can do routine dental procedures using either local anesthesia or systemic anesthesia, they usually choose local anesthesia because of its superior safety. Local anesthesia is widely regarded as being safer than systemic anesthesia. Systemic anesthesia is safest when administered by an attentive anesthesiologist. The dangers of systemic anesthesia increase when either the surgeon or the anesthesiologist ignore the risks of excessive liposuction, or the risks of attempting multiple unrelated surgical procedures on the same day. It is in the patient’s best interest to tell the surgeon not to attempt an excessive amount of liposuction on the same day.
Convenience Versus Safety
When considering liposuction of a large volume of fat, one must weigh the safety against the convenience and economy of doing all the liposuction during a single day. Considering the expense associated with each use of general anesthesia, financial concerns may induce a patient to have multiple cosmetic surgery done on a single day. Doing one mega-session of cosmetic surgery only requires one recovery period, but dividing multiple cosmetic surgeries into separate days may allow shorter recovery periods and less total time away from work. Many patients and surgeons believe it is safer to 1) limit the amount of liposuction done in one day, and 2) avoid doing liposuction with unrelated cosmetic surgeries on the same day. It is up to the patient to make the choice.
Liposuction by either local or general anesthesia is regularly accomplished without serious morbidity. However, when attempting a very large volume of liposuction, there is a tendency for a surgeon to unwittingly exceed the limits of safety. In this sense, there are far greater risks with liposuction using general anesthesia. To the best of our knowledge, there have been no deaths associated with tumescent liposuction totally by local anesthesia when the surgeon used well recognized safe dose limits of local anesthesia.