Key Takeaways
- In the US, awake liposuction is only performed under local anesthesia, either lidocaine or Exparel. This technique is safer and provides a more rapid postoperative recovery than general anesthesia.
- Lidocaine provides immediate pain relief, is widely available and is affordable. Its pain control may not extend for long enough for some patients post-surgery needs.
- Exparel’s slow-release formula offers longer-lasting pain relief. This allows us to dramatically reduce the need for opioids, but it usually involves a greater upfront expense.
- Choosing between lidocaine and Exparel depends on your pain tolerance, comfort preferences, and budget—discuss these factors with your surgeon.
- Better pain control leads to happier patients and quicker healing, so be sure to communicate with your care team about what level of pain you are comfortable discussing beforehand.
- Get the most out of your awake lipo comfort and recovery! Don’t downplay additional factors such as surgical technique, post-care support, and your lifestyle.
Waters uses either lidocaine or Exparel for awake lipo pain-control to help numb the area during the procedure. Lidocaine, a local anesthetic that acts quickly to numb, can be mixed into tumescent fluid.
Lidocaine, on the other hand, provides only short-acting relief of up to three days. Both are approved by the FDA for use in the United States and commonly used by board-certified plastic surgeons.
Lidocaine remains the preferred option due to rapid onset and low cost. In contrast, Exparel is favored for its longer-term pain relief after surgery.
In Los Angeles, nearly every clinic does both and will choose based on patient need, pain tolerance, and cost. Choosing the best pain control for awake lipo is key to the patient’s comfort and experience.
The following section delineates important differences and real world advice.
What’s Awake Liposuction?
Awake liposuction is a highly effective body contouring procedure in which the patient remains awake throughout the procedure. Rather than general anesthesia, which can require a longer recovery time, doctors use local anesthesia to numb the treatment area. This method gives patients the confidence to reach out to their care team.
Students can use the lens of empathy to communicate their feelings at every step during the process. Today, the technique is hugely popular—especially in places such as Los Angeles. It allows patients to wake up faster and poses less risk than general anesthesia or deeper sedation.
In fact, most patients of awake liposuction are back to light activity within a week. On the other hand, swelling and bruising typically return to normal after a few days. This type of lipo is ideal for treating an average of three areas in one sitting. It’s an ideal liposuction option for busy people who are looking for immediate results without interrupting their normal lives!
The Basics Explained
Doctors use a technique called tumescent analgesia. They inject a mix of saline, lidocaine, and epinephrine into the fatty tissue. This fluid numbs the area, shrinks blood vessels, and makes it easier to remove fat.
Common target spots include the abdomen, thighs, arms, and flanks. The process starts with marking the treatment area, prepping the skin, and then slowly adding the numbing fluid. The surgeon gently suctions out the fat through small tubes.
An anesthesiologist might not always be in the room, but the surgeon tracks comfort and safety through the whole session.
Why Choose Awake?
Here are just a few of the many benefits of awake liposuction. Not only is the recovery much quicker, the risks associated with general anesthesia are eliminated.
Patients are able to have conversations with their surgeon and provide feedback, creating an increased sense of safety and control. The prices tend to be less, ranging between $3,500 to $7,500 since there is a decrease in hospital stays and anesthesia costs.
Patients often take fewer painkillers post-op too, because local anesthesia controls the pain substantially.
Pain Control: The Essentials
Proper pain management is essential to achieving good results post-awake liposuction. Short-acting local anesthetics provide numbing of the target area, the patient remains awake and experiences less pain. In LA and many other U.S. Cities, localized pain control is quickly becoming the standard for office-based cosmetic procedures.
We find many surgeons using a combination of pain control options — lidocaine, bupivacaine, and sometimes liposomal bupivacaine. We employ these anesthetics in a superwet fashion with wetting solutions. Taking this approach can prevent pain from escalating and enable us to remain below dangerous dose levels.
E.g., tumescent anesthesia (up to 55 mg/kg lidocaine) is documented safe for lipo.
How Anesthetics Work
Local anesthetics, such as lidocaine, act by preventing the conduction of nerve signals that would otherwise inform the brain that something is painful. They inhibit sodium channels in peripheral nerves, preventing pain signals from ever getting to the peripheral central nervous system.
While lidocaine provides immediate pain control, the longer-acting liposomal bupivacaine can last as long as 72 hours. Getting the dose right is critical—too much dose results in toxicity, too little results in untreated pain.
Local anesthetics are different from general anesthesia, which works on the entire body, because they only affect the area being treated, allowing patients to remain awake and aware.
Why Good Pain Relief Matters
When pain relief is good, everyone is happier and patients recover faster. Better pain relief = less need for opioids = safer opioids. Opioids, like morphine, work on mu, kappa, and delta receptors in the brain.
That reduces risks such as nausea or dependence. Regional blocks, including transversus abdominis plane blocks, further reduce postoperative pain and opioid consumption in cosmetic surgery. Gabapentin is not for all patients, but can be beneficial to some investors.
Your Comfort Goals
Along with other goals, the aim is to minimize pain and maximize recovery. Setting realistic expectations goes a long way.
Patients need to have an open dialogue with their care team to understand and discuss their pain and comfort goals during and immediately following lipo. These goals are achieved through the team’s use of multimodal pain plans to help ensure patients are comfortable.
Lidocaine: Tried and True
Retrospective Over the years, Lidocaine became the mainstay agent for performing awake liposuction cases. For these reasons, doctors use it frequently, especially due to its rapid relief, low cost, and broad availability. This local anesthetic has a very long history of effectiveness.
Its usefulness extends beyond lipo and plastic surgery and is felt everywhere in medicine—from dentistry to nerve blocks to other specialty surgeries. Lidocaine is the most popular agent used in median branch blocks. It’s used as a control in studies of newer anesthetics, a testament to its reliability and trust in clinical settings.
Lidocaine’s Quick Action
Lidocaine’s Quick Action
That’s one major reason why lidocaine works quickly. Patients typically start to feel numb within 5 minutes of injection. This rapid onset alleviates not only acute pain, but anxiety, calming the overall experience and reducing perceived threat and risk.
The numbing effect usually lasts for 20 minutes to several hours, sufficient to span liposuction procedures. Lidocaine’s quick action matters for patient comfort relief and is especially important in busy outpatient clinics. When compared to several alternatives, lidocaine’s rapid action reduces pre- and procedural anxiety.
Benefits for Lipo Patients
Benefits for lipo patients Lidocaine has a number of advantages to offer lipo patients. It’s affordable, easy to carry around and obtain. When used correctly, side effects are not common and are typically mild.
It works on pain that is very localized or spot focused, so is perfect for lumpy bumpy little or limited procedures. Easy to administer, lidocaine fits in outpatient offices like those in Los Angeles. Doctors have the ability to adjust the dose for each patient, providing added flexibility.
Lidocaine: Points to Consider
Some individuals might have sensitivities or very allergic reactions to lidocaine. Careful dosing and monitoring is very important. Excessive doses can lead to toxic effects—particularly in situations such as systemic acidosis or hypoalbuminemia (lowered protein in blood).
The pain relief achieved, though rapid, is not 24 hours a day, requiring additional measures for pain control to be implemented post lipo.
The Lidocaine Experience
Patients can expect to feel a small poke and some initial stinging. Soon, her feet and legs go numb. Input with lidocaine Feedback throughout the procedure aids in ensuring optimal comfort.
The tried and true It’s decades of experience that make lidocaine an invaluable partner in ensuring smooth, safe and satisfying lipo experiences.
Exparel: Extended Relief Option
Exparel is an exciting new option for pain control in awake liposuction. Its distinguishing feature is its slow-release, long-acting pain relief, lasting up to 72 hours post procedure. The FDA approved Exparel for use in postoperative pain. This acknowledgment, along with its long-lasting pain management potential, makes it an ideal choice for patients seeking to be awake during lipo.
Exparel has a unique formula that delivers long-lasting pain relief. Unlike other local anesthetics, such as lidocaine, which typically last just a few hours, Exparel offers long-lasting relief.
Exparel’s Slow-Release Magic
Exparel operates using a proprietary liposome technology. The secret is that the drug is imprisoned within minuscule fat-like spheres, or liposomes, which gradually release the drug over several days. That one dose can provide effective pain relief for 72 hours, a significant improvement over other products.
The even pain relief allows patients to be more comfortable and sometimes require fewer breakthrough or rescue pain medications. Patients typically need rescue meds 10 hours after Exparel. In stark contrast, they required them at an average of 3 hours after the administration of standard bupivacaine.
Potential Exparel Perks
There are a number of perks in using Exparel. Patients have indicated a need for fewer opioids with Exparel. On average, they need only 12 mg, where older treatments need about 19 mg. Many report less pain, and almost all (95%) report that they’re satisfied with their pain management.
Consider how the single-dose approach simplifies treatment. This single-dose approach greatly simplifies care for both patients and doctors.
Exparel: What to Know
Prior to awake lipo, it’s best to have an honest discussion with your care team about Exparel. Sure, it’ll be more expensive than lidocaine, but there’s some significant evidence that indicates that it works better. It does not raise the risk of adverse effects!
Science is on its side, with the drug’s efficacy proven in a wide variety of surgeries, ranging from knee replacements to breast reconstructive work.
The Exparel Journey
Since Exparel is injected into the tissue, it’s not unusual to use it during awake lipo. Most patients discover that the pain control continues long after surgery and through the bulk of their recovery. Following the procedure, physicians monitor patients’ pain levels as well as for adverse effects.
Patients should be equipped with pain charts to denote their level of comfort each day.
Lidocaine vs. Exparel Showdown
When it comes to effective pain control during awake liposuction, both lidocaine and Exparel (liposomal bupivacaine) have important roles. The two present very different experiences for patients, with very unique advantages and disadvantages.
Below is a quick side-by-side look at their main features:
| Feature | Lidocaine | Exparel (Liposomal Bupivacaine) |
|---|---|---|
| Onset Time | Fast (minutes) | Moderate (up to an hour) |
| Duration | Short (2–8 hours) | Long (up to 72 hours) |
| Cost | Lower | Higher |
| Pain Relief Strength | Good for short-term | Strong for long-term |
| Opioid-Sparing Effect | Minimal | Yes, lowers opioid use |
| Side Effects | Numbness, rare toxicity | Numbness, less motor block |
1. Speed vs. Staying Power
Lidocaine onset is rapid – often within minutes. It does a great job of keeping patients comfortable during the procedure, but it wears off within a few hours.
Exparel, on the other hand, has a delayed onset, but it can provide the area with numbness for two to three days. This makes Exparel more appropriate for patients who would prefer extended pain control, and lidocaine more appropriate for patients who intend to have a rapid recovery.
A person on a tight timetable might choose lidocaine since they get quick relief in the least amount of downtime. When it comes to the anxiety of anticipated post-op pain, providers often choose Exparel.
2. After-Surgery Comfort Levels
Since lidocaine’s effects wear off quickly after surgery, patients will require additional pain medications at that time.
Exparel’s extended release provides more consistent post-surgery comfort and reduces reliance on opioids. In fact, numerous studies have demonstrated that Exparel reduces post-operative pain significantly.
This translates into patients requiring fewer prescription painkillers, resulting in a more comfortable recovery.
3. Safety Check: Key Differences
Overall, both drugs have excellent safety profiles when used appropriately. You might experience some numbness, or in very rare cases, heart or nerve effects if too much lidocaine is used.
The risk of motor block is lower with Exparel, as with any medication, it should be monitored for infrequent adverse events. Considering past medical history—such as issues with the heart or liver—can help determine which option is the safest.
4. Side Effect Profiles
The most common side effects with lidocaine are tingling and mild numbness. Rarely, patients may experience dizziness or headache.
Exparel has some of these too, though they are accompanied by less muscle weakness and more consistent numbness. Understanding these matters allow patients to make a more informed decision, balancing comfort’s benefits with its risks.
5. Dollars and Sense in the US
| Item | Lidocaine | Exparel |
|---|---|---|
| Average Cost | $2–$5/vial | $300–$400/vial |
| Insurance Cover | Often Yes | Varies |
| Long-Term Savings | Low | Possible |
At a fraction of the cost, lidocaine is where most clinics turn. Exparel is more expensive initially, but could save costs if it reduces opioid consumption or additional appointments.
While lidocaine is typically covered by insurance, coverage for Exparel is unpredictable.
My View: Your Best Choice
If you are trying to decide between lidocaine and Exparel for awake liposuction pain control, think about your own comfort level and pain threshold. In addition, talk to your surgeon, and listen to their professional recommendations. Every single one of these options is great.
The ideal candidate differs depending on your medical background, the region being treated, and the volume of fat being extracted. Nothing beats open, honest conversation with your surgeon to determine the best option for you.
Is Lidocaine Right for You?
Lidocaine is the most widely used local anesthetic for smaller awake lipo procedures. It acts quickly, it’s well-known among physicians, and it’s cost-effective. If you’re looking for moderate pain relief with a higher threshold or just a fast, short-term fix for a localized area, lidocaine is a no-brainer.
Those who have received local anesthesia in the past and tolerated it can be reassured with this route. In some cases, it can wear off sooner. Patients may experience discomfort or pressure during the procedure, particularly if the field is more extensive.
Could Exparel Be Better?
Exparel provides longer-lasting pain relief than plain lidocaine—up to 72 hours. This is beneficial if you’re concerned about post-operative pain or have a low pain tolerance. It can be appropriate for patients with a history of difficulty controlling their pain, or for patients who desire a recover period with more ease and comfort.
Even though it’s more expensive, the longer lasting relief can often result in a reduced need for other post-surgical pain medications.
Talk With Your US Surgeon
As always, discuss with your US your best choice for you. Inquire about their experience with each drug and their technique for awake lipo cases. A competent surgeon will clearly go over the risks involved, such as specific side effects or rare complications associated with the use of local anesthesia.
Your Comfort, Your Call
Your comfort should determine your choice. Don’t just share your concerns, but share your questions. The right plan is a collaboration between your comfort level and your doctor’s knowledge.
Beyond the Meds: Other Factors
Pain control involves considerations that go beyond any drug. In addition to the physician’s expertise, the environment and post-surgical support play crucial roles.
These new findings show recovery correlates more closely to how much fat is consumed rather than which psychoactive drug is used. Patients who are lean or have unique medical requirements may need to be particularly cautious.
We understand cost is a concern—saving money upfront shouldn’t lead to expensive disasters down the line.
Conclusion
Conclusion In conclusion, both lidocaine and Exparel are effective options to control pain after awake lipo. One benefit of lidocaine is that it has very rapid onset and offset, giving faster and clearer patient expectations. Since Exparel has a longer duration, it could benefit those looking to reduce pain beyond the first day. Each one meets a unique need. Some of them like the old-school, heavy-handed stuff that they’re used to and they trust. Still others are motivated to try something that provides longer lasting pain control. At LA, our docs are well-versed in both and adept at pairing them to your goals. Cost, comfort, and aversion to new medications all factor into the equation as well. Unsure about joining us? Have an open discussion with your physician and understand the scoop for your body and your procedure. You do have options, and your voice can make a difference.
Frequently Asked Questions
What is awake liposuction?
Awake liposuction is a fat-removal procedure done while you’re awake but numbed with local anesthesia. You are awake and comfortable throughout the procedure, and you’re able to return home the same day.
How does lidocaine work for pain control in awake lipo?
How does lidocaine work for pain control in awake lipo? This helps block pain signals during and immediately after your procedure, helping you feel more at ease throughout the process.
What makes Exparel different from lidocaine?
Exparel is a new type of long-acting anesthetic. It can help control pain for up to 72 hours after surgery, which means fewer prescription pain pills are needed.
Is Exparel safer than lidocaine for awake liposuction?
Both are FDA-approved and safe in the hands of properly trained, board-certified doctors. Whether lidocaine or Exparel is used, your provider should recommend the one most appropriate for your health and needs to keep you comfortable.
Which pain control method is more affordable?
Which pain control method is more affordable? Exparel is more expensive due to its long-term pain relief advantages.
Can I request Exparel for my awake lipo in Los Angeles?
Yes. That means most Los Angeles plastic surgeons will have Exparel available. Discuss with your provider whether it is appropriate for you during your consultation.
Which pain control option has fewer side effects?
For the most part, people tolerate both extremely well. Lidocaine side effects are very uncommon, and if they do occur, they tend to be quite mild. Though Exparel’s side effects are rare, it’s important to review your complete health history with your surgeon.