How is liposuction performed in Singapore, and must it be under general anaesthesia?

The basic liposuction operation in Singapore involves making a small incision less than 1cm long in the skin then inserting a metal ‘straw’ called a cannula into the fat and sucking the fat out. The fat is not liquid, so the cannula needs to be moved in and out to loosen it so it can be removed.

A good knowledge of anatomy is essential to avoid putting the cannula in the wrong place.

There are many ways this basic operation can be modified. Personally, I perform a technique called SAFE lipo. This uses special cannulas and powered liposuction to break up the fat prior to suction and then redistributing the fat to reduce contour irregularities.

In Singapore, the Ministry of Health regulates who can do liposuction and how it can be done. A doctor needs to be accredited to perform liposuction outside of restructured hospitals. It can only be done in clinic if the amount of fat removed is less than 100mls and only a syringe is used to suck out the fat.

Unless it’s liposuction of the face, most liposuction procedures will remove more than 100mls, therefore, it usually needs to be done in at least an Ambulatory Surgery Centre (ASC). If more than 2L of fat is removed, then the procedure must be performed in a hospital on an inpatient basis.

Not all liposuction must be performed under general anaesthesia, but patients will not struggle or feel any pain under a full general anaesthesia. Liposuction can be done under deep sedation or even just infiltration with local anaesthesia, but patients may feel some mild discomfort.

For that reason I prefer a general anaesthetic. In any case, whether using general anaesthesia or deep sedation it must be administered by an anaesthetist, so I don’t see much benefit in performing liposuction under deep sedation.

In Singapore, the surgical procedure of liposuction is regulated by the Ministry of Health.

Only certified doctors are able to perform liposuction. There are many regulations in place such as

• Amount of fat removed
• Choice of facility where the procedure is carried out.

These determine the type of anaesthesia that is used.

No more than 100ml of pure fat removed:

• A small amount of liposuction is to be done to areas such as double chin, arms or inner knees
• The amount of pure fat removed is no more than 100ml

In this case, this procedure can be done in the clinic under local anaesthethesia.

More than 100ml and no more than 2L of pure fat removed:

This can be done in an Ambulatory Surgical Centre (ASC)

More than 2L of pure fat removed

For these cases, liposuction has to be performed in the hospital and I would recommend a minimum of 1 night stay.

For procedures carried out in the ASC and Hospital, they can be done under Local Anesthesia with sedation (with an anaesthetist around), or under General Anesthesia.

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For most of my cases where I usually perform multiple areas of liposuctions or circumferential liposuction, I usually prefer to have the procedure done in the hospital under General Anesthesia.

I prefer GA as it is safer and more comfortable for my patient. Patients get knocked out by the Anaesthetist, and this allows us to turn the patient so as to position them properly.

Thus we can perform the liposuction without fearing the patient will moan in pain or move during the procedure.

This reduces a lot of wasted surgical time compared to doing it under local anesthesia with sedation.

When the liposuction is completed, the anaesthetist can stop the GA drugs and wake the patient up immediately.

The patient's parameters are monitored regularly in the ward. (Usually I prefer that they spend at least 1 night in hospital.)

If I am just performing liposuction on only 1 small area such as the chin, or the arms, I usually like to always have an anaesthetist around to sedate the patient a bit.

This means that they can also take care of the patient for his / her pain , comfort level and safety, so that I can concentrate to perform the liposuction procedure.

It is important for your Plastic Surgeon to plan the surgery carefully and discuss with the you which will be the best choice.

If possible, I would suggest that a pre-surgery consultation be done with the anaesthetist before the surgery so that the patient will have a smooth and safe anaesthesia, whether it is local, or local with sedation or general anaesthesia.