Awake syringe liposuction under local anesthesia

Why does Dr Arthur Tjandra of Elixir de Vie perform liposuction and autologous fat grafting on awake patients under local anesthesia with mild sedation only? It is because in liposuction surgery and fat grafting procedures, such as fat transfer to face or breasts, what you see when a patient is lying flat, is not what you get when the patient eventually stands up. Therefore, if a surgeon cannot sit and stand a patient up during liposuction and fat grafting procedures, the result is definitely going to be compromised. Ultimately, a patient needs to ask herself what her priority is, undergoing a 100% pain-free surgery or getting the best possible result? In liposuction and fat grafting procedures, unfortunately you cannot have the best of both worlds, 100% pain-free surgery AND the best possible outcome. You can only choose one!

Dr Arthur Tjandra of Elixir de Vie performs liposuction with just a plastic syringe, an outdated method which was practiced back in the 1980s and 1990s, which hardly any surgeon is trained to perform anymore today. Machines have taken over syringe work since the early 2000s. Go and take a look at plastic surgery residency training anywhere in the world. None of those residency training (a.k.a specialist training) offers training to perform liposuction with just a syringe! As a matter of fact, there is no experienced and skilled instructor to conduct such training.

However, Dr Arthur Tjandra of Elixir de Vie has explained in great detail why “back to basics” is still the best and safest method in liposuction, with the highest satisfaction rates and lowest risk of complications: “Liposuction Case Studies @ Elixir de Vie“. You will never be able to find this page on all major search engines, because it has been black-listed. Why? Because the liposuction devices industry, which is worth tens of billions of dollars a year, does not want prospective patients to learn the information on this page! After all, a set of liposuction device costs at least US$100,000, while a piece of plastic syringe costs less than US$2. There is too much to lose if patients start asking for syringe liposuction! What you see on your search results from search engines are determined largely by advertisers’ dollars to either promote or suppress any website(s) and/or information. You must understand that search engines’ revenues come from advertisers! With tens of billions of dollars in profits every year, liposuction devices manufacturers would not mind spending a few million dollars, a tiny fraction of their profits, to aggressively promote machine liposuction, and to suppress information on syringe liposuction!

Dr Arthur Tjandra’s YouTube channel, which had garnered close to 500 million views by the time it was terminated by YouTube, was terminated for that very reason! Now you can no longer find any information about awake syringe liposuction under local anesthesia on YouTube, because lobbyists managed to lobby YouTube to shutdown Dr Arthur Tjandra’s channel.

Besides performing liposuction with nothing but just a plastic syringe, Dr Arthur Tjandra of Elixir de Vie also performs all his liposuction cases under awake anesthesia, which means that patients are completely awake during the procedure! But, as local anesthesia, also called tumescent anesthesia, is being administered, the procedure is almost painless. We have posted a number of videos of patients getting liposuction done under local anesthesia on our YouTube channel, and put up the links on our website: Elixir de Vie Liposuction Case Studies.

Dr Arthur Tjandra of Elixir de Vie even performed awake liposuction under local anesthesia on himself, twice! Unfortunately, he did not film it when he did it the first time round in 2008. He only started filming his surgeries and posting them on YouTube in 2014. When he performed a second liposuction on himself in December 2019, he made sure that it was filmed, and the case study was also published on his Vlog. He is Patient No. 532.

Below is one of the videos of Dr Arthur Tjandra performing liposuction on himself, posted on our YouTube channel. How many surgeons in the world do you know, who have performed liposuction on themselves while filming it, then publish it on YouTube for the whole world to see? That is why YouTube deleted the video and terminated our account! The issue is not performing liposuction on oneself. Nor is it an issue of pornography. No, Dr Arthur Tjandra did not show his dick in the video. Neither did he show his balls or buttocks. His dick is too small to be shown. He is Chinese, after all. Chinese are known to have small dicks. He only showed his abdomen! But, that video was immediately taken down by YouTube, which labelled it as pornography. Is that really the issue? No! The issue is he was showing the world that a surgeon could perform liposuction on himself with just a plastic syringe! If a surgeon can do such surgery on himself, he definitely can do it on his patients. If that is the case, and all patients start requesting their liposuction surgeries to be performed with syringe while they are awake, what will happen to the liposuction industry? Who will still buy $100,000 liposuction devices?

If one could get a surgery done under local anesthesia, while one is completely awake and playing with one’s mobile phone:

why should one get it done after being knocked-out unconscious with general anesthesia, not breathing on one’s own, and with a tube going down into one’s windpipe, which is connected to a ventilator?

And eventually dies because of complications from general anesthesia, like what happened to a 24-year-old Singaporean woman, who chose to have wisdom teeth removal under general anesthesia, when she could have got it done under local anesthesia? She was probably scared of pain, that was why. And because of that, she was willing to trade safety with pain-free. Which eventually cost her her life!

Another incident in Mexico should perhaps be a lesson to all patients undergoing surgeries that they should not opt for a surgery to be performed under general anesthesia, if it is possible to perform that particular surgery under local anesthesia: “Influencer Dies Seeking Treatment for Underarm Sweating“.

When one gets an elective surgery done, one has to accept all risks associated with that particular surgery, by signing a surgery consent form. When one gets an elective surgery done under general anesthesia or deep sedation, one has to accept additional risks of general anesthesia or deep sedation, in addition to the surgical risks. So, why would you double the risks you have to accept unnecessarily? While at the same time, it also increases the risk of unsatisfactory results, because a liposuction surgeon will never be able to sculpt the body of a patient who is knocked-out unconscious, the way he sculpts the body of a patient who is able to obey commands, by turning around, sitting up, and even standing up during a liposuction procedure!

Odalis Santos Mena, a 23-year-old social media influencer, athlete, bodybuilder, and fitness competitor, recently died of cardiac arrest while seeking treatment for underarm sweating with MiraDry device. MiraDry is a handheld medical device, used as a nonsurgical underarm procedure that is supposed to be performed with local anesthesia, usually involving only numbing the armpit area, not “general” or “full” anesthesia that puts a person in a sleep-like, unconscious state. However, the surgeon who performed the procedure for her, decided to put her under general anesthesia for a procedure which could have been performed under complete local anesthesia, and that decision ended her life!

Both death cases cited above were eventually classified as “misadventures” by coroners, because they are caused by adverse reactions to general anesthesia, which all patients undergoing surgeries under general anesthesia, have to accept by signing the surgery consent forms. You cannot sue your surgeons, anesthesiologists and hospitals if you die because of adverse reactions to general anesthesia, because you are assumed to have understood all the risks and are made to sign consent forms to accept the risks. Therefore, it is best to opt for surgeries to be performed under local anesthesia only, whenever possible. Especially if the results are going to be compromised if performed under general anesthesia or deep sedation, as in the case of liposuction surgeries.

Currently, many surgeons still misrepresent facts about liposuction suggesting it is safer if performed under general anesthesia rather than local anesthesia when, in fact, the opposite is true.

Unfortunately, many physicians and anesthesiologists still believe that modern general anesthesia is the safest route for liposuction. Consequently, many do not make the effort to learn the new technique that allows liposuction totally by local anesthesia. Although modern general anesthesia is considered safe, it may expose the patient to unnecessary risk given that a safer alternative is available. Now that liposuction can be performed totally by local anesthesia, it might be considered that general anesthesia is often abused in the world of cosmetic surgery. 

Kucera, M.D., Ian J., Liposuction: contemporary issues for the anesthesiologist. Journal of Clinical Anesthesia, 2006, 18: 380).

The type of anesthesia used for liposuction surgery can influence the risk associated with liposuction. There have been no deaths reported with liposuction that is accomplished using the tumescent technique totally by local anesthesia. Virtually all deaths associated with liposuction are associated with the use of either general anesthesia or the use of intravenous (IV) sedation. A publication in the journal, Plastic and Reconstructive Surgery, reported 95 deaths associated with liposuction from 1994 to mid-1998, all of which occurred in the hands of surgeons who typically use general or systemic anesthesia. In the same period of time there were no reported deaths associated with liposuction when performed by surgeons who do tumescent liposuction totally by local anesthesia. (Reference: Grazer FM, de Jong RH. Fatal outcomes from liposuction: census survey of cosmetic surgeons. Plastic and Reconstructive Surgery 105:436-446, 2000).

The most common causes of death associated with liposuction are 1) Pulmonary Embolus (blood clot in the lung), 2) Infections, 3) Injury to Abdominal Organs (liver, intestines) or Lungs, and 4) Drug Reactions and Side Effects of Anesthesia. An article published in 2000 found 95 deaths among 475,000 liposuction patients who had liposuction by surgeons using general anesthesia or heavy IV sedation. In contrast, a 2002 study of surgeons who do liposuction by local anesthesia found no deaths among 65,000 liposuction patients.

Almost all surgeons in the world perform liposuction under deep sedation or general anesthesia. Performing liposuction with a mechanical device under deep sedation/general anesthesia is a recipe for disaster. There have been a few high profile cases of liposuction death in the region:

1. The first liposuction death case in Singapore. The patient ended up dead because he could not breathe due to deep sedation and his intestines were punctured multiple times with ultrasound-assisted liposuction device. As the patient was under deep sedation, he did not show any sign of distress at all, as the surgeon punctured his intestines times and times again.
2. A woman who almost died after her intestines were punctured by a plastic surgeon during liposuction surgery, in the largest hospital in Singapore. This news has apparently been removed from all mainstream media websites. We can only find it on a forum post.
3. A case of a blocked artery in the arm of a patient who had liposuction in Singapore. He almost lost his arms because of this.
4. A woman who had 3rd degree burns of her thighs after VASER liposuction in Singapore. She ended being admitted to Burns Intensive Care Unit and required skin graft.
5. A woman who died after liposuction by a general surgeon in Singapore. The surgeon is known to perform liposuction with VASER.
6. A dance instructor who died after liposuction in Hong Kong. She was morbidly obese, weighing 136 kg. As Dr Arthur Tjandra has explained on his website, Vlog and all the videos he has published on his YouTube channel, liposuction is not a tool for weight loss. It is merely a sculpting tool to sculpt the body of a person who is already within his/her ideal range of weight into a much desirable shape! If one is overweight or obese, one has to lose weight through sensible dieting and exercise, not through liposuction! This patient was obviously not a candidate for liposuction, as she was not only obese, but morbidly obese! During search, prosecutors found 165 ampoules of pethidine, a dangerous pain-killer, in the clinic. The liposuction might have been performed with a cocktail of dangerous anesthetic drugs without the presence of an anesthetist.
7. A 35-year-old Thai woman died during liposuction in Seoul.
8. A 34-year-old granddaughter of a Hong Kong tycoon who owns Bossini, died during liposuction in Seoul. Just like the high profile case in Singapore, the Korean surgeon also used Propofol, a strong anesthesia. As the patient was still moving, he added a cocktail of 2 more sedatives, ketamine and midazolam, which killed the patient instantaneously.
9. Bonnie Evita Law, granddaughter of Bossini clothing chain tycoon, died after falling into a coma during a liposuction procedure in a plastic surgery clinic in Seoul, in January 2020.
10. A 54-year-old Thai woman, who was the sister of a former deputy governor of Nakhon Si Thammarat, died during liposuction in Bangkok, in February 2021.

In all the high-profile cases above, we see one striking similarity. Those surgeons performed liposuction with machines, and they were done under either deep sedation or general anesthesia. The doctor in the first death case in Singapore above, who was a general practitioner, even went as far as puncturing his patient’s intestines 13 times, without realizing it, as the patient was deeply sedated, hence did not respond to pain. As intestines are located underneath thick abdominal muscles, it means the doctor also had to puncture through the patient’s abdominal muscles, before he could reach his intestines. This means that he used his liposuction cannula to puncture the patient’s abdominal muscles and intestines, a total of 26 times!

How could he not feel it when he punctured both the patient’s abdominal muscles and intestines? Because he was using a machine! A machine is much heavier than a plastic syringe. A machine produces vibration and movement, which may confuse the tactile sensation of the surgeon’s hands. Remember, liposuction surgery is a blind surgery where the surgeon performing the surgery has no view of the operating field at all, unlike a laparoscopic surgery or an open surgery. In a liposuction surgery, the surgeon relies entirely on his hands tactile sensation to guide him, in determining how deep his cannula is, which anatomical plane his cannula is located, how much fat is left behind, whether or not there is the same thickness of fat left behind and whether he hits the abdominal muscles or not. If he hits the abdominal muscles, he should not proceed to push inwards as he may puncture the abdominal muscles. If he punctures the abdominal muscles, he will come across intestines. If he continues to push forward, he will eventually puncture those intestines. If the surgery is performed under local anesthesia only, local anesthesia only numbs the fat layer, but not the muscles. When a cannula hits the abdominal muscles, it will cause severe pain, which makes the patient scream out loud. However, if the surgery is performed under deep sedation or general anesthesia, the patient will not react at all. This is why Dr Arthur Tjandra of Elixir de Vie favors performing liposuction surgery with just a syringe, under awake condition, with local anesthesia only. It makes the surgery a lot safer. It is almost impossible to kill a patient by puncturing his internal organs if the surgery is done while the patient is awake! The surgeon would be lucky if the patient did not sit up and punch him on his face, the moment he poked his liposuction cannula into the patient’s abdominal muscles! But, a deeply-sedated or unconscious patient would not be able to react at all, which led to all the deaths in the news above.

Many plastic surgeons in Singapore blamed the death on this GP’s educational qualification, stating that non-plastic surgeons should not even be allowed to perform liposuction. The second case, however, was performed by a senior plastic surgeon, in the largest teaching hospital in Singapore, Singapore General Hospital. As we have pointed out in another article, most plastic surgery trainees may have observed less than a handful of liposuction surgeries during their training. Most may not have assisted the surgery as a second surgeon, let alone perform it as a lead surgeon. Most learned it this way:

It is because of all the high-profile liposuction deaths, health authorities in some countries mandate that liposuction be performed only in a hospital operating theater or day surgery center under general anesthesia or deep sedation. Why do those health authorities impose such stringent measure, when liposuction can be performed safely with only local anesthesia when patient is completely awake, like what Dr Arthur Tjandra has shown in the thousands of videos he has published in the last 1 decade? It is exactly because everyone knows that the safest way to perform liposuction is with a plastic syringe. But, the medical authority cannot, lawfully, mandate surgeons to perform liposuction with a syringe only. Therefore, in order to make liposuction safer, they make it compulsory to get it done under deep sedation or general anesthesia. By making it mandatory to have liposuction done under deep sedation or general anesthesia, surgeons have no choice, but to have the surgeries performed in a hospital operating theater or a day surgery center, as normal clinic operating rooms are not equipped to handle surgeries under general anesthesia or deep sedation, as this needs more extensive monitoring with more sophisticated instruments. They also have to engage anesthetists to administer general anesthesia or deep sedatives. By making it mandatory for liposuction to be done in a hospital or day surgery center, in the event of complication, there are always 2 doctors in the operating room at any point of time, who may better manage a complication. If the 2 doctors are unable to manage, as they are in a hospital or day surgery center, they can call out for help from other doctors and surgeons who are performing other surgeries in other operating theaters. This is perhaps the logic behind such regulation.

Almost nothing could ever go wrong if a surgeon performs liposuction with nothing but a plastic syringe. The downside of this method is, however, the surgery becomes extremely long, and it is extremely exhausting for the surgeon, as the surgeon has to aspirate fat little by little using an extremely low-pressure syringe, which pressure is not constant and often lost, and has to be created with the surgeon’s fingers. Most of the time, the surgeon’s fingers would become swollen after pulling on the plunger of his syringe hundreds of thousands or perhaps millions of times during a liposuction surgery. Unless the surgeon performing liposuction has good endurance and strong arm muscles, as well as strong fingers, it is extremely challenging to perform liposuction for a few hours with nothing but a plastic syringe!

What are the downsides of performing liposuction under general anesthesia or deep sedation?

1. Ironically, having liposuction done under general anesthesia or deep sedation actually increases the risk of complications and death, compared to having it done under only local anesthesia. We have presented the facts and references to medical literature on our website: Liposuction Case Studies. Why do the authorities still make it compulsory to have liposuction done under deep sedation or general anesthesia even as they carry higher risk of complications? As they cannot tell surgeons what method of liposuction to use, as they cannot order surgeons to use syringe to perform liposuction, this is, unfortunately, the next best thing they can do to make the surgery much safer, as we have explained above.
2. It is extremely hard and may even be dangerous to move a patient who is deeply sedated or is under general anesthesia who is not even breathing on his/her own. A patient under general anesthesia has a tube inserted down his wind pipe, which is attached to a breathing machine (ventilator). If this tube is accidentally pulled out without deflating the balloon which keeps it in place inside the airway, it may cause serious injury in the airway. If it is accidentally pulled out on a patient who is not even breathing on his own, fatal consequences may ensure. If a patient cannot be flipped and turned around from side to side, if a patient cannot sit and stand up on his/her own, there is no way to perform 3-dimensional liposuction like what Dr Arthur Tjandra of Elixir de Vie does. Without 3D liposuction, the result will definitely be compromised. We recommend you visit our Vlog, and go through all the revision liposuction cases we have published. Almost all the botched results by other surgeons were caused by the fact that they did not perform 3D liposuction, and/or the surgeries were performed using machines, instead of just syringes.

What are the benefits of performing awake liposuction with just a plastic syringe?

1. It is much safer, as it is almost impossible to cause internal injury with just a microcannula and a plastic syringe.
2. As patient is awake, it is possible to perform 3-dimensional liposuction. Patient can flip around, sit and even stand up with minimal assistance.
3. In order to produce excellent result, patient needs to be able to flip round, sit up and even stand up during the surgery, which cannot be done when the patient is deeply-sedated or under general anesthesia.
4. Patient can give feedback during the entire surgery. This becomes an interactive surgery. Sometimes what the surgeon wants and thinks is beautiful, may not be what a patient wants and thinks is beautiful. Dr Arthur Tjandra always lets his patients stand in front of a mirror in his operating room to make sure they are happy with the results, before calling it a day.
5. Faster recovery.

With the raves surrounding the latest high-tech devices in liposuction: powered-suction, laser device, ultrasound device, water jet device, you name it, Dr Arthur Tjandra of Elixir de Vie went against all odds by sticking to his guns and attempted to popularize the concept of liposuction with just a plastic syringe, after learning it from A/Prof Fong Poh Him, a plastic surgeon who introduced liposuction surgeries in Singapore back in the late 1980s. It was also A/Prof Fong Poh Him who encouraged Dr Arthur Tjandra to stick to his guns and not to bow to the temptation of performing liposuction with mechanical devices.

To prove his points, Dr Arthur Tjandra went on to publish some 5,000 videos on his YouTube channel showing the results of syringe liposuction which he performed, which resulted in the channel being terminated by YouTube, in December 2016. Dr Arthur Tjandra of Elixir de Vie launched this video blog (Vlog) one week after his YouTube channel got terminated in 2016. Within a year, he went on to publish another 3,000 videos on this video blog (Vlog). Unlike YouTube, where Dr Arthur Tjandra is at their mercy, because he is getting free hosting for his videos, no one can take down his video blog this time, as he pays for his own web-hosting. By end of 2019, Dr Arthur Tjandra has published approximately 10,000 videos on this Vlog!

Thanks to Dr Arthur Tjandra‘s videos, patients have now become more knowledgeable and realize that good result depends not on the type of devices used to perform liposuction, but rather the skill and experience of the surgeons performing liposuction. Modern fanciful devices have been shown to increase the risk of complications. Most importantly, to achieve good result, liposuction has to be performed in a 3-dimensional way, respecting the nature of our bodies, which is 3-dimension. We have discussed this concept in great detail on our website: “Liposuction Case Studies @ Elixir de Vie“.

Here are some of Dr Arthur Tjandra’s more recent videos showing how he performs “awake syringe liposuction under local anesthesia”: