Dr. Burton Sundin and Dr. Reps Sundin of the Virginia Institute of Plastic Surgery in Richmond offer an awake tummy tuck at their Richmond practice using local anesthesia. Here's how it works, what changes without general anesthesia, and who it's actually right for.
Awake Body Surgery
General anesthesia is a safe and well-established part of surgical care, but it is not the only option for every procedure. At the Virginia Institute of Plastic Surgery in Richmond, Drs. Burton and Reps Sundin offer awake body surgery as an alternative for carefully selected patients, including tummy tuck procedures performed under local anesthesia with sedation rather than general anesthesia.
For the right patient, the awake approach offers real advantages. For the wrong patient, it is not the appropriate path. Here is an honest look at what changes when you skip general anesthesia, what stays the same, and how to know which category you fall into.
What "Awake" Actually Means
The term awake surgery is sometimes misunderstood. Patients undergoing an awake tummy tuck at VIPS are not lying on the table, fully conscious and alert, watching every move the surgeon makes.
Awake procedures at VIPS are performed using tumescent local anesthesia, which numbs the surgical area directly, combined with oral or IV sedation that keeps the patient relaxed and comfortable throughout. Most patients describe the experience as drowsy and calm rather than tense or painful. The key difference from general anesthesia is that the patient continues to breathe independently and does not require intubation or the medications used to induce and maintain a fully unconscious state.
This distinction matters for several practical reasons.
What Changes Without General Anesthesia
Removing general anesthesia from the equation changes a number of things about the procedure and recovery.
Before Surgery
Patients undergoing awake procedures typically have fewer pre-operative requirements. The fasting restrictions are less stringent, preparation is simpler, and there is no need for pre-anesthesia workup related to airway management.
During Surgery
Without a general anesthetic, the procedure is performed entirely in the VIPS office surgical suite rather than a hospital or ambulatory surgical center. Drs. Sundin have developed a refined approach to tumescent anesthesia that provides effective, comfortable numbing throughout the treatment area.
After Surgery
This is where many patients notice the most meaningful difference. Without the systemic effects of general anesthesia, recovery from an awake procedure tends to be faster and smoother. Nausea and grogginess, which are common side effects of general anesthesia, are largely absent. Patients often feel more alert, more comfortable, and ready to go home sooner. Many awake tummy tuck patients are up and moving within hours of their procedure.
Recovery Overall
While the tummy tuck itself still requires a significant healing period regardless of anesthesia type, patients who undergo awake procedures often report feeling more in control during the early recovery phase and experiencing less of the fog that general anesthesia can produce in the first day or two.
What Stays the Same
Removing general anesthesia does not mean compromising the procedure itself.
Drs. Sundin perform the same muscle repair, tissue removal, and skin repositioning that a traditional tummy tuck involves. Diastasis recti correction, excess skin excision, and contour refinement are all achievable under local anesthesia and sedation in the right patient. The surgical goals do not change. The pathway to achieving them is simply different.
The Sundins' approach to awake surgery at VIPS reflects their broader philosophy: that patient safety and surgical quality are non-negotiable, and that reducing unnecessary risk from general anesthesia when it can safely be avoided is the right approach for appropriately selected patients.
What the Awake Experience Actually Feels Like
One of the most common concerns patients have about awake surgery is not whether it is safe or effective but whether it is comfortable. The answer depends significantly on how the anesthesia is administered and managed throughout the procedure.
How Tumescent Anesthesia Works
Tumescent anesthesia involves injecting a dilute solution of lidocaine, epinephrine, and saline directly into the tissue of the abdominal area before surgery begins. The solution numbs the tissue completely, and the epinephrine constricts blood vessels, which reduces bleeding during the procedure. The result is a surgical field that is both insensate and significantly less vascular than it would be under general anesthesia alone.
The injection process itself takes time and requires patience. Patients typically feel pressure and mild stinging as the solution is administered, particularly in the early moments before the numbing takes full effect. Drs. Sundin administer the tumescent solution gradually and allow adequate time for it to work fully before proceeding with surgery.
During the Procedure
Once the tumescent solution has fully taken effect, patients should feel no sharp pain during surgery. What many patients do report is a sense of pressure, movement, and pulling as the surgeon works. These sensations are distinct from pain and are a normal part of the awake experience. Most patients find them manageable, particularly with the sedation keeping them relaxed.
If at any point a patient experiences discomfort beyond what is expected, Drs. Sundin can administer additional local anesthetic or adjust sedation levels. Patients are encouraged to communicate throughout the procedure, and the VIPS team monitors comfort continuously.
The Role of Sedation
Oral or IV sedation works alongside the tumescent anesthesia to manage anxiety and create a calm, drowsy state. Most patients have only fragmented memories of the procedure afterward, similar to the experience of conscious sedation during a dental procedure or colonoscopy. The sedation does not render the patient unconscious, but it significantly reduces awareness and anxiety during surgery.
Who Is a Good Candidate for an Awake Tummy Tuck?
The awake tummy tuck is not appropriate for every patient, and Drs. Sundin are direct about this during consultations. Patient selection is where outcomes are made or lost.
Good candidates for an awake tummy tuck at VIPS typically include:
- Patients with mild to moderate abdominal skin laxity and limited diastasis recti who do not require the most extensive correction
- Those who have medical conditions that make general anesthesia higher risk, including certain cardiac, pulmonary, or metabolic conditions
- Patients who have had negative experiences with general anesthesia in the past, including severe post-operative nausea or prolonged grogginess
- Those who place a high priority on shorter recovery time and faster return to function
- Patients who are anxious about general anesthesia for personal reasons and who are good candidates anatomically for the awake approach
Who Is Not a Good Candidate
General anesthesia remains the safer and more appropriate choice for a meaningful subset of patients. Drs. Sundin will recommend against the awake approach in the following situations:
- Extensive muscle repair required: Significant diastasis recti that requires a lengthy and complex repair is better addressed under general anesthesia, where the surgical team has full control of the environment, and the patient's comfort is not dependent on local anesthesia holding throughout a prolonged procedure.
- Large volume of excess skin: Patients with substantial skin redundancy, particularly those who have undergone major weight loss, typically require a more extensive resection that is not well suited to the awake approach.
- High anxiety or needle phobia: The tumescent injection process involves multiple injections into the abdominal tissue before surgery. Patients with significant anxiety around needles or medical procedures who are unable to manage this step comfortably are better candidates for general anesthesia.
- Certain medications or medical conditions: Patients taking blood thinners, those with lidocaine sensitivity or allergy, and those whose medical conditions affect how local anesthetics are metabolized may not be appropriate candidates. Drs. Sundin review full medical histories before making any anesthesia recommendation.
- Planned combination with multiple procedures: Patients interested in a comprehensive mommy makeover involving breast surgery, liposuction, and a tummy tuck simultaneously will generally require general anesthesia to safely manage a longer operative time and broader surgical scope.
The goal at VIPS is always the safest possible procedure for each individual patient. For some, that means embracing the awake approach. For others, it means recommending general anesthesia without hesitation.
Combining Awake Tummy Tuck With Other Procedures
One of the advantages of working with a practice that offers both awake and traditional surgical approaches is flexibility. Drs. Sundin can discuss combining an awake tummy tuck with other procedures, such as liposuction, depending on the scope of work and the patient's individual situation.
For patients interested in a mommy makeover or more comprehensive body contouring, the combination of procedures and anesthesia type will be planned carefully to prioritize safety and optimal outcomes.
Starting the Conversation at VIPS
The awake tummy tuck at Virginia Institute of Plastic Surgery is one expression of a broader commitment Drs. Burton and Reps Sundin have made to expanding patient options and reducing unnecessary surgical risk. With more than 30 years of combined experience and a patient-centered approach to every consultation, VIPS is where Richmond patients come to understand what is actually possible for their specific situation.
To find out whether an awake tummy tuck is the right choice for you, schedule a consultation at the Virginia Institute of Plastic Surgery in Richmond today.
