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Redefining What's Possible Without Going Under

Drs. Burton and Reps Sundin have built their reputations on combining surgical expertise with a patient-first approach, and their awake body surgery program is a direct extension of that commitment. Both board-certified by the American Board of Plastic Surgery, the Sundin brothers have extensive fellowship training and hands-on experience with advanced local anesthesia techniques that allow many body procedures to be safely and comfortably performed without general anesthesia. For patients who qualify, awake surgery offers a meaningful alternative, one that reduces risk while still delivering the results they want. All awake procedures are also available under traditional sedation or general anesthesia. Drs. Sundin will recommend the safest, most appropriate anesthesia plan based on your anatomy, goals, and health history.

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What Is Awake Surgery?

Awake surgery refers to procedures performed using local anesthesia, often combined with mild oral or IV sedation (sometimes called "twilight" anesthesia). The treatment area is numbed completely so you feel no pain, while you remain comfortable, breathing on your own, and able to communicate with the surgical team throughout.

A key component of many awake body procedures is the tumescent technique: a solution of local anesthetic (lidocaine), epinephrine, and saline is infiltrated into the target area. This numbs the tissue, minimizes bleeding, and reduces post-operative swelling, making recovery smoother and faster.

Benefits of Awake Body Surgery

Choosing awake surgery, when appropriate, offers several meaningful advantages such as:

  • Reduced anesthesia risk, avoiding the systemic effects and complications associated with general anesthesia, particularly for patients with underlying health conditions
  • Faster recovery with no grogginess, nausea, or extended anesthesia metabolization; many patients feel alert and can walk out the same day
  • Lower cost, as the approach eliminates anesthesiologist fees and associated facility costs
  • Real-time communication, allowing your surgeon to ask you to adjust positions or contract muscles during the procedure, enabling more precise contouring
  • Reduced bleeding and swelling, as tumescent solution constricts blood vessels and minimizes bruising and trauma
  • Performed in-office, with many awake procedures done in the accredited Richmond facility without a hospital stay
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Awake Body Procedures Offered at Virginia Institute of Plastic Surgery

Awake Liposuction

Liposuction is one of the most commonly performed awake procedures and is the foundation of the Sundins' signature LITTLE Lipo® technique. Using tumescent local anesthesia, Drs. Sundin precisely remove stubborn fat deposits while you remain comfortable and alert. 

Awake Tummy Tuck

An awake tummy tuck (abdominoplasty) removes excess abdominal skin and tightens the underlying muscles, performed under local anesthesia with mild sedation rather than general anesthesia. 

Awake Brachioplasty (Arm Lift)

Brachioplasty removes excess skin and fat from the upper arms to create a firmer, more contoured appearance. 

Awake Fat Grafting

Fat grafting involves harvesting fat from one area of the body and transferring it to another for volume restoration or contouring. Whether used to enhance facial features, add volume to the hands, or augment other body areas, awake fat grafting is well-suited to local anesthesia when the treatment areas are limited in scope.

Awake Butt Lift

Butt lift procedures using fat grafting can, in select cases, be performed with local anesthesia and conscious sedation. During your consultation, Drs. Sundin will assess your goals and anatomy to determine whether the awake approach is appropriate or whether traditional anesthesia will provide better results.

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Are You a Candidate for Awake Body Surgery in Richmond?

Awake body procedures may be right for you if you:

  • Are in good overall health and near your goal weight
  • Have specific areas of stubborn fat or skin laxity you'd like to address
  • Have concerns about general anesthesia or a history of anesthesia-related complications
  • Prefer a faster recovery and shorter procedure time
  • Are having a more limited or targeted procedure rather than extensive multi-area correction
  • Understand that awake surgery may not be appropriate for larger-volume or more complex procedures

Patients requiring extensive correction, significant skin removal, or multi-procedure combination surgeries are typically better candidates for traditional sedation or general anesthesia. 

Why Choose Virginia Institute of Plastic Surgery for Awake Body Surgery?

The Sundin brothers pioneered their own in-office liposuction program, LITTLE Lipo®, precisely because they recognized the value of offering patients exceptional results without the demands of general anesthesia. Dr. Burton Sundin, who has been in practice since 2004, brings two advanced surgical fellowships and decades of in-office procedure experience to every awake case.

Dr. Reps Sundin trained at the prestigious Manhattan Eye, Ear and Throat/Lenox Hill under some of the world's most celebrated surgeons, giving him the technical precision these procedures demand. Their 4.7-star patient rating across 540+ reviews reflects a practice that patients consistently trust, even for the most delicate procedures.

What to Expect: Awake Body Surgery

Consultation and Cost

  • Drs. Sundin will assess your anatomy, goals, and anesthesia suitability during an in-person consultation
  • Both awake and traditional anesthesia options will be presented and discussed
  • Cost varies by procedure and extent; awake procedures generally carry lower fees due to reduced anesthesia costs
  • Financing options are available; virtual consultations are offered for out-of-area patients

Procedure Steps

  • Pre-operative markings are made with you standing or in the target position
  • Oral or IV sedation is administered for relaxation if desired
  • Tumescent local anesthesia is carefully infiltrated into the treatment area
  • The procedure is performed with you comfortable, awake, and able to communicate with the team
  • You are monitored throughout; compression garments are applied at completion
  • You walk out of the office the same day, alert and under the care of a companion

Recovery and Results Timeline

  • Same day: You leave the office alert, without anesthesia grogginess; a compression garment is worn
  • Days 1 to 5: Rest recommended; some swelling, bruising, and soreness are normal and typically milder than with general anesthesia procedures
  • Days 3 to 7: Many patients return to light desk work and daily activities
  • Weeks 2 to 4: Gradual increase in activity; compression garment continues to be worn
  • 3 Months: Swelling resolves and results become clearly visible
  • 6 Months: Final results are fully apparent
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Schedule Your Awake Body Surgery Consultation in Richmond

Curious whether awake surgery is the right approach for your body goals? Drs. Burton and Reps Sundin will walk you through every option with honesty and care. Call (804) 390-5660 or request your consultation online today.

FAQs: Awake Body Surgery

Will I feel any pain during an awake body procedure?

Can I eat before an awake body procedure?

What if I feel anxious about being awake during surgery?

Is there a limit on how much fat can be removed during an awake liposuction procedure?

Do I need to wear a compression garment after awake body surgery?

Can awake procedures be combined with each other in a single session?

Will I need a driver to take me home after an awake procedure?

How soon after childbirth can I have an awake body procedure?

Will I feel any pain during an awake body procedure?

The tumescent local anesthesia used in awake procedures numbs the treatment area completely, so patients do not experience pain during surgery. Some patients report sensations of pressure or movement, which is normal and expected while the area is fully anesthetized.

Can I eat before an awake body procedure?

Unlike general anesthesia, awake procedures with local anesthesia do not require the same strict overnight fasting protocol, though Drs. Sundin's team will provide specific pre-operative instructions tailored to your procedure and any sedation being used. Following those instructions carefully helps ensure the safest and most comfortable experience.

What if I feel anxious about being awake during surgery?

It is completely normal to feel nervous, and the team at Virginia Institute of Plastic Surgery will walk you through exactly what to expect before, during, and after the procedure. Mild oral or IV sedation is available to help patients feel relaxed and at ease throughout the surgery.

Is there a limit on how much fat can be removed during an awake liposuction procedure?

Awake liposuction is generally best suited for targeted, moderate fat removal rather than very large-volume cases. The safe limit for awake liposuction is typically in the range of three to four liters.

Do I need to wear a compression garment after awake body surgery?

Yes, a compression garment is applied immediately following the procedure and should be worn consistently during the early recovery period. Compression helps reduce swelling, supports optimal contouring, and promotes smooth healing.

Can awake procedures be combined with each other in a single session?

Certain awake procedures can be performed together, though the extent of combination depends on the total volume of local anesthesia that can be safely administered and the overall length of the procedure. Drs. Sundin will discuss what is appropriate to combine during your consultation.

Will I need a driver to take me home after an awake procedure?

Yes, even if sedation is minimal, you will need a responsible adult to drive you home following any surgical procedure. The practice recommends having someone available to stay with you for the first several hours after you return home.

How soon after childbirth can I have an awake body procedure?

Most plastic surgeons recommend waiting a minimum of six months after delivery before undergoing any elective body contouring, and longer if you are breastfeeding. Drs. Sundin will discuss appropriate timing based on your individual recovery and goals during your consultation.

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Delivering premier plastic surgery and non-invasive procedures, our services extend to popular cosmetic procedures such as mommy makeover, facelift, and liposuction for clients in Richmond.

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