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DVT and Pulmonary Embolism: Awake Surgery vs General Anesthesia

Blood clots are a serious risk of any surgery. Here is what the research does and does not tell us about awake surgery versus general anesthesia.

The short answer

We did not find head-to-head trials in aesthetic surgery showing that one anesthetic type causes fewer clots. Any claim that awake surgery eliminates clot risk, or that general anesthesia carries a higher risk, would go beyond the evidence.

What affects clot risk

  • The operation. A systematic review of abdominal contouring found circumferential abdominoplasty had the highest venous thromboembolism (VTE) rate at 3.40%, versus 0.35% for abdominoplasty alone.
  • Combining procedures. A literature review noted a higher VTE incidence when abdominoplasty was combined with liposuction, and listed circumferential procedures, obesity and hormone replacement therapy as independent risk factors.
  • Your health. Previous clots, family history, obesity, smoking, estrogen-containing medication and limited mobility all matter.
  • Operating time and immobility. Longer operations and less movement afterward increase risk.

Why people think awake might help

Shorter, more limited procedures, and the ability to walk soon after, may reduce risk in theory. But this is not proven for aesthetic surgery, and the extent of the operation is likely to matter more than whether you were awake.

Low-risk is not zero-risk

One 2024 report describes VTE as a serious but rare complication of aesthetic surgery, quoting an incidence of 0.017% for liposuction. Large complication reviews of cosmetic liposuction (31,010 liposuction patients in one study) examine clots among other complications.

How we reduce risk

  • Individual risk assessment before surgery, for example with a Caprini-type score.
  • Early walking and compression devices when advised.
  • Considering medication to prevent clots in selected patients, balanced against bleeding.
  • Staging large procedures when appropriate.

When to seek help

Call 911 for sudden shortness of breath, chest pain or collapse. Call the clinic and seek urgent care for a swollen, red, painful or warm calf or thigh.

Explore your options at a consultation

References

  1. Hatef DA, Trussler AP, Kenkel JM. Procedural risk for venous thromboembolism in abdominal contouring surgery: a systematic review of the literature. Plast Reconstr Surg. 2010;125(1):352-362. PMID 20048626
  2. Mittal P, Heuft T, Richter DF, Wiedner M. Venous thromboembolism (VTE) prophylaxis after abdominoplasty and liposuction: a review of the literature. Aesthetic Plast Surg. 2020;44(2):473-482. PMID 31858207
  3. Perzia BM, Marquez J, Mellia JA, et al. Venous thromboembolism and bleeding events with chemoprophylaxis in abdominoplasty: a systematic review and pooled analysis of 1596 patients. Aesthet Surg J. 2021;41(11):1279-1289. PMID 33599713
  4. Kaoutzanis C, Gupta V, Winocour J, et al. Cosmetic liposuction: preoperative risk factors, major complication rates, and safety of combined procedures. Aesthet Surg J. 2017;37(6):680-694. PMID 28430878
  5. Palacios Huatuco RM, Giovanardi G, Coloccini A, et al. Venous thromboembolism after aesthetic surgeries in low-risk patients without hypercoagulability. J Surg Case Rep. 2024;2024(9):rjae604. PMID 39314778
  6. Comerci AJ, Arellano JA, Alessandri-Bonetti M, et al. Risks and complications rate in liposuction: a systematic review and meta-analysis. Aesthet Surg J. 2024;44(7):NP454-NP463. PMID 38563572