Abstract

Objectives: To describe and delineate the key anatomical landmarks and operative strategies that minimize complications in the high‑BMI (HBMI) population undergoing awake body‑contouring procedures. Additionally, to identify techniques that support reproducible, high‑quality aesthetic outcomes in HBMI patients who elect wide‑awake large‑volume liposuction or abdominoplasty. Introduction: Wide‑awake body contouring for high‑BMI patients under minimal sedation offers advantages such as patient preference, easier recovery, lower cost, and fewer anesthetic risks. Common targeted areas include the arms, pannus, and abdomen. Office‑based large‑volume liposuction with or without pannus excision, combined with safe analgesia, has expanded the aesthetic candidacy population. This shift is driven by GLP‑1 use, improved sterility protocols, epinephrine‑enhanced tumescent techniques, and telemedicine monitoring. Materials / method: The author retrospectively reviewed medical records from patients treated at the private clinic, Dr. Lissa Plastic Surgery Clinic, who underwent either wide‑awake HBMI body contouring or an awake tummy tuck between 2020 and 2025. All procedures were performed by the author. Patients were categorized into three groups based on body mass index (BMI): Group 1: BMI 35–40 Group 2: BMI 41–45 Group 3: BMI 45–50 Results: The authors evaluated a cohort of 250 patients over a 5‑year period who underwent either office‑based large‑volume liposculpture or lipoabdominoplasty. Anesthetic management consisted of minimal oral sedation combined with regional anesthesia. The most frequently observed complications included seroma formation, bruising, and cutaneous wrinkling. Notably, no cases of deep vein thrombosis (DVT) or partial‑ or full‑thickness wound dehiscence were reported. Conclusion: Awake high‑BMI (HBMI) large‑volume liposuction and awake abdominoplasty can be performed safely and comfortably in an office‑based setting while achieving a natural‑appearing improvement in abdominal contour and silhouette. In this cohort, no major complications were observed, including no cases of deep vein thrombosis (DVT) or pulmonary embolism (PE). This approach prioritizes patient safety—particularly in the HBMI population—while maximizing aesthetic outcomes through a comprehensive integration of medical, anatomic, artistic, and technological expertise.