Awake liposuction is one of our most popular procedures, and demand is only increasing as time goes on. While the term “awake liposuction” is a bit vague, as it could potentially refer to twilight anesthesia since one is technically “awake” in this setting, the term practically applies to liposuction procedures performed without any form of intravenous or inhalational sedation. Success with awake liposuction is predicated on proper patient selection. In the right patient, awake liposuction can be a great alternative to twilight or general anesthesia. Choosing an awake approach for the wrong case can, however, lead to potentially dangerous situations or suboptimal aesthetic outcomes. We regularly perform awake liposuction for small treatment areas such as the chin, arms and flanks with great success.