Background <p>High-definition abdominal liposuction is a complex procedure requiring optimal anesthetic management to ensure patient safety and favorable outcomes. This study evaluates and compares the safety and efficacy of general anesthesia and deep sedation in this context.</p> Methods <p>We retrospectively analyzed 681 patients who underwent high-definition abdominal liposuction between 2015 and 2023. Patients were divided into two groups: 187 received general anesthesia (Group I), while 484 underwent deep sedation (Group II). Perioperative management, including the use of compression garments, Caprini score-based thromboprophylaxis, and standardized follow-up protocols, was consistent across groups.</p> Results <p>No statistically significant differences in major complications such as hematomas (<i>p </i>= 0.08), infections (<i>p </i>= 0.15), or VTEs (<i>p </i>= 1.00) were observed between the groups. Both techniques facilitated early mobilization and timely discharge. Tailored interventions, including preoperative risk assessments and perioperative warming, contributed to a low overall complication rate. Despite the absence of tranexamic acid, outcomes remained favorable, likely due to adequate tumescent infiltration times and other precautionary measures.</p> Conclusions <p>Both general anesthesia and deep sedation are effective and safe for high-definition abdominal liposuction. The findings underscore the importance of individualized risk management strategies and highlight the feasibility of deep sedation as a routine alternative. This study provides evidence-based guidance for selecting anesthetic techniques in cosmetic surgery.</p> Level of Evidence III <p>This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors <a href="http://www.springer.com/00266">www.springer.com/00266</a>.</p>