The advantage of Rams is that local anesthesia is possible, but the pain is enormous. It hurt so much while doing abdominal surgery that I thought, "I really can't take it anymore. It's the first time I've had such a thought since I was born. It's not like my stomach has been reduced a lot like liposuction, but I have a bit of a complex." It's gone and I recommend it if you can bear the pain.