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Development of Tumescent Technique Liposuction
Although liposuction is a relatively new form of cosmetic surgery, there have been several recent improvements in the technique. One of the most significant improvements has been the introduction of the Tumescent Technique, developed by Dr. Jeffrey A. Klein, MD. It permits liposuction totally by local anesthesia instead of general anesthesia. This technique is now considered the safest form of liposuction for removing very large amounts of fat because there is virtually no blood loss. Not only has the Tumescent Technique proven to be safer than the standard technique using general anesthesia but it also has proven to be less painful, has minimized post operative recovery time, and has produced optimal cosmetic results.
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Tumescent Liposuction (Totally By Local Anesthesia)
The word tumescent means swollen and firm. The Tumescent Technique uses large volumes of saline solution, lidocaine (a local anesthetic / "numbing" agent ) in combination with the vaso constrictive drug epinephrine, which temporarily shrinks small blood vessels and capillaries. In addition, dilute sodium bicarbonate (baking soda) is added in the solution to minimize further the unpleasant stinging otherwise associated with the lidocaine and epinephrine.
Local anesthesia used in the Tumescent Technique for liposuction is so effective that patients no longer need intravenous sedatives, narcotic analgesics, nor general anesthesia.
The tumescent solution is injected into the fatty tissue through small, "numbed" incisions in the skin (1 – 2 mm only). The tumescent fluid is injected under pressure, which causes the target fatty tissue to become firm and inflated (tumescent or "ballooned"). This ballooning allows the surgeon to later extract the fat in a more accurate and uniform fashion, thereby producing smoother results. The anesthetic and other agents in the tumescent solution should be allowed sufficient time to diffuse (percolate) and take full effect throughout the fatty tissue. The solution will numb the areas as well as reduce bleeding by temporarily closing down capillaries. Constricting the capillaries is important to reduce bleeding during and after surgery. Less bleeding means less bruising. Not only does this make the surgery safer, it also speeds up recovery. As a result, most patients can return to work or their regular routines in a couple of days.
The tumescent technique is especially well suited to office surgery. Allowing the tumescent solution the time (30 – 60 minutes) to diffuse (percolate) and take effect throughout the target fat is very important. In a hospital-based liposuction, time is money. Only one case can be performed in the hospital operating room at a time. Hospital operating rooms cost much money to run because of expensive maintenance and equipment and numerous personnel. At the same time, plastic surgeons are unwilling to wait for solutions to percolate and take full effect. They may not do as well financially as those who choose to use the "wet method" or another "dry method" under general anesthesia. Performance of a procedure in a properly equipped office surgical suite allows the staff and doctor to handle other tasks while solutions percolate. Patience is a virtue in the case of Klein solution diffusion. Surgeons who are able to take the necessary time in a Surgi-center or hospital-based setting can have equivalent results with the tumescent method performed in an office setting. |
Who are the best Candidates? |
The best candidates for liposculpture under local anesthesia:
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Have firm, elastic skin |
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Are in good general health |
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Have realistic expectations of liposuction. "Realistic" means that improvement, not always perfection, is the goal. |
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Have distinct areas of localized accumulations of fat that are disproportionate to the rest of their bodies |
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Only slightly to moderately overweight |
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There is no definite age limit for liposuction but it is not advised for people under 18 years old. |
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Those who understand that Liposuction is not treatment of general obesity. Liposuction is not a substitute for a prudent diet, good nutrition, and regular exercise for weight loss. Liposuction surgery is not effective as a last resort for people who are unable to maintain a reasonable weight by dieting. However, an overweight person whose weight has been stable for many years may be good candidates for limited liposuction if the goal is simply to improve the shape of certain limited areas of the body. Obesity is associated with an increased risk of surgical complications. |
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You are not a candidate for Tumescent Liposculpture if you have:
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Severe cardiac or renal disease |
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Severe coagulation disorder |
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Active hepatitis or liver disease |
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Active cancer or chemotherapy within the past two years |
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Morbid obesity |
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Immunosuppression / HIV / AIDS |
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Pregnancy |
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History of malignant hyperthermia |
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Allergy to lidocaine (local anesthetics) |
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Unrealistic expectations |
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Is Fat Removal Permanent? |
| Fat cells that are removed by liposuction do not grow back. As long as the patient does not gain excessive amounts of weight, the new, more pleasing silhouette is permanent. A woman who always tends to put weight on her thighs and knees, will find that after liposuction, these areas are less likely than other areas to accumulate fat when she gains weight. In fact a number of our patients have had liposuction and have subsequently gained weight. The areas originally treated by liposuction have maintained their new desirable silhouette, whereas areas not treated by liposuction have been the sites of new deposits of fat. |
How is the skin affected? Will it contract to fit my new profile? |
Dimples, ripples, and stretch marks remain unchanged following liposuction. Your figure will be similar to what you would expect if you could lose an equal amount of localized fat through diet and exercise alone. Because the small Cannulas simply make small tunnels through the fat, there remain multiple connections between the skin and the underlying tissue. These fibrous connections contract with the healing process and maintain the skin in its natural position. After liposuction by the Tumescent Technique, one does not have to worry about excessive folds of skin in the areas treated by liposuction. This effect is so dramatic that many patients who previously would have required a surgical excision of skin, called a tummy tuck, can now have excellent results simply by having liposuction.
In some instances, removal of excess skin may be necessary to achieve a smooth result. Unfortunately, the surgical removal (by cutting) of excess skin must result in the formation of a scar which may be unsightly in some surgeons' hands. However, the scar may be more desirable than leaving the redundant skin fold. Some of these procedures are referred to as the "tummy tuck," "arm reduction," and "leg reduction. |
What are the advantages of Tumescent Liposuction? |
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Performed in the privacy of our office omitting the need for hospitalization saving the enormous cost of a hospital and the cost of anesthesia. |
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Decreased bruising:
There is dramatically less bruising using local anesthesia for liposuction as compared to general anesthesia. There are two reasons for this significant decrease in bruising. Firstly, because there is so little bleeding with the Tumescent Technique, there is almost no blood that remains beneath the skin after surgery to cause bruising.
The second reason for decreased bruising is that with the Tumescent Technique there is a considerable amount of post-operative drainage of the anesthetic solution which is slightly blood tinged. Because the incision sites are so small and do not require stitches, these wounds are slightly open for two to three days after the surgery and permit most of the residual anesthetic solution and blood to drain out. This minimizes bruising and swelling and accelerates the rate of healing. |
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Virtually no blood loss:
As a result of the widespread capillary constriction caused by the epinephrine in the anesthetic solution, there is minimal bleeding during and after surgery. This is a major improvement in the liposuction technique compared to older methods that simply use general anesthesia.
The Tumescent Technique is so effective at minimizing blood loss that the majority of patients with large volume liposuction lose less blood during the surgery than they do at the time of their routine pre-operative laboratory studies. Because of the minimal blood loss associated with the Tumescent Technique, there is no need for blood transfusions. |
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Less painful with relatively little discomfort than general anesthesia:
Tumescent Technique is a dramatically less painful experience than with general anesthesia. With the Tumescent Technique infiltrating the local anesthesia is associated with minimal discomfort. Once the area has been completely numbed, surgery in the area is essentially painless. In addition, because the local anesthesia persists in the treated area for more than 12 hours, there is no pain immediately after the surgery. |
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Decreased risk of infection:
Infections are extremely rare. Although there have been reports in the medical literature of patients who have had serious infections following liposuction surgery, to the best of our knowledge, there has never been any patients who have had an infection following liposuction totally by local anesthesia using Tumescent Technique. Lidocain, the local anesthetic that used for the Tumescent Technique kills bacteria. With this technique, areas that are being treated surgically are the areas that will receive the Lidocaine that kills bacteria. |
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Better, smoother, and optimal cosmetic results:
The large volumes of dilute local anesthetics infiltrated into the fatty tissue causes the tissue to become swollen and firm. The Tumescent Technique magnifies the fatty area that is to be treated by liposuction. If there is an area that has not been completely treated, this is more easily detected because the area is swollen and enlarged. Thus the risk of post-surgical irregularities and unevenness is minimized.
With the Tumescent Technique small Cannulas are used. This permits a more delicate and gentle approach to liposuction. The liposuction cannulas which have been specifically designed for the Tumescent Technique are 2.5 and 3.1 mm in diameter. These micro cannulas require a minimal amount of force in order to advance them into the fatty tissue. As a result, this surgery is much more gentle and the surgeon can control the direction and position of the cannula with much more accuracy. The suction Cannula creates tiny tunnels through the fatty layers. After surgery, these tiny tunnels collapse resulting in an improved body contour. (Figure 1). The ultimate result is a greatly reduced risk of inadvertently approaching too close to the undersurface of the skin and unintentionally causing irregularities. |
Figure 1
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Less visible or no scars
Because the Tumescent Technique uses very small cannulas, only tiny incisions are required. The incisions are so small that no stitches are used. The wounds heal by themselves and virtually disappear with time. |
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Immediate post operative recovery:
Because it does take additional time to inject the local anesthesia by the Tumescent Technique, the patient does remain on the surgical table longer than with liposuction by general anesthesia. However, because the recovery time is so short, the total amount of time that the patient is in the surgical facility is much shorter with the Tumescent Technique than with general anesthesia. After completion of liposuction by the Tumescent Technique, patients are discharged home in about 30 minutes. When you go home, rest for few hours, after which you may gradually increase your activity as tolerated. After 2 to 5 days you may resume normal activities. You may need to wear a snug elastic dressing, girdle, or body stocking over the treated area. |
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Quick return to normal activities:
Because the Tumescent Technique eliminates bleeding and because the residual anesthetic solution drains out so quickly, there is less inflammation and the healing process is significantly accelerated. Patients are able to return to normal physical activities very soon after surgery. There is no limitation to physical activity other than what common sense would dictate. Some patients are able to return to jogging, golf, light aerobic exercise within a day or two after surgery. Some patients do find the soreness after surgery more significant than others, but on the average, most patients are quite surprised at how quickly they are able to return to normal activity. |
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Risk of General anesthesia is eliminated:
The drugs that are used to produce general anesthesia are relatively dangerous compared to those used for local anesthesia. The serious complications associated with general anesthesia are eliminated as serious risk factors just by not using these medications. In addition, the risks associated with endotracheal intubation used in general anesthesia such as hypoxemia (low blood oxygen) among others are eliminated. |
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Areas treated by Liposuction
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The most frequently treated areas in women and men are:
| Abdomen |
Hips |
Love handles |
| Waist |
Inner and outer thighs |
Knees |
| Calves and ankles |
Chin and jaw line |
Breasts |
| Arms |
Buttocks |
Back |
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What are the side effects and complications Associated with Liposuction? |
Numerous peer-review medical journal studies have confirmed that the technique and cosmetic results of tumescent liposuction are excellent and very safe.
As with any surgical procedure, liposuction is associated with possible side effects. These side effects are greatly minimized by the use of small-diameter cannulae and the tumescent technique.
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Bruising: It varies from person to person, although noticeable bruising is usually gone within a couple of weeks. Bruising is much less with Tumescent liposuction. |
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Swelling: usually gradually improves within one to three months after surgery, with optimum results being apparent in about three to six months. |
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Irregularities of the skin at the treated area. Liposuction can produce some irregularities of the skin which can be visible in certain conditions of lighting. In general the smoothness of the skin is much improved after micro cannulas liposuction. These are usually imperceptible to the casual observer. It is reasonable to expect significant improvement, but the results are rarely perfect. |
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Discomfort, pain in the surgically treated areas and mild soreness. It should be temporary and controlled by either over-the-counter medication, or by a prescription. |
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Temporary numbness which is an altered sensation at the site of the liposuction. This may either be in the form of an increased sensitivity (pain) in the area, or the loss of any feeling (numbness) in the area. sometimes persists for a few weeks. |
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Seroma. After liposuction, there may be a pooling of serum, the straw colored liquid from your blood, in areas where fat has been removed. This side effect is less common with the Tumescent Technique because the incision sites are so small and do not require stitches. These incisions are slightly open for few days after the surgery and permit most of the fluid to drain out. |
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Scarring: Incisions for liposuction may result in scarring. Tiny (1 to 2 millimeter) round holes in the skin, called adits, are used for inserting the cannulas through the skin and into the fat. Typically, when adits heal they become virtually invisible. Although you may be able to find them upon close examination, most other people would not be able to see them. Some patients may experience temporary hyper-pigmentation (darkening) that usually fades after several months. Some patients may have a genetic predisposition for persistent discoloration at incision sites. Any one who has previously experienced hyper-pigmentation or hypo-pigmentation (pale or light colored scars) of the skin in the past might expect to also experience it with liposuction adits or incisions. Certain areas of the body, such as the back or upper flanks, may be more likely to have pigmentation changes. |
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Possible complications |
As with any surgery, there are certain risks, beyond the temporary and minor side effects. Careful patient selection minimizes their occurrence. Their likelihood is somewhat increased when treated areas are very large or numerous and a large amount of fat is removed.
A study published in Dermatologic Surgery (July 2004, pp. 967-978), found that:
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“The overall clinical complication rate [for liposuction] ... was 0.7% (5 of 702)” |
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The minor complication rate was 0.57% |
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The major complication rate was 0.14% with one patient requiring hospitalization |
The following Serious complications are extremely rare: |
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Infection: Infections may happen after any surgery and may occur after liposuction. Antibiotcs are usually prescribed before and after surgery. Serious or life threatening infection are very rare. |
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Embolism. Embolism may occur when fat is loosened and enters the blood through blood vessels ruptured (broken) during liposuction. Pieces of fat get trapped in the blood vessels, gather in the lungs, or travel to the brain. This is very rare and has not been reported with the tumescent liposuction. |
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Blood clots and thromboembolism: although liposuction is a low-risk procedure for thromboembolism including pulmonary embolism, the risk can't be ignored. |
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Skin Necrosis (skin death). The skin above the liposuction site may become necrotic or "die." This was more common with the older techniques were large more aggressive cannulas were used. |
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Toxicity from Anesthesia. Lidocaine, a drug that numbs the skin, is frequently used as a local anesthetic during liposuction. Large volumes of liquid with lidocaine may be injected during liposuction. This may result in very high doses of lidocaine. The signs of this are lightheadedness, restlessness, drowsiness, tinnitis (a ringing in the ears), slurred speech, metallic taste in the mouth, numbness of the lips and tongue, shivering, muscle twitching and convulsions. Lidocaine toxicity may cause the heart to stop. Of course, this can be fatal. In general, any type of anesthesia may cause complications and is always considered a risk during any surgery. |
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Allergic reaction to anesthetic: most liposuction is done with local anesthetic, so the risks of general anesthesia are avoided. |
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Puncture of an internal organ: since the surgeon can't see the cannula, sometimes it damages an internal organ, such as the intestines during abdominal liposuction. Such damage can be corrected surgically, although in rare cases it can be fatal. An experienced cosmetic surgeon is unlikely to puncture any internal organ. |
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Fluid imbalance: since fat contains a lot of fluid and is removed in liposuction, and since the surgeon injects fluid for the procedure, even a very large amount of it for tumescent liposuction, there is a danger of the body’s fluid balance being disturbed. This could happen afterwards, after the patient is at home. If too much fluid remains in the body, the heart, lungs and kidneys could be badly affected. |
Before Liposuction |
At Vein & Laser Center, we want to provide you with the very best surgical care. You can help to minimize the risk of complications by carefully following your preoperative and postoperative instructions.
You will be given specific instructions on how to prepare for your surgery, including guidelines on eating and drinking, smoking, and taking or avoiding vitamins, and certain medications. If you develop a cold or an infection of any kind, especially a skin infection, your surgery may have to be postponed.
Prior to surgery, we recommend that you have blood test ahead of time. Medications will be prescribed and you should take them as directed. Be sure to arrange for someone to drive you home after the procedure and, if needed, to help you at home for a day or two. |
After Liposuction |
After surgery, you will experience some fluid drainage from the incisions. To control swelling and to help your skin better fit its new contours, you will be fitted with a snug elastic garment to wear over the treated area.
You may experience some nausea, pain, burning, swelling, and temporary numbness. Pain can be controlled with Tylenol®. It is normal to feel a bit anxious in the days following surgery. However, this feeling will subside as you begin to look and feel better.
You may drive the day after surgery and resume normal activities as tolerated. You may carefully resume exercise and vigorous physical activity 2 to 4 days after surgery. It is suggested that you begin slowly and increase your activity daily as tolerated. Most people can return to a desk job within one to two days after surgery, although one must expect to be sore and easily fatigued for several days. |
Your New Look
You will see a noticeable difference in the shape of your body soon after surgery. However, improvement will become even more apparent after about four to six weeks, when most of the swelling has subsided. After about three months, any persistent mild swelling usually disappears and the final contour will be visible.
If your expectations are realistic, you will probably be very pleased with the results of your surgery. You may find that you are more comfortable in a wide variety of clothes and more at ease with your body. And, by eating a healthy diet and getting regular exercise, you can help to maintain your new shape.
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(This information has been taken from Dr. Jeffrey Klein, www.Liposucion.com)
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