Tumescent technique: The worldwide standard of care for Liposuction.
Liposuction is the second most popular cosmetic surgery procedure in the United States, with 258,558 surgeries performed in 2018, according to the American Society of Plastic Surgeons (1). Liposuction is ideal for patients who have tried unsuccessfully to eliminate localized fat deposits through diet, exercise and weight loss. The primary goal of liposuction (also known as lipoplasty) is to reduce fat deposits in specific localized areas and achieve the well-proportioned body contours without much downtime. The most common form of liposuction in the U.S is the Tumescent Liposuction, which is more effective, safer, less painful and has a quicker recovery time than traditional liposuction methods. The tumescent technique is the worldwide standard of care for liposuction nowadays. Tumescent Liposuction can safely remove fat from almost all parts of the body, including the face, neck, chin, breast stomach, hips, flanks, back, inner and outer thighs, buttocks, knees, calves, and ankles. It used to remove lipomas, or benign fatty tumors, and to treat excessive underarm sweating and enlarged male and female breasts.
Any liposuction procedure that is performed using tumescent fluid is considered as Tumescent Liposuction. Tumescent fluid is local numbing of the fatty area prior to removal using a dilute lidocaine solution. Once injected, the fat tissue swells and becomes tight, or becomes “tumesced”, making it easier for the plastic surgeons to sculpt the target area with a more advantageous outcome. Dr. Jeffrey Klein is credited as the originator of the tumescent technique, which has allowed liposuction to be performed with minimal blood loss (2). Since its inception, liposuction performed with the tumescent technique has had an excellent safety profile. Tumescent Liposuction, as defined by Klein, includes using tumescent anesthetic and small microcannulae. The small cannulae form tunnels in the subcutaneous tissue and allow for more effective and less traumatic fat removal than the large cannulae. The use of the tumescent technique and micro-cannulas allows the plastic surgeon to do liposuction more superficially and to produce smoother results than could be done with old-fashioned techniques that used larger cannulas. Using micro-cannulas (less than 3 mm in outside diameter) for liposuction can require a little more time than using larger cannulas, but micro-cannulas permit both the removal of more fat and smoother results.
During Tumescent Liposuction a solution containing a local anesthetic (which helps with pain control during and after surgery), and a drug called epinephrine which minimizes blood loss will be injected into the targeted areas of excessive fatty deposits. The solution fills the fatty layer of the skin and causes it to swell and become firmer, allowing the plastic surgeons to have better control when contouring the area. The solution also causes the blood vessels to temporarily shrink, greatly reducing blood loss during the procedure, and reduces bruising, swelling and pain after the procedure(3). The tumescent technique is so effective at minimizing blood loss that the majority of patients lose approximately 15ml to 30ml (1 to 2 tablespoons) of blood during large volume liposuction. This is the same volume of blood that is taken for routine pre-operative laboratory studies. In the days before the advent of the tumescent technique, the biggest risk of liposuction was excessive loss of blood during surgery. In fact, many plastic surgeons required their patients to donate their own blood several weeks before surgery, and then during surgery, the blood would be returned to the patient by transfusion. With the advent of the tumescent technique, blood transfusions are no longer a part of liposuction surgery. Moreover, the vasoconstriction produced by the tumescent technique for liposuction has virtually eliminated the occurrence of hematomas. A hematoma is a lake-like collection of whole blood that has leaked out of injured blood vessels and become trapped inside the body. Tumescent fluid is also antibacterial, so there is less risk of infections with Tumescent Liposuction.
After the tumescent solution is injected, the plastic surgeon makes a small incision in the skin and inserts a cannula (a small, thin tube that is connected to a vacuum-like machine) into the fatty layer. Using back and forth, gentle movements, the fat is sucked through the tube into a sterile collection system. An elastic compression garment is then worn to help the skin contract and heal. Post-operative dressing is a very important step in Tumescent Liposuction. An important feature of the Tumescent Liposuction is that some amount of the fluid is still left behind at the end of the procedure, which ensures anesthesia in the immediate post-operative period, minimizing the need for potent oral analgesics. With the modern “open-drainage” technique for post-liposuction care, the tiny incisions called “adits” are allowed to remain open (not closed with stitches), and the reason for using compression garments is to promote the rapid drainage of the residual blood-tinged tumescent anesthetic solution from beneath the skin(4). If this blood-tinged fluid is allowed to remain under the skin, it increases the degree of bruising, swelling and tenderness and the risk of infection. By using “open-drainage” with good compression, most of this fluid is squeezed out within the first 24 hours after surgery, and healing is more rapid. This minimizes bruising and swelling and accelerates the rate of healing.
(1)“2018 National Plastic Surgery Statistics”. American Society of Plastic Surgeons. https://www.plasticsurgery.org/documents/News/Statistics/2018/plastic-surgery-statistics-report-2018.pdf
(2) Shelton, Ron. “Tumescent Liposuction”. WebMD. https://emedicine.medscape.com/article/1835414-overview
(3) “Tumescent Liposuction”. University of California. https://www.ucsfhealth.org/treatments/tumescent_liposuction/
(4) Kassardjian, Norma. “FAQ: Elastic Compression Garments”. Liposuction.com https://www.liposuction.com/elastic-garments-html