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Tumescent Liposuction
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IMPORTANT INFORMATION ABOUT LIPOSUCTION SURGERY BY
THE TUMESCENT TECHNIQUE
What is Tumescent Anesthesia?
One of the most significant improvements in liposuction in recent years has been the use of tumescent anesthesia, introduced by Dermatologist Jeffrey Klein 1n 1987. The tumescent technique minimizes post-operative discomfort. Because the residual local anesthesia lasts for 12-18 hours or more, plain Tylenol is sufficient to treat post-operative discomfort. With the Tumescent Technique there is no post-surgical nausea, nor the unpleasant feeling of a "hang-over" usually associated with general anesthesia.
The Tumescent Technique uses large volumes of a dilute solution of lidocaine, a local anesthetic, in combination with the drug epinephrine which temporarily shrinks capillaries. Recently, it has been noted that adding a very small amount of triamcinolone (10 mg), a hydrocortisone-like anti-inflammatory medication, to each litre of anesthetic solution has resulted in marked decrease in post-operative soreness.
The Tumescent Technique dramatically reduces both the bleeding during surgery, and the post-operative bruising and swelling as compared to liposuction by general anesthesia. In fact, there is so little blood loss with the Tumescent Technique that patients usually lose more blood for pre-operative laboratory tests (about 4 teaspoonsful) than during the actual liposuction surgery. Minimal bleeding reduces post-operative recovery time. Most patients can return to work and begin exercising again within a day or two after surgery. An elastic support garment is worn for a few weeks following surgery.
About 90% of patients can actually see at least some improvement in their silhouette by one week after surgery. However, because of the slow resolution of post-surgical swelling, the ultimate results following liposuction usually require 12-16 weeks (or longer) to be achieved.
The fat cells that are removed by liposuction do not grow back. The patient's new, more pleasing silhouette is permanent. If the patient gains or loses weight, the change tends to be distributed proportionately over the entire body. The change of silhouette produced by liposuction is equivalent to being able to focus the effects of dieting to specific areas of the body. The degree of skin change after liposuction is the same as one would expect after having lost an equal amount of localized fat by dieting.
Since the fat is removed by suctioning small "tunnels" through the fat, the skin remains intimately connected to the underlying muscles by multiple fibrous attachments. As healing occurs after surgery, these fibrous strands contract and pull the skin into close proximity with the muscles. It is this process which insures that the skin will not hang in loose folds after liposuction surgery. Because the surgeon is careful to leave a thin blanket of fat attached to the skin, the skin will look and feel soft and normal after the liposuction. By "puffing up" the fatty compartment, Tumescent Technique permits more accurate removal of fat, with greater assurance that the liposuction cannula will not inadvertently be allowed to approach too near the undersurface of the skin which would cause irregularities. Thus the tumescent technique helps to minimize the risk of post-surgical irregularities or rippling of the skin.
Although the results of liposuction are often quite spectacular, it is not realistic to expect perfection. Liposuction of the thighs, while improving the silhouette, does not necessarily eliminate the subtle "puckering" of the skin often called "cellulite". Cellulite results from the pull of fibrous tissue that connects skin to underlying muscle. Liposuction with the tumescent technique may reduce the degree of cellulite but it is unlikely to eliminate it.
As with any surgical procedure, liposuction is associated with certain expected side-effects such as bruising, swelling, and temporary numbness. Although irregularities of the skin are possible following liposuction, this side-effect is minimized by the tumescent technique, especially when performed with small cannulas. As judged by current world-wide experience, tumescent liposuction is amazingly safe. Serious complications such as blood clots, infection and allergic reactions are extremely rare. Most of the dangers associated with surgery are related to the type of anesthesia that is used. Surgery of the skin and subcutaneous fat is safest using local anesthesia with the patient awake.
What to Expect on the Day of Surgery
Your surgery will be performed at Dr. Pollack's Clinic, Suite 216, 200 St. Clair Avenue West, Toronto. Shortly after your arrival, you will change into an operating gown and the areas on your body that are to be treated with liposuction are marked with a felt-tipped pen. It usually takes about an hour getting set-up before the surgery actually begins.
A blood pressure cuff will be placed on one arm and an Intraveneous line (IV) may be established in the other arm. A small instrument will be placed on one of your fingers to monitor the oxygen levels in your blood. Next, using extremely thin and short little needles, the doctor or nurse will anesthetize the skin at sites where the longer needles will be inserted to anesthetize the subcutaneous fat. The actual injection of the anesthetic solution is almost painless. Patients usually experience a slight pricking sensation under the skin as the area becomes numb.
Once an area has been well infiltrated with a large volume of dilute anesthetic solution, it is usually completely numb. However, there may be small areas that are only 50% or 75% numb. In order to check that the entire area is 100% numb, a small blunt tipped cannula is passed throughout the area. If an incompletely anesthetized area is encountered, the patient will feel a mildly sharp discomfort. By immediately indicating whenever the slightest tenderness is encountered, more anesthetic solution can be infiltrated through the small cannula exactly where it is needed. Thus, with the patient's alert cooperation, 100% numbness is achieved. After completing the infiltration of the local anesthetic but before Dr. Pollack actually begins removing the fat by liposuction, you will be escorted to the bathroom to empty your bladder.
It may seem somewhat ironic, but experience has shown that giving mild sedation permits better local anesthesia than when patients are heavily sedated. This is because an alert patient is more capable of detecting subtle areas of incomplete anesthesia. A sedated patient might easily ignore an incompletely anesthetized area, and then feel more discomfort when liposuction is actually done. Therefore, minimizing sedation actually maximizes patient comfort. Our usual sedation consists of 10 mg of Valium given as a pill which is allowed to dissolve under your tongue
After completing liposuction, an antibiotic ointment is applied to the tiny incision sites. The incisions are so small that stitches are not generally used. Elastic garments will be placed and you are ready to get up and go home. Because of residual local anesthetic, it is several hours after completing the liposuction before any significant soreness begins. Although you will feel well enough after surgery to drive yourself home, you should not do so because large amounts of local anesthetic and the valium may cause some drowsiness.
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