Liposuction was initially developed in 1978-1982 in Italy and France, and introduced into the United States in 1982. At that time liposuction could only be performed under general anesthesia and was called dry liposuction when no fluid was introduced into fat. Later a small amount of fluid was introduced into fat and was referred to as the wet technique.
These methods were associated with so much blood loss that patients frequently required hospitalization and blood transfusions. In 1985, Dr Jeffrey A. Klein, M.D., a dermatologist in California, revolutionized liposuction surgery when he developed the tumescent technique, which permits liposuction totally by local anesthesia and virtually eliminates surgical blood loss. Because the tumescent technique is by far the safest form of liposuction, it has become the worldwide standard of care. Not only has the tumescent technique proven to be safer than the older techniques that required general anesthesia, it has also proven to be less painful, has minimized post-operative recovery time, and has produced optimal cosmetic results.
Previously (and even now by most doctors), liposuction has been performed as follows:
- General anesthesia.
- Introduction of small amount of fluid.
- Making large incisions (1.5 cms) to introduce cannulae.
- Sucking the fat out through large cannulae 1cm in diameter.
- Suturing the incision wounds of cannulae.
While the procedure was quick (lasting 2-3 hours) and thus saved time for the surgeon, it had several disadvantages:
- Since the method was under general anesthesia, patient had to be hospitalized
- This added significantly to the cost.
- General anesthesia always has its risks.
- Use of large cannulae causes damage to tissue and hence bleeding is more.
- Since large cannulae were used to suck out fat rapidly, these needed large incisions which had to be stitched leaving behind significant scars.
- Recovery time was slow, as after any procedure under general anesthesia.
Because of these limitations, tumescent liposuction became popular. In this method, a larger volume of anesthesia fluid is introduced through tiny holes and allowed to act. This fluid has 3 actions:
- It anesthetizes the area so no pain is felt.
- It breaks down the fat so it is easier to remove.
- It closes blood vessels so bleeding is less.
Mechanism of tumescent liposuction
The Klein formula tumescent solution is injected into the fatty tissue through small, “numbed” holes in the skin. Many of these holes are made, when possible, in inconspicuous places. 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.
Here’s a patient experience before, during and after the procedure.
What is a microcannula?
Tumescent liposuction totally by local anesthesia requires the use of very small cannulae or microcannulas. Microcannulas have an outside diameter up to 2.8 mm. These are only slightly larger than the IV needles used for drawing blood in laboratories. Microcannulas permit a more delicate and gentle approach to liposuction than can be achieved using larger cannulae. Because microcannulas require a minimal amount of force to be pushed through fatty tissue, the surgeon can control the direction and position of the cannula with much more accuracy: The ultimate result is a better cosmetic result.
The procedure of liposuction
In summary, the procedure of tumescent anesthesia is as follows:
- Introduction of a large amount (1-3 L) of special Klein’s solution into fat-both for purposes of ballooning, to decrease bleeding and most importantly for anesthesia.
- Making several small holes ( 2-3mm) to introduce cannulae.
- Sucking the fat out through small cannulae 2-3 mm in diameter.
- Leaving the incision wounds of cannulae open to drain out fluid.
- Applying compression bandages and sending the patient home without any admission.
- The whole procedure lasts 3 -5 hours
With this method, there is no need for general anesthesia or even IV sedation for the patient. The patient is fully conscious throughout the procedure. This has major advantages:
Safety: The dangers of traditional liposuction happen when the cannula goes in a region it is not meant to, which can happen if the muscle is relaxed. Because in tumescent liposuction, no general anesthesia is used, there is no muscle relaxation that happens. Hence there is less chance of injuring any structure. This makes the technique safer
Better results: In tumescent technique, the patient is fully conscious. Hence they are able to stand up in the middle of the procedure. And in this position, it is possible to see if any areas need more liposuction and avoid any irregularities or asymmetries. This is not possible with traditional liposuction. Hence the final result is better.
What are the benefits of tumescent liposuction?
There are several advantages :
- Local anesthesia used in the tumescent technique for liposuction is so effective that patients no longer need intravenous sedatives, narcotic analgesics, or general anesthesia.
- There is minimal bleeding during and after surgery as a result of the widespread blood vessel constriction caused by the epinephrine in the anesthetic solution. This is a major improvement in the liposuction technique compared to the older methods that simply use general anesthesia.
- Tumescent anesthesia provides pain relief for several hours after surgery, as the anesthetic fluid persists in the fat.
- It is an outpatient procedure-patient can walk out of the clinic after surgery.
- It is safer as it avoids the risk of general anesthesia, Bleeding is also much less.
- It is cheaper as there is no hospitalization.
- The patient can return to work within 2-3 days-recovery time is less.
How much blood is lost during tumescent liposuction?
The tumescent technique is so effective at minimizing blood loss that the majority of patients lose approximately 15 to 30 ml (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 of these patients need a blood transfusion. With the advent of the tumescent technique, blood transfusions are no longer a part of liposuction surgery.
How does the tumescent technique reduce bruising after liposuction?
There is dramatically less bruising with tumescent liposuction totally by local anesthesia compared to other liposuction techniques under general anesthesia. There are two reasons for this significant decrease in bruising. First, because there is so little blood loss with the tumescent technique, there is almost no blood that remains beneath the skin to cause bruising after surgery.
The second reason for decreased bruising is that with the tumescent technique, there is a considerable amount of post-operative drainage of the blood-tinged anesthetic solution. The incisions are so small (about 1.5 mm), the incisions do not require stitches. By allowing these wounds to remain open for two to three days after the surgery, most of the residual blood-tinged anesthetic solution drains out. This minimizes bruising and swelling and accelerates the rate of healing.
Is there any disadvantage of tumescent liposuction?
Perhaps the only disadvantage (if it can be termed so) is that tumescent liposuction takes a longer time to perform as both the anesthesia itself takes more time to set and also the use of microcannula makes the procedure slower. However, as stated earlier, in liposuction, speed is not the criterion for excellence. Ultimately, excellence is measured in terms of patient happiness which is a function of safety, patient comfort, finesse, and quality of results. And by these criteria tumescent liposuction scores.
How can these disadvantages be overcome?
We overcome these disadvantages in 3 ways:
- Using powered machines for infiltration and aspiration, duration of surgery can be minimized.
- Powered liposuction also helps to enhance the volume of extraction.
- Laser lipolysis allows the destruction of fat in tight areas and allows tightening of the skin.
We have now been able to extract up to about 7-8 liters of fat comfortably and safely in about 4 hours.
A detailed explanation of how we perform Tumescent Liposuction at the Venkat Center.