An Overview of Tumescent Liposuction
Being one of the most popular cosmetic surgeries performed in North America, liposuction has made some significant leaps in both technology and technique since it was first introduced in the 1970s.
The early form of this procedure, sometimes referred to as “dry liposuction,” required blood transfusions because so much blood was lost during each surgery. It wasn’t until the mid 1980s, and developments made by Dr. Jeffery Klein, that tumescent liposuction became the gold standard.
This liposuction method has many advantages over other techniques, including minimizing blood loss and eliminating the risks of general anesthesia. Since invention, it has shown an excellent safety record. That’s why we prefer it over other methods, including laser assisted liposuction (e.g. Smartlipo), power assisted liposuction (PAL) and ultrasonic assisted liposuction or ultrasound assisted liposuction (UAL).
When liposuction was first developed, surgeons used a medical tube, called a cannula, to remove unwanted fat. Nothing was done to prep the area. This older technique, known as dry liposuction, was a fairly serious procedure, requiring both general anesthesia and hospitalization.
Probably the most worrisome aspect was that it required a blood transfusion for every traditional liposuction procedure. This unrefined technique resulted in a lot of blood being removed with the fat. In fact, blood would make up 30-45% of the fluid removed. That much blood loss was not only dangerous and impractical, but after further development it turned out to be horribly inefficient as well.
If the percentage of blood in the tissue removed could be lowered, more fat could be removed in the same amount of time.
The dry technique also resulted in longer recovery times as well as a much higher rate of complications and poor aesthetic results for skin and soft tissue. These issues led a few doctors to experiment throughout the early 1980s in an attempt to create a better method for fat removal.
Experimental surgeons developed a technique we call "wet" liposuction today. This involves adding fluid to the area to assist in the traditional liposuction procedure. This extra fluid helps to both aspirate the fat and maintain an equilibrium of the fluid in the body. Wet liposuction still requires general and IV anesthesia, but the blood loss was reduced to 15-20% of the mass removed from the body.
A significant improvement to be sure, but still somewhat risky.
The largest stride forward in liposuction safety and efficiency came about in the mid 1980s when Dr. Jeffery Klein, a dermatologic surgeon, introduced tumescent liposuction. Dr. Klein’s new tumescent liposuction technique was quickly considered to be the safest and most effective technique to be developed.
The word "tumescent" means "swollen" or "becoming swollen," making it an accurate description of the procedure. A fluid is injected into the areas that are to be treated. This fluid is usually made up of saline with doses of lidocaine (a numbing agent) and epinephrine (commonly known as adrenaline). The saline balloons the fatty tissue (hence “tumescent”), the epinephrine causes the blood vessels in the area to constrict, decreasing blood flow and reducing bleeding, and the lidocaine works as a local anesthesia.
Once one to four litres of the solution (depending on the scope of the procedure) has diffused evenly throughout the area being treated the suction can begin. This is done with a microcannula, which is much smaller than the cannulas used in older liposuction techniques, measuring only 1.5 to 3 mm in diameter. The smaller diameter of the microcannula requires a shorter incision and less traumatic procedure.
Unwanted fat is suctioned out of the subcutaneous tissue, along with most of the tumescent fluid.
Some fluid stays in the body for several hours after the surgery is completed, and the local anesthetic provides some relief from discomfort.
This type of liposuction offers a number of advantages over other techniques:
The risks involved with general anesthesia are completely removed.
There is no need for hospitalization and you will most likely be able to go home the same day.
The epinephrine contained in the fluid works wonderfully to prevent bleeding by closing off vessels, which results in:
– No need for blood transfusions.
– The blood lost can make up as little as 1% or less of the removed tissue, meaning more fat is removed in the same amount of time as previous techniques. This is a huge improvement in efficiency over earlier techniques.
The slow rate that the tumescent fluid is absorbed into the subcutaneous fat means that all the blood vessels are slowly closed and replaced with an equal volume of fluid. This maintains a fluid equilibrium inside your body throughout the entire procedure.
Tumescence magnifies defects and problem areas, making them easier to identify, reducing the probability of needing a second surgery.
Developed in the mid 1980s, tumescent liposuction has remained one of the safest and most efficient forms of liposuction ever developed for plastic surgery. Dr. Klein was able to develop a tumescent fluid, sometimes still called “Klein’s solution,” made up of a saline solution with lidocaine for anesthesia and epinephrine to restrict blood flow.
When large volumes of this fluid are injected into the fat below the skin, the area to be treated becomes swollen and firm, making it easy to identify and remove, reducing the possibility of subsequent surgeries. This technique not only delivers a local anesthesia directly to the area, removing the need for general anesthesia in some cases, it also reduces blood flow. This prevents unnecessary blood loss, significantly reducing the risk to you.
The method has remained the standard technique for cosmetic plastic surgeons because of the increased safety and the multitude of advantages it offers.