FAQ: FAQ: Tumescent Liposuction
1. What is the definition of the word tumescent?
The word tumescent means swollen and firm.
2. What is the tumescent technique?
The tumescent technique for local anesthesia involves the injection of large volumes of very dilute lidocaine (local anesthetic) and epinephrine (drug that shrinks capillaries) into subcutaneous fat. The word tumescent means swollen and firm. With the tumescent technique, the volume of dilute lidocaine that is injected into fat is so large that the targeted areas literally become tumescent (swollen and firm). The tumescent technique produces profound and long-lasting local anesthesia of the skin and subcutaneous fat. Tumescent liposuction designates a form of liposuction that uses tumescent local anesthesia.
3. What is tumescent liposuction?
The word tumescent refers to anything that is swollen and firm. In the tumescent
technique for liposuction, a large volume of very dilute solution of local
anesthesia (lidocaine and epinephrine) is infiltrated (injected) into the fat
beneath the skin, causing the targeted area to become tumescent, in other words,
swollen and firm. The local anesthetic lidocaine in the tumescent solution
provides such complete local anesthesia, that it eliminates the need for general
anesthesia, or IV sedation. The drug epinephrine (adrenalin) provides profound
localized vasoconstriction that it virtually eliminates surgical bleeding during
tumescent liposuction. By eliminating the risks of general anesthesia and the
risks of excessive surgical bleeding, the tumescent technique for liposuction
totally by local anesthesia has eliminated the greatest dangers associated
with the older forms of liposuction.
4. What are the benefits of tumescent liposuction?
Local anesthesia used in the tumescent technique for liposuction is so effective that patients no longer need intravenous sedatives, narcotic analgesics, or general anesthesia. 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 the older methods that simply use general anesthesia.
5. What is the history of the tumescent technique?
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 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. Dr. Klein
first presented the tumescent technique at a medical meeting in Philadelphia
in 1986. The first publication describing the technique was published in the
American Journal of Cosmetic Surgery in 1987. Because the tumescent technique
is by far the safest form of liposuction, it has become the world wide 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.
6. 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 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.
7. 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.
8. Have there been any deaths related to tumescent liposuction totally by local anesthesia?
No. There have been no reported deaths associated with tumescent liposuction
totally by local anesthesia. Virtually all deaths associated with liposuction
have been associated with 1) multiple unrelated surgical procedures performed
on the same day (facelift, breast augmentation, hysterectomy, etc), 2) excessive
amounts of liposuction or an excessive number of body areas treated by liposuction
on a single day, 3) the use of general anesthesia or heavy IV sedation with
narcotics. Liposuction is an extremely safe procedure provided the patient
is not exposed to excessive surgical trauma, excessive narcotic analgesics,
or prolonged use of general anesthesia.
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