The Tumescent liposuction Technique
The Tumescent Technique for liposuction by local anesthesia
is a significant improvement in liposuction surgery. It is so effective
that liposuction patients no longer need intravenous sedatives, narcotic
analgesics, or general anesthesia. Postoperative discomfort is minimized
since the local anesthesia remains in the surgically treated areas for
approximately 18 hours after surgery. Patients usually require nothing
more than plain Tylenol for discomfort after surgery.
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 liter of anesthetic solution results
in a marked decrease in postoperative soreness.
The Tumescent Technique dramatically reduces both the bleeding
during surgery and the postoperative bruising and swelling 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
preoperative laboratory test (about 4 teaspoonfuls) than during the actual
liposuction surgery. Minimal bleeding reduces postoperative 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 seven days.
With general anesthesia, elastic garments are worn for two weeks or more.
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 to 16 weeks to be achieved.
The fat cells that are removed by liposuction do not grow
back. If the patient later 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 attachments.
It is this process which assures that the skin will not hang in loose folds
after liposuction. Because the surgeon is careful to leave a thin blanket
of fat attached to the skin, the 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 under surface 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, which is 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.
As judged by current worldwide experience, liposuction is amazingly safe.
Serious complications, such as blood clots, infections, 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.
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