With the tumescent technique, the surgeon injects a solution of epinephrine (adrenaline), lidocaine (local anaesthetic), and a mild painkiller into the targeted fatty tissue. Epinephrine constricts the blood vessels, which helps minimize blood loss during fat removal.
The targeted tissue also becomes swollen and firm because of the solution, making it more easily removed. (The word “tumescent” in fact comes from the Latin verb “to swell.”)
Tumescent Technique vs Dry & Wet Techniques
During the early days of liposuction, blood loss was a major risk. In the past, liposuction often required blood transfusions because of the significant amount of blood loss. The dry technique, for instance, which does not inject fluids into the tissues, resulted in 20-45% blood loss. The wet technique, which injects 100-300 ml of saline into the tissues, helped mitigate the blood loss, reducing it to between 15-30%. This was still, however, a fairly high amount of blood loss. The tumescent technique is now the method of choice for liposuction, as it has reduced blood loss to as little as 1%. (Studies show that with the tumescent technique, blood loss generally ranges between 1-7.8%.).
The tumescent technique is a much safer alternative to the dry and wet techniques, not only because of the mitigated blood loss, but also because it has made certain procedures that used to require general or epidural anaesthesia now feasible with only local anaesthetic. The use of a localized anaesthetic such as lidocaine permits surgeons a window of 10 hours to perform surgery safely, and includes the benefit of avoiding the post-operative nausea and vomiting associated with general anaesthesia.
Dilution + Localized Anaesthesia = Safety
The improvement in safety in this technique owes itself largely to the dilution of the lidocaine and epinephrine, a method that delays the rate at which the drugs are absorbed into the bloodstream. As such, the body processes the substances over a period of 24 to 36 hours, reducing potential toxicity. Furthermore, in the majority of cases, patients should not feel any pain during the procedure, because of the localized anaesthesia. In a small percentage of instances, however, patients may experience varying degrees of discomfort during and following the surgery.
Preparing for Liposuction
Before undergoing liposuction, be sure to have a complete physical exam in order to assess whether you are suitable for the procedure. A patient considering liposuction should be in normal health without any impaired performance. Your surgeon will want to discuss details of your medical history. Possible complications related to previous illnesses, especially those that affect the lungs, liver, heart, central nervous system, and the thyroid gland must be carefully assessed. Known allergies and medications will also be considered during this preparation period. These conditions will require further preoperative laboratory tests, which may include an ECG/chest X-ray.
Some Health Conditions That Require Special Consideration:
- Lungs: patients with unhealthy lungs should avoid respiratory-suppressive medication; the surgeon should carefully monitor oxygen saturation in such cases.
- Liver: because lidocaine is mainly metabolized in the liver, patients with liver function disorders will be prescribed another local anaesthetic. Prilocaine may be a good alternative. Please note, however, that when using prilocaine as a local anaesthetic, especially in the case of Mediterranean patients, a glucose-6-phosphate-dehydrogenase deficiency will increase the risk of methemoglobin formation.
- Heart: large amounts of the tumescent solution could strain an unhealthy heart. Patients with arrhythmia tendencies will be carefully monitored. The dosage should also be limited.
- Thyroid: hyperthyroidism can increase the risk of arrhythmia.
- Central Nervous System:a lower dosage will be used for patients with a history of convulsions, since local anaesthetics can increase the likelihood of convulsions.
What to Expect During Surgery
On the day of the surgery, before the tumescent solution is introduced into the body, the patient will be photographed from several perspectives. The surgeon will then mark the operating area, focusing especially on irregularities and indentations. Intravenous drugs will also be prepared in case of emergency. During this preparation phase, the patient’s skin is sprayed with disinfectants.
Please be warned that the infiltration cannulas generally cause some discomfort when inserted into un-anaesthetized tissue. After infiltration, the surgeon will maintain verbal contact with the patient in order to monitor the state of consciousness; through continual palpation, the surgeon will also monitor the turgor of the patient’s skin. It takes about 15-45 min for the optimal distribution of the solution in the injected area. The infiltration stage is considered complete when the tissue reaches a firm yet elastic state. The infiltrated area will look different from the rest of the tissue, because of its swollen state. Usually, before the fat removal procedure occurs, another injection of the tumescent solution will take place.
Similar to other liposuction techniques, surgeons employ highly efficient tools called microcannulas to remove localized fat. These are stainless steel tubes possessing a diameter ranging from 1 mm to 3 mm. Since the microcannulas enter through incisions in the skin, patients benefit from their minute size, which minimizes the formation of large scars.
Advantages of the Tumescent Technique:
- Lower percentage of blood loss.
- Large operating areas can be completely anaesthetized, because of the extremely diluted tumescent local anaesthetic.
- The tumescent local anaesthetic has a fairly long lasting effect. The anaesthetic effect can last for up to eight hours after the operation.
- Because of the long lasting effect of the anaesthetic, there is generally less postoperative pain.
- The tumescent solution lowers the risk of hematoma (the clotting of blood in a tissue or organ due to blood vessel breakage) by creating high tissue pressure, which reduces blood circulation.
- The tumescent solution has an antibacterial effect.
- The carrier solution (usually saline) helps replenish intraoperative fluid loss.
- Local anaesthesia makes surgeon-patient interaction possible.
- The patient is generally mobile immediately after the procedure.
Disadvantages of the Tumescent Technique:
- The tumescent solution can take a long time to take effect. The application process could take between 30 min and 1.5 h. Afterwards, it will take between 15-45 min for the solution to take effect. Reinfiltration is sometimes necessary. The application of the tumescent solution often takes longer than the fat removal process.
- A nervous patient may not want to be conscious during the procedure.
- The anaesthetized area may be difficult to assess.