For many patients, liposuction has become a dream come true. Though it’s not intended as a weight loss technique, liposuction can literally remove aesthetically displeasing, localized accumulations of fat, and sculpt the body into a slimmer profile. These local areas of fat are often preprogrammed by inheritance and are found to be stubbornly diet and exercise resistant.
What is the history of liposuction and the tumescent technique?
Though liposuction is a relatively new form of cosmetic surgery, it has nonetheless, become one of the most common operations performed for cosmetic reasons in the United States. Since its first U.S. introduction in the early 1980’s, many refinements have been made. The most significant improvement is the use of local anesthetic instead of general anesthesia with the tumescent technique, the most revolutionary technique in liposuction to date.
The tumescent technique, which permits the local anesthesia of large areas of subcutaneous fat, was developed by Jeffrey Klein, M.D., in 1985. He first presented his findings in 1986 at the Second World Congress of Liposuction Surgery in Philadelphia. The first scientific publication describing the tumescent technique appeared in the American Journal of Cosmetic Surgery in 1988. More recently, Dr. Klein’s study detailing the benefits of the tumescent technique for liposuction surgery was published in the prestigious Plastic and Reconstructive Surgery in November of 1993.
What are the benefits of the tumescent technique over more traditional methods of liposuction?
The tumescent technique utilizes large volumes of saline solution, containing dilute local anesthetic and adrenaline, which is injected into the fatty tissue. The injected area then becomes locally anesthetized. There is usually only minimal, if any, discomfort during the process of injection. With this technique, liposuction patients need no general anesthesia, as with more traditional liposuction methods, and rarely require intravenous sedation or narcotics. In fact, the vast majority receive only minor sedation to help them relax, and are completely conscious and comfortable during surgery.
After surgery, patients can get up and walk out of the office themselves, and are usually back to their regular routine in a couple of days. With the tumescent technique, postoperative discomfort is significantly reduced since the area of fat removal remains anesthetized for 8 to 16 hours after surgery. And since this technique utilizes much smaller suction cannulas (the metal tubes used to remove the fat), bleeding and bruising are also minimized. Patients frequently require only extra strength Tylenol or Tylenol with Codeine for postoperative discomfort after having liposuction surgery by this method.
In summary, the tumescent technique has been proven to produce smoother results for even large areas of fat, minimize bruising and bleeding, and promote a more rapid recovery, all using local anesthesia.
How is this procedure performed?
The basics of liposuction are really quite simple. A small stainless steel tube, called a cannula, is inserted through tiny incisions in the skin and the fat is removed utilizing suction. Because of the strides made in liposuction over the years, and due to the use of the tumescent solution, the cannulas used today are very small, measuring one quarter inch or less in diameter. The resultant incisions are usually so small they heal themselves, frequently, without the use of sutures, and with minimal scarring, if any.
Going into even more detail, the tumescent technique utilizes large volumes of saline solution that contain dilute Lidocaine (local anesthetic) in combination with epinephrine (adrenaline) which temporarily constricts the small blood vessels known as capillaries. In addition, dilute sodium bicarbonate in the solution reduces the unpleasant stinging otherwise associated with the Lidocaine and epinephrine.
The solution is injected into the fatty tissue through small, anesthetized incisions made in mostly inconspicuous places causing the tissue to become firm and inflated, or, tumescent. This allows the surgeon to extract the fat in a more accurate and uniform fashion, thereby producing smoother results. The anesthetic agent in the solution is allowed time to diffuse throughout the fatty tissue, assuring both optimal anesthesia as well as constriction of the capillaries. The shrinkage of capillaries is instrumental in minimizing bleeding during and after surgery, as well as bruising. Not only does this make the surgery safer, it also speeds up recovery. As a result, most patients can return to work and to their regular routines in a couple of days.
What areas of the body can be treated?
Fat deposits beneath the chin, on the flanks, hips, abdomen, inner and outer thighs, knees, and legs are areas where body contouring with liposuction produces impressive results. The most frequently treated areas in women are the abdomen, hips, thighs, and knees, while in men, the “love handles”, abdomen, and enlarged male breasts (gynecomastia) are the most often treated.
After the fat is removed, can it grow back?
We believe that once the fat cells have been removed by liposuction, they do not grow back. The patient’s new, more balanced and pleasing silhouette is permanent. However, if the patient does gain weight later on, the change tends to be distributed proportionately over the entire body. The same applies to weight loss. It is thought that the total number of fat cells in the body of an adult, once established during adolescence, is fairly constant. The more fat cells there are in a specific location, the more difficult it is to reduce that area simply by dieting. Weight gain is the actual enlargement of these existing fat cells, not the creation of new ones. This is why dieting reduces the size of all fat cells proportionately, leaving the basic silhouette unchanged to a large degree. The change of body contour produced by liposuction is the equivalent to focusing the effects of dieting to specific areas of the body.
Will my skin contract to fit my new profile?
The degree of skin contraction after liposuction is the same as one would expect after having lost an equal amount of fat in that area by dieting. The skin is an amazing organ, with the ability to stretch and contract to a great degree. A perfect example is pregnancy. Most women’s abdominal skin contracts to its original condition soon after delivery.
Who is the best candidate for liposuction?
Those individuals best suited for liposuction contouring are active, healthy persons of average or near average weight (those overweight can also benefit), have good skin tone, and also have realistic expectations. Age by itself is not a significant factor. Liposuction is a good choice for those who’ve done just about everything possible to lose the unwanted fat accumulations and who seek improvement in their body’s silhouette.
What kind of result can I expect?
Although the results of liposuction can be quite spectacular, it is not realistic to expect perfection. Liposuction is the skillful recontouring of the body by removing inches in unwanted areas, rather than pounds. Patients are often advised that while liposuction can enhance one’s appearance in clothing, it cannot be guaranteed to improve the appearance of a person who is nude or wearing a skimpy bathing suit. Skin and muscle tone play an important role in the overall appearance of a person. Aesthetic aspects of one’s appearance liposuction, alone, cannot influence. The need for surgical excision of excessive skin (or a “tuck”) is rarely needed, but occasionally it can be required to enhance the results of liposuction. Additionally, the problem known as “cellulite”, or doughy, pucker appearance most commonly seen in female skin, cannot be expected to improve with liposuction.
What side effects should I be aware of?
As with any surgical procedure, liposuction is associated with possible side effects such as bruising, swelling, temporary numbness, and discomfort in the surgically treated area. Although irregularities of the skin are possible following liposuction, this side effect is greatly minimized by the tumescent technique. The swelling gradually improves one to three months after surgery, with optimum results being apparent at about six months. Bruising varies from person to person, though any noticeable amount is usually gone within a couple of weeks. Because the tumescent technique minimizes post-surgical soreness, simple pain relievers such as Tylenol are most often all that is required. In some instances, Tylenol with Codeine, or even stronger pain relief medications is necessary. As judged by current worldwide experience, liposuction using the tumescent technique is amazingly safe. Serious complications such as blood clots, infection or allergic reactions are extremely rare. Prior to surgery we will, of course, discuss all possible side effects with you.
When can I begin activities and exercise?
One of the primary benefits of the tumescent technique is the rapid recovery afforded by the use of local anesthetic rather than general anesthesia. We encourage walking as soon as possible after surgery, particularly the next day, and most patients feel well enough to go for a walk or drive a car by this time. In fact, patients report feeling better if they keep moving around as opposed to sitting or lying down in one position for too long. Light exercise may be resumed one week after surgery or occasionally even sooner, though we strongly suggest avoiding vigorous exercise for one or two weeks. Activities that put excessive stress on treated areas may cause bruising or some discomfort. Our experience is that the majority of patients return to their work and regular routine within a couple of days. Some report being slowed down somewhat.
What can I expect the day of surgery, and how can I be prepared?
Upon receiving a scheduled surgical appointment, you will be given separate, detailed materials outlining all preoperative instructions that will help you prepare for surgery. The following, however, will give you a better idea of the actual experience of liposuction surgery and what you can expect.
We ask that patients plan to arrive at our office one hour prior to their scheduled surgery time. You must plan ahead and make arrangements for someone to pick you up after surgery, especially if you were given a mild sedative. Even though our patients report feeling remarkably good, we still insist on this as a precautionary measure.
After you check in, we then take preoperative photographs and mark the areas of your body that are to be treated with liposuction. At this time, a nurse will “paint” the surgical areas of your body with a yellowish antiseptic liquid to help sterilize the area. You may also be offered a mild sedative to help you relax. Then you may get comfortable on the surgical table in the position best suited for the area to be treated.
We occasionally start an IV in your arm to give fluids directly and additional sedation as needed. In most instances, a blood pressure cuff is placed on your opposite arm, and cardiac monitor leads are placed on your back. In addition, a pulse oximeter may be placed on a finger to measure the amount of oxygen in your blood. Next, we anesthetize the sites where the small incision will be made, and finally we are ready to begin surgery. It generally takes about an hour of preoperative set-up time before surgery actually begins.
Although there is some variation from patient to patient, the actual injection of the anesthetic solution into the fatty tissue is surprisingly easy. Many patients report feeling more pressure from the inflation of the tissue than they do discomfort from the injections themselves. Then we allow some time for the anesthetic to diffuse into the tissue and fully anesthetize the area. Once the area has been completely “numbed”, the actual liposuction proceeds with little to no discomfort while you are fully awake. If tender areas are encountered, more anesthetic solution will be injected. It’s our objective to make this a comfortable experience for you. Depending on the area to be treated, you may be asked to shift to different positions making surgical access easier.
After completing surgery, the small incisions are left open and uncovered to allow normal drainage. Because the incisions are so small, they usually heal without the need for sutures.
Finally, after the monitors and blood pressure cuff are removed and the IV discontinued, the surgical area may be covered with a thin layer of foam designed to inhibit swelling. Then you will be helped into your elastic compression garment, which also controls swelling, and you’re ready to get dressed and go home. Because of residual local anesthetic in the tissue, it may be up to twelve hours or more before any significant soreness, if any, begins. It’s a good idea, however, to have someone keep you company for the first night after surgery.
Before you leave, we’ll give you written postoperative instructions. It’s very important that you follow these implicitly to assure the best results possible. We’ll also make a follow-up appointment for approximately one week after your surgery at which time the garment, dressing, taping or foam will be removed. Although the swelling tends to resolve itself slowly, often you will note a new, slimmer body profile within the first 7 to 30 days.