Aesthetic Medicine

I have been asked by many of my patients to explain the use of tumescent anesthesia and performing cosmetic procedures such as liposuction, liposuction with fat transfer as well as Dermolipectomy (technique for performing what is commonly called a tummy tuck).

Many patients believe that cosmetic procedures must be done under general anesthesia and in the hospital or surgical center. The fact is that tumescent anesthesia is the preferred method of performing all these procedures. The use of this relatively new technique allows the patient not only to be awake and interact with the physician but also minimizes bruising, swelling, postoperative pain and most importantly blood loss.

Tumescent anesthesia is technique for delivery of local anesthesia that maximizes safety by using pharmacokinetic principles to achieve extensive regional anesthesia of skin and subcutaneous tissue. The subcutaneous infiltration of a large volume of very dilute lidocaine and epinephrine causes the targeted tissue to become swollen and firm, or tumescent, and permits procedures to be performed on patients without subjecting them to the inherent risks of local anesthesia and blood loss.

In the tumescent technique, areas of excess fat are injected with a large amount of anesthetic liquid before liposuction is performed. The warmed tumescent liquid — a dilute solution containing lidocaine, epinephrine and normal saline, is injected into the area to be treated. As the liquid enters the fat, it becomes swollen, firm and blanched. The liquid causes the compartments of fat to become swollen and firm or “tumesced.” The expanded fat compartments allow the liposuction cannula to travel smoothly and safely beneath the skin as the fat is removed. The shrunken blood vessels as well as the nerves are never traumatized.

Any person who is a candidate for traditional liposuction is also a good candidate for the tumescent technique. Although the technique can be used on any area of the body, it is commonly used on areas that require enhanced precision, such as the face, neck, arms, calves and ankles. Individuals who have large areas of excess fat may also be good candidates for tumescent liposuction.

The time required to perform liposuction may vary considerably, depending on the size of the area, the amount of fat being removed, the type of anesthesia and the technique used. Through a tiny incision, a very narrow tube or cannula is inserted and used to vacuum the fat layer that lies deep beneath the skin. The cannula is pushed then pulled through the fat layer, breaking up the fat cells and suctioning them out. The suction action is provided by a vacuum pump or a large syringe, depending on the surgeon’s preference. If many sites are being treated, your surgeon will move from one area on to the next area, working to keep the incisions as inconspicuous as possible.

The long-acting effects -up to 48 hours- of this anesthetic solution help to provide pain relief after the procedure and decrease the need for additional pain medication. For the first day or two after surgery, most patients experience swelling in the treated areas, as well as some fluid drainage from the incision sites. Light activity is usually resumed within the first few days after tumescent liposuction; normal activity can be resumed within a few weeks.

Patients are usually able to see a noticeable difference almost immediately after surgery. However, more improvement can be seen after three weeks, when most of the swelling has subsided. After about six weeks, any persistent mild swelling will disappear and the final contour will be visible.