Tumescent Liposuction

Introduced in the United States in the early 1980’s, liposuction, also called liposculpture, lipoplasty, or suction lipectomy, is a surgical procedure designed to remove stubborn fat deposits that do not respond to dieting and exercise. A small tube (called a cannula) connected to a vacuum machine is used to remove the unwanted fatty tissue through tiny incisions placed in inconspicuous locations on the skin. The result is a re-sculpting of bulging areas into more attractive contours. Although liposuction is not a substitute for dieting and exercise, it is a safe, effective, permanent technique to help you achieve your body ideal by removing stubborn areas of fat that do not respond to traditional weight loss methods.

Tumescent liposculpture is a new, advanced, essentially painless method of liposuction that is performed under local anesthesia. It is called tumescent (which means to swell) because the subcutaneous fat layer is anesthetized by injecting large volumes of a dilute mixture of lidocaine (the anesthetic agent) and epinephrine (which constricts the blood vessels). This special solution completely numbs the area with only local anesthesia. General anesthesia and intravenous sedation are not used, thus avoiding risks associated with them. It is called liposculpture because the surgeon can artistically sculpt the body into a new shape using smaller, more delicate instruments. This technique produces less bruising and less blood loss; offers a faster, safer, more comfortable recovery; and produces superior results compared to “old-style” liposuction performed under general or intravenous anesthesia.

Who is a candidate for tumescent liposuction?

The best candidates for liposculpture are healthy men and women with good skin elasticity and realistic expectations who exercise regularly, maintain good eating habits, and are within 25 lbs of their ideal body weight. Age is not a significant factor. Good results are much more dependent upon skin tone and activity level rather than biological age. Individuals who have good muscle tone from exercise appear to achieve better results from the procedure. Liposculpture is a treatment for localized areas of unwanted body fat. It is not a treatment for generalized obesity and is not a substitute for weight loss. There is a limit to how much fat can be safely removed at one time.

What areas are treated?

The most commonly treated areas in women include the lower abdomen, upper outer thighs (saddlebags), hips, waist, buttocks, inner knees, jowls, and neck.

The common areas in men include the flanks (love handles), upper and lower abdomen, and neck. Liposculpture is the treatment of choice for gynecomastia (enlarged breasts in men).

How is the procedure performed?

Tumescent liposculpture is an outpatient procedure performed in our surgery center under local anesthesia. An oral and/or intramuscular sedative is usually used for first-time patients. Often times, a patient who has already undergone one session of liposculpture will request the second session be done with only local anesthesia and no sedation. This is a major advance over “old-style” liposuction under general or intravenous anesthesia in a hospital, often requiring blood transfusions after surgery.

After marking the areas to be treated and cleansing the skin, the tumescent anesthetic is infiltrated into the areas to be sculpted. From one to three small incisions, approximately 1⁄4 inch in length, are made near the area where the fat is to be removed. The surgeon then begins sculpting in each area in a criss-cross pattern with fine cannulas. This delicate process appears similar to a person playing the violin. The cannula is attached by clear tubing to a suction machine which draws the fat into a container. The actual sculpting can take from 1-3 hours, depending upon the number of fatty areas and their size. Great care is taken to assure that each area is naturally contoured and symmetrical, and that the optimal amount of fat is removed. Once the sculpting is complete, the tiny incisions are left open to allow any remaining tumescent fluid to drain from the sites. Because the tiny incisions are so small, they are barely noticeable once healed.

What about recovery?

Although much of the remaining tumescent anesthesia is absorbed, some of the fluid drains out though the incisions sites for a day or so after the procedure. The fluid is collected on absorbent pads placed over the incisions. The local anesthesia continues to be effective for the remainder of the day, so very little, if any, pain medication is required.

After tumescent liposculpture, elastic shorts or girdles are used. Stretch waistbands also may be utilized. A special elastic head strap is used following tumescent liposculpture of the face and neck. These compression garments are worn at all times except when bathing or showering for four to seven days. In selected cases, we may encourage the patient to wear the garments for up to 12 hours a day for an additional week or two. These special garments are lightweight and can be worn in public without difficulty.

Recovery from tumescent liposculpture is surprisingly rapid. Most patients spend the afternoon following the surgery resting. Light exercise may be resumed the day after the surgery. Patients may begin their normal aerobic exercise as soon as they wish and typically can return to work in 2-3 days.

When are the final results seen? Most patients observe that their clothes fit more loosely within a few days. Nearly all patients notice improvement by four weeks, however, the final results of tumescent liposculpture may not be apparent for six months or more.

Is the procedure safe?

Tumescent liposculpture is the safest method of liposuction available. In 1995, the American Society for Dermatologic Surgery published national survey data on 15,336 patients who had undergone tumescent liposculpture. The study reported no admissions to the hospital for treatment of complications and no blood transfusions in any of the patients. The complications that were reported were minor and infrequent. A slight amount of bruising is common. Minor soreness of the treated areas may last for several weeks. Infections and major complications are extremely rare. Blood loss is minimal making blood transfusions unnecessary. Occasionally, skin irregularities may occur, especially in older patients with poor skin elasticity.

How are the benefits of liposculpture measured?

Cosmetically speaking, successful liposculpture is measured in inches rather than pounds. The weight removed is not as important as contour. Many patients find the results to be such a psychological boost that it gives them the incentive to exercise even more than before the surgery to improve other parts of their physique. The goal is for you to be more comfortable with your body and happy with your new shape.

Is the fat removal permanent? Yes! Once puberty is reached, no new fat cells develop. The fat cells either swell or shrink in size depending upon weight gain or loss. When fat cells are removed from a treated area, they do not return. Liposculpture is, indeed, the only true spot reducer.

What about touch-up procedures?

 Reoperation is almost never necessary. Subtle fine-tuning sessions taking 10-15 minutes are not uncommon if large volumes of fat from multiple body sites have been previously suctioned.

How much will the procedure cost?

 The cost of tumescent liposculpture is much less than that for “old-style” liposuction. “Old-style” liposuction usually includes the cost of operating room time and general anesthesia. This alone can amount to thousands of dollars. Since tumescent liposculpture is liposuction performed entirely under local anesthesia, the costs for the operating room and general anesthesia are eliminated. The cost of tumescent liposculpture will vary depending upon the body areas treated, the time involved, and whether or not another procedure is performed at the same time.