Tumescent is very popular technique of liposuction. The word “tumescent” means swollen and firm. In this method by injecting a large volume of very dilute local anesthesia (lidocaine) and epinephrine (capillary constrictor) into subcutaneous fat, so the targeted tissue becomes swollen and firm or tumescent. Tumescent technique provides local anesthesia to large volume of subcutaneous fat hence permits liposuction thoroughly by local anesthesia. This method is also known as suction-assisted lipo because the fat once loosens by the fluid; it is suction out of the body. The tumescent liposuction reduces both the requirement of general anesthesia and requirement for IV narcotics and sedatives. The tumescent technique for liposuction provides local anesthesia, compress capillaries and prevent surgical blood loss, and also supply fluid to the body by subcutaneous injection hence no IV fluid are required.
Tumescent Liposuction Procedure
First surgeon will insert a cannula through short incisions in the skin. this hollow tube is used to inject lidocaine and solution of saline (or salt water) into the layer of the fat beneath the skin and above the muscles. This fluid anesthetized the tissue and breaking apart the fat so that it can be removed through the cannula. The other end of the cannula is connected to a suction device, enabling the doctor to gently suction away excess fat.
While this fat is removed, the layer of fat left behind is form into to visually pleasing curves. Most tumescent liposuction surgeries remove five pounds or less of fatty tissue along with creating more balanced or smoother contours. This procedure can take one to five hours, depending on the volume of the fat being removed. Once fat removal process is complete, the cannula or tube is removed. Its depending on the length of incisions needed to achieve the desired results, they may or may not be closed with sutures.
The tumescent anesthetic solution may contain 5 to 40 fold intensity of lidocaine found in commercially available formulation of local anesthesia. Commercial solution of lidocaine used by anesthesiologists or dentists generally contains 1 gram of lidocaine and 1 milligram of epinephrine per 50 milliliters of saline. In contrast, tumescent solution of local anesthesia contains approximately 1 gram of lidocaine and 1 milligram of epinephrine in 1000 milliliters of saline. This is a 20 fold dilution of the commercial version of lidocaine and epinephrine.
Dilution & Vasoconstriction Produce Safety
Despite of the use of the unprecedented large doses of lidocaine and epinephrine, the tumescent liposuction totally by local anesthesia has proven to be extremely safe. The reason of this significant safety is the great dilution of the tumescent local anesthesia solution. Large volume of dilute epinephrine produces extreme restriction of capillaries in the targeted fat which in turn greatly delays the rate of inclusion of lidocaine and epinephrine. Undiluted lidocaine and epinephrine is immersed into the bloodstream in less than an hour. Tumescent dilution causes widespread capillary constriction that causes the absorption process to be extended over 24 to 36 hours. This diminishes peak concentration of lidocaine in the blood, which in sequence reduces the potential toxicity of a given dose of lidocaine. Dentists typically use concentrated epinephrine which may cause a rapid heart rate if the epinephrine is rapidly absorbed. When very dilute tumescent epinephrine is used, the wide spread vasoconstriction slows the rate of epinephrine absorption, which in sequence prevents an increase in heart rate.
Vasoconstriction Prevents Blood Loss
Deep vasoconstriction (shrinkage of capillary blood vessels) results from the tumescent penetration of a large volume of dilute epinephrine into subcutaneous fat. Tumescent vasoconstriction is so absolute that liposuction can be done with almost no blood loss. Quite the opposite the earlier forms of liposuction which is used before the invention of the tumescent technique were related to so much blood loss which autologus blood transfusion were often habitual.
Vasoconstriction Prolongs Local Anesthesia
Because of the vasoconstriction delays lidocaine absorption, the local anesthesia remains in place in the fat for many hours. this prolonged or delayed anesthesia allows surgery for up to 10 hours after penetration and provide 24 to 36 hours of significant postoperative analgesia.
Recommended Lidocaine Dosage
For tumescent liposuction the maximum recommended lidocaine dosage is 40mg/kg to 50 mg/kg when lidocaine is greatly diluted. This is quite large dosage compared to the 7mg/kg which is generally accepted as the safe maximum doses for lidocaine with epinephrine that anesthesiologist use. They use non-diluted lidocaine for nerve blocks such as epidural blocks.
A liposuction cannula is a stainless steel tube which is inserted into subcutaneous fat through a small opening or incision in the skin. A micro cannula has an outside diameter of less than 3 millimeters (mm). The diameter of microcannulas range from 1mm to 3 mm with special designs, microcannulas can remove fat very efficiently. The use of larger cannulas those having an outside diameter ranging from 3 mm to 6 mm need larger incisions which usually leave visible scars.
Adits are small holes in the skin which made with round skin-biopsy punches. Adits are used as access sites, in which the liposuction cannula is passed in and out of during the liposuction process. Adits also smooth the process of the drainage of blood-tinged anesthetic solution after liposuction. Microcannula can typically fit through a 1.0 mm, 1.5 mm or 2 mm round hole made in the skin with a skin biopsy puch because of the skin’s ability to stretch. Such tiny holes generally vanish without scars after liposuction. Adits are so small so there is no need to close them with sutures. Because adits are not closed with sutures, they encourage plentiful postoperative drainage of boold-tinged tumescent anesthesia, which in sequence reduces post operative bruising, tenderness and swelling. Large cannulas need larger incisions. When larger incisions are closed with sutures, there is delayed drainage and prolonged swelling, bruising and pain after liposuction.
Smoother Liposuction Results
By using microcannula which allow a more steady and controlled removal of fat one can achieved smother liposuction results. This improves the ability of the surgeon to get smoother results. Larger cannulas increased risk of liposuction generating skin depression and irregularities. There is also risk of removing too much fat because the larger cannulas remove fat so quickly. It is also difficult to accurately control the direction of a large cannula. There is also difficulty with any attempt to make a small incremental change in the way of large cannula, there is tendency to re-enter a pre-existing tunnel within the fat. When using large cannulas this deficiency of accurate control contributes to the risk of skin irregularities combine with liposuction.
Advantages of Tumescent Anesthesia
Tumescent liposuction is less painful and more pleasing compare to liposuction under general anesthesia or IV sedation because tumescent local anesthesia lasts very long. Patients are able to avoid the post-operative nausea and vomiting related with general anesthesia because of tumescent local anesthesia. Tumescent anesthesia is so efficient to provide fluid to the body that it is unnecessary to use IV fluids. If excessive IV fluids are given to a tumescent liposuction patient, there is a risk of dangerous fluid overload.
Tumescent Liposuction Recovery and Risks
Tumescent technique of liposuction is the oldest form of liposuction which is still being normally used. Newer techniques use additional methods to breaking apart the fat and result in reduced trauma to the adjoining tissues and less side effects. Traditional tumescent liposuction associated with a somewhat higher rate of side effects and longer recovery period compare to some other forms of liposuction because traditional tumescent does not use these methods. Some patients also find it more uncomfortable compare to other methods of liposuction.