Liposuction (also called Liposculpture, or suction assisted lipectomy) is the selective removal of fat from under the skin through very small incisions using a specialized surgical hollow metal tube, or Cannula. Before liposuction is performed, the areas of fat to be removed are filled with a solution containing local anesthetic and adrenaline (epinephrine) in what is called theTumescent, or wet technique. This is to minimize any discomfort, to remove fat evenly and safely, and minimize blood loss.
Dr. Walker has considerable experience with liposuction and has mastered the artistic approach to careful selective removal of undesired fat. At the same time he can sometimes add fat to places where it will enhance desired curves. Surgical skill and experience is essential to achieving good liposuction results.
Dr Walker has performed liposuction on patients ranging in age from 16 to 72. He gives each patient a detailed evaluation and treatment plan so they understand where they will benefit most from liposuction and what results to expect. Liposuction is a wonderful tool for removing fat from areas that are resistant to diet and exercise, such as the abdomen and love-handles/”muffin top”, inner knees, and thighs, as well as jowls, and neck areas.
To “Tumesce” is to make firm. By injecting fluid volume containing dilute local anesthetic and epinephrine into subcutaneous fat, targeted tissues become swollen and firm, or tumescent. The tumescent liposuction technique is a method that provides local anesthesia to large volumes of subcutaneous fat and thus permits liposuction under local anesthesia. This tumescent liposuction technique eliminates both the need for general anesthesia and need for IV narcotics and sedatives. The tumescent technique for liposuction 1) provides local anesthesia, 2) constricts capillaries and prevents surgical blood loss 3) provides fluid to the body by subcutaneous injection so that minimal IV fluids are needed.
Depending upon the clinical requirements, anesthesia type, size of patient, etc, a tumescent anesthetic solution may contain 5 to 40 times less lidocaine dilution than found in commercially available formulations of local anesthesia. Commercial solutions of lidocaine used by dentists and anesthesiologists typically contain 1 gram of lidocaine and 1 milligram of epinephrine per 50 milliliters of saline. In contrast, tumescent solutions of local anesthesia contain approximately 1 gram of lidocaine and 1 milligram of epinephrine in 1,000 milliliters of saline. This is 20 times more dilute than the commercial version of lidocaine and epinephrine.
Vasoconstriction Produces Safety
Tumescent liposuction with local anesthesia has proven to be extremely safe. Nonetheless, patients, and surgeons may elect to use different types of additional anesthesia to minimize patient discomfort, and to maximize artistic effect in the surgical results.
The explanation for this remarkable safety is the extreme dilution of the tumescent local anesthetic solution. Large volumes of dilute epinephrine produce intense constriction of capillaries in the targeted fat, which in turn greatly delays the rate of absorption of lidocaine and epinephrine. Undiluted lidocaine and epinephrine is absorbed into the bloodstream in less than an hour. Tumescent dilution causes widespread capillary constriction, which causes the absorption process to be spread over 24 to 36 hours. This reduces peak concentration of lidocaine in the blood, which in turn reduces potential toxicity. When very dilute tumescent epinephrine is used, the wide spread vasoconstriction slows the rate of epinephrine absorption, which in turn prevents an increase in heart rate.
Vasoconstriction Prevents Blood Loss
Profound vasoconstriction (shrinkage of capillary blood vessels) results from infiltrating the targeted tissues with a large volume of dilute epinephrine. Tumescent vasoconstriction is so complete that liposuction can be done with minimal amounts of blood loss to virtually none, depending on the targeted area.
Vasoconstriction Prolongs Local Anesthesia
Because the vasoconstriction delays lidocaine absorption, the local anesthetic remains in place in the fat for many hours. This prolonged anesthesia permits surgery for up to 10 hours after infiltration, and provides 24 to 36 hours of significant postoperative pain relief.
Recommended Lidocaine Dosage
Maximum recommended lidocaine dosage is 40 mg/kg to 50 mg/kg for tumescent liposuction when lidocaine is greatly diluted. This is a relatively large dosage compared to the 7 mg/kg which is widely accepted as the “safe maximum dose for lidocaine with epinephrine” that anesthesiologists use. They use non-diluted lidocaine for nerve blocks such as epidural blocks.
Other Advantages of Tumescent Anesthesia
Because tumescent local anesthesia lasts so long, tumescent liposuction is less painful than liposuction under general anesthesia or IV sedation. With tumescent local anesthesia, patients are able to avoid the post-operative nausea and vomiting associated with general anesthesia.
Tumescent anesthesia is so efficient at providing fluid to the body that it is unnecessary to use IV fluids. There is a risk of dangerous fluid overload if excessive IV fluids are given to a tumescent liposuction patient.
Other types of Liposuction
Wet Technique – The wet technique required the injection of approximately 100 milliliters of local anesthesia containing epinephrine.
Super Wet Technique – The super wet technique requires the injection of a volume of dilute local anesthesia that is less than half the volume used for the tumescent technique.
Ultrasonic (UAL) – Ultrasonic Assisted Liposuction (UAL) requires the use of a large volume of tumescent fluid and uses either a metal probe or metal paddle to deliver ultrasonic energy and heat into subcutaneous fat. Specific indications include male liposuction, fibrous tissue, and revision liposuction.
Vaser Liposuction – Vaser liposuction, also called LipoSelection, is another alternate technology to traditional liposuction.Vaser ultrasonic liposuction is still a process by which fatty deposits are removed from beneath the skin to improve the aesthetics of a particular body part. Similar indications to ultrasonic assisted liposuction.
Power Assisted Techniques (PAL) – PAL devices use power supplied by an electric motor or compressed air to produce either a rapid in-and-out movement or a spinning rotation of an attached liposuction cannula.
Laser Liposuction – Laser Liposuction requires the use of tumescent fluid and uses a microcannula inserted through a small incision to deliver laser energy and heat into subcutanteous fat.
SmartLipo – Smart Lipo is actually where laser liposuction began. Brought to the marketplace by Cynosure, the SmartLipo system offers all the benefits of a high quality laser lipolysis system and the benefit of experience in the market. Risks include burns.
CoolLipo – CoolLipo, like other laser lipo systems is a technology that uses laser wavelengths to dissolve fat and firm the skin. CoolLipo by CoolTouch, Inc. is designed specifically for smaller areas of treatment in the face, chin and neck areas.
ProLipo PLUS – Cosmetic surgeons using ProLipo PLUS or laser Sciton are using laser liposuction for specific and precise contouring of the body. ProLipo PLUS can be used under local anesthetic and the use of the laser typically reduces bleeding and bruising.
LipoLite – The LipoLite laser liposuction technique uses the 1064 nm wavelength to melt away and remove fat from beneath the skin. The tiny cannula and fiber optic laser make for minimal invasiveness during the procedure.
LipoTherme and LipoControl – LipoTherme by Osyris Medical is another well regarded laser lipolysis technology. The real difference that Osyris Medical has brought to the market is in their LipoControl technology, which is used in conjunction with their LipoTherme laser liposuction treatment.
Water Jet Assisted Liposuction (Tickle Lipo) – Water jet assisted liposuction is another method of liposuction being used by cosmetic surgeons today. Water jet assisted liposuction uses a slightly pressurized stream of saline to dislodge fat and simultaneously remove the cells. Instead of destroying fat cells, this type of liposuction loosens the fat cells to facilitate more gentle removal.
Coolsculpting (Freeze the fat) – A device sandwiches the fat on the selected areas between two cooling plates. The fat cells die and are reabsorbed by the body. Coolsculpting is FDA approved and does work. However, since it is a new technology, it is still unclear how long the effects last or how much fat will be removed in different patients. While Coolsculpting appears to be safe and is a promising treatment, we will not know for several more years if there is a downside or if fat removal is truly permanent. Initial results are promising.