The word “tumescent” means swollen and firm. Local anesthesia is widely regarded as the safest form of anesthesia. In the tumescent technique for liposuction, a large volume of very dilute solution of local anesthesia (lidocaine and epinephrine) called Klein solution is infiltrated (injected) into the fat beneath the skin, causing the targeted area to become tumescent, in other words, swollen and firm. Fat is then removed by using small cannulae, with micro incisions.

The local anesthetic lidocaine in the tumescent solution provides such complete local anesthesia, that it eliminates the need for general anesthesia, or IV sedation. The drug epinephrine (adrenalin) provides profound localized vasoconstriction that it virtually eliminates surgical bleeding during tumescent liposuction. Because local anesthesia persists for many hours there is no need for narcotic pain medications after surgery.

By eliminating the risks of general anesthesia and the risks of excessive surgical bleeding, the tumescent technique for liposuction totally by local anesthesia has eliminated the greatest dangers associated with the older forms of liposuction.

In summary the procedure of tumescent anesthesia is as follows:

• Introduction of large amount (1-3 L) of special Klein’s solution in to fat-both for purposes of ballooning, to decrease bleeding and most importantly for anesthesia
• Making several small incisions ( 2-3mm) to introduce cannulae
• Sucking the fat out through small cannulae 2-3 mm in diameter
• Leaving the incision wounds of cannulae open to drain out fluid
• Applying compression bandages and sending the patient home without any admission.

The whole procedure lasts 3 -5 hours.

4. What are the benefits of tumescent liposuction?

There are several advantages :

• Local anesthesia used in the tumescent technique for liposuction is so effective that patients no longer need intravenous sedatives, narcotic analgesics, or general anesthesia.
• As a result of the widespread blood vessel constriction caused by the epinephrine in the anesthetic solution, there is minimal bleeding during and after surgery. This is a major improvement in the liposuction technique compared to the older methods that simply use general anesthesia
• Tumescent anesthesia provides pain relief for several hours after surgery, as the anesthetic fluid persists in the fat
• It is an outpatient procedure-patient can walk out of the clinic after surgery
• It is safer as it avoids the risk of general anesthesia, Bleeding is also much less
• It is cheaper as there is no hospitalization
• Patient can return tow work with in 2-3 days-recovery time is less.

Mechanism of tumescent liposuction

The Klein formula tumescent solution is injected into the fatty tissue through small, "numbed" slit incisions in the skin. Many of these slit incisions are made, when possible, in inconspicuous places. The tumescent fluid is injected under pressure, which causes the target fatty tissue to become firm and inflated (tumescent or "ballooned"). This ballooning allows the surgeon to later extract the fat in a more accurate and uniform fashion, thereby producing smoother results.

The anesthetic and other agents in the tumescent solution should be allowed sufficient time to diffuse (percolate) and take full effect throughout the fatty tissue. The solution will numb the areas as well as reduce bleeding by temporarily closing down capillaries. Constricting the capillaries is important to reduce bleeding during and after surgery. Less bleeding means less bruising. Not only does this make the surgery safer, it also speeds up recovery. As a result, most patients can return to work or their regular routines in a couple of days.

What is a microcannula?

Tumescent liposuction totally by local anesthesia requires the use of very small cannulae or microcannulas. Microcannulas have an outside diameter up to 2.8 mm. These are only slightly larger than the IV needles used for drawing blood in laboratories. Microcannulas permit a more delicate and gentle approach to liposuction than can be achieved using larger cannulae. Because microcannulas require a minimal amount of force to be pushed through fatty tissue, the surgeon can control the direction and position of the cannula with much more accuracy: The ultimate result is a better cosmetic result.

Tumescent Technique is Safest

The tumescent method provides for the highest safety levels possible in liposuction.

Smoother Cosmetic Results

The tumescent technique permits the use of microcannulas which in turn yields smoother cosmetic results. Traditional liposuction cannulae (stainless steel tubes) have a relatively large diameter and remove fat rather quickly. However with the use of large cannulae (diameter greater than 3 millimeters) there is an increased risk of irregularities and depressions in the skin. Microcannulas, with a diameter less than 3 millimeters, allow fat to be removed in a smoother and more uniform fashion.

Rapid Healing

After tumescent liposuction there is a certain amount of blood-tinged local anesthetic solution that remains under the skin. This excess fluid is either slowly absorbed over several weeks into the blood stream, or it can be rapidly removed by drainage through skin incisions and absorbed by special absorptive pads .

Rapid Drainage

After liposuction, injected fluid drains out rapidly out of incision sites, accelerates the rate of healing, and reduces post-operative pain swelling, and bruising. At this time, patient is advised to wear compression garments for about 3-4 days.

GETTING BACK TO NORMAL

Healing is a gradual process. You can start walking the next day itself .You can do your household chores the very next day. You can be back at work within a few days following your surgery. Activity that is more strenuous can be started in a week.

YOUR NEW LOOK

You will see a noticeable difference in the shape of your body quite soon after surgery. However, improvement will become even more apparent after about four to six weeks, when most of the swelling has subsided. After about three months, the full results and the final contour will be visible.

If your expectations are realistic, you will probably be very pleased with the results of your surgery. You may find that you are more comfortable in a wide variety of clothes and more at ease with your body. And, by eating a healthy diet and getting regular exercise, you can help to maintain your new shape.

Are there any disadvantage of tumescent liposuction?

Perhaps the only disadvantage (if it can be termed so) is that tumescent liposuction takes a longer time to perform as both the anesthesia itself takes more time to set and also the use of microcannula makes the procedure slower. However, as stated earlier, in liposuction, speed is not the criterion for excellence. Ultimately, excellence is measured in terms of patient happiness which is a function of safety, patient comfort, finesse, and quality of results. And by these criteria tumescent liposuction scores.