Liposuction Q & A
What is the “tumescent” technique?
The tumescent method is a simple but revolutionary technique, which has improved results and enabled faster recovery from liposuction since it was introduced several years ago.(I was one of the pioneers of the tumescent technique in the Northwest in the early 1990’s.) Nevertheless, there is a considerable amount of confusion about exactly what it is. Basically, it involves the injection of a relatively large amount of fluid into the fatty tissue which the surgeon plans to remove by liposuction. The fluid contains a small amount of lidocaine (a local anesthetic similar to Novocaine) and epinephrine (adrenaline.) The lidocaine helps to make the area numb, and the epinephrine constricts the blood vessels so there is dramatically less bruising and blood loss. Virtually all liposuction procedures done today involve the infusion of fluid for these reasons. The confusion has to do with the use of the tumescent technique as the only form of anesthesia. This approach has traditionally been advocated by non-surgeons (such as dermatologists) who did not have access to surgical facilities. I believe that most patients are far more comfortable with additional anesthesia from a qualified anesthesia professional, since the injections of large amounts of fluid can be painful.
What other techniques are available and how can I decide which is most appropriate for me?
It is important to make your decision in consultation with a plastic surgeon who has extensive experience in state-of-the-art techniques. There are several new technologies in liposuction, and these are often introduced with so much marketing hype that it can be difficult to separate truth from fiction. Remember that all of the current methods use the tumescent technique, so in and of itself the tumescent technique is not really a specific method.
“Traditional” method: With the traditional or standard method, suctioning is done with a small instrument called a cannula; this is a blunt-tipped instrument about the diameter of a cocktail straw, with holes near the tip. After the area is infused with tumescent fluid, the cannula is connected to suction and the tip is inserted through a small incision in the skin. The cannula is moved continuously until the desired amount of fat has been removed and the planned contour change has been achieved.
Internal ultrasonic-assisted liposuction (IUAL): The most significant advance in technology since the introduction of the tumescent technique is the use of ultrasound to emulsify the fatty tissue. Ultrasound is high-frequency sound waves, which can help to soften and liquefy fat cells making it much easier to achieve good results in areas where the fat is more dense (such as abdomen, hips, back, and chest.) The internal UAL method uses a specially designed cannula to deliver the ultrasonic energy directly into the fat compartment. I have published award-winning research showing that ultrasound, when properly applied, selectively emulsifies the fat cells while sparing nerves, connective tissues, and blood vessels. IUAL is used on areas where it will improve results, while traditional techniques are adequate for areas of softer fat such as the inner thighs. Most IUAL procedures employ a combination of ultrasonic and traditional techniques. Those interested in the technical details of IUAL can learn more from my chapter in www.emedicine.com, an online plastic surgery textbook.
Laser-assisted liposuction: It seems like I get an inquiry at least once a week about laser-assisted liposuction. Of all the new procedures that have appeared over the last few years, this one has undoubtedly received the most hype. But does it really offer any advantage over traditional techniques including ultrasound? The procedure still involves injection of anesthetic fluid, and requires the use of a suction cannula just like regular liposuction; the only difference is the use of a laser which is supposed to soften up the fat and stimulate the skin so that it might tighten better. One problem is that no one has proven that it does that. Another is that published studies report no evidence that treating the fat with a laser has any measurable advantages either. This may be another idea that requires time and experience to prove itself, but at the moment it doesn’t appear to justify the considerable expense.
How much fat can be removed?
Keep in mind that liposuction is a body contouring procedure, not a weight-loss shortcut. And even though the use of tumescent technique enables larger amounts of fat to be removed because of the reduced blood loss, infusion of large amounts of fluid creates a physiologic strain on the body. For these and other reasons, the American Society of Plastic Surgeons has recommended that outpatient liposuction procedures remove no more than 5000cc (about 5 quarts of fat.) Very large volumes of fat removal are much less likely to result in either long-term weight reduction or satisfactory contours.
Are fat cells removed permanently?
The number and distribution of fat cells is believed to be determined at an early age, as a manifestation of genetics. With adult weight gain, there are not more fat cells, but rather the cells expand. Also, fat cells in different parts of the body respond differently to diet, exercise, and hormonal changes. That is why the usual liposuction patient has discrete problem areas such as the outer thighs that are out of proportion to the rest of the body. Liposuction does remove cells permanently, reducing the fat “storage capacity” in specific areas. Normally, this results in more even distribution of body fat.
How long is the recovery time after liposuction?
Generally there is relatively little discomfort after liposuction, although everyone’s experience is unique as with anything else. I recommend light activity for the first 5 days, followed by gradually progression to normal routines over the next 2 weeks. A compression garment s worn for 3 to 4 weeks, in order to control swelling and hold the skin smooth.
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