About Tumescent Technique
Liposuction is by far, the most popular cosmetic surgical procedure in North America. Men and women across the continent are turning to liposuction to improve their body contour to achieve a level of self-esteem and confidence they deserve.
Liposuction can be performed in a variety of ways, differentiated by the amount of fluid used during the procedure; there is dry, semi wet, and wet. Tumescent liposuction is considered a form of “wet technique”, as you learn from below.
The Evolution Of The Tumescent Technique From The Dry Technique
The Dry Technique
Dating back to 1974, the development of a using a cannula to remove fat was started. This technique is named today as the “dry” form as further advancements have led to improvements on how liposuction is performed.
The dry technique made use of general anesthesia and required hospitalization. As 30-45% of the fluid suctioned out of the body was blood, a blood transfusion was required with every liposuction procedure. This excessive blood loss was not only dangerous and impractical but it meant that less fat could be suctioned out at a time.
The “Dry technique” has also lead to longer recovery time and higher incidence of complications such as seromas, not to mention, some very undesirable cosmetic results. This led several surgeons in the 1980’s to take liposuction one step further...
The Wet Technique
The wet technique included adding fluid into the areas to be treated to assist in liposuction. The fluid both aspirated the fat as well as maintained fluid equilibrium within the body, reducing blood loss and reducing the risks. It still required general and IV anesthesia. The blood lost in this method was greatly reduced to 15-20% of fluid suctioned, but this was still dangerously high.
The Beginning of Tumescent Liposuction
The art of Liposuction was a constant work in progress throughout the twentieth century as surgeons experimented with various techniques and technologies to make liposuction safer and more effective.
A major breakthrough came in 1987 from a dermatologic surgeon Jeffrey Klein, and is still used widely today:
The introduction of the tumescent liposuction technique is considered one of the safest and most effective techniques. In fact, the tumescent solution used is still sometimes referred to as Klein’s Solution.
Tumescent Technique in a Nutshell
With tumescent liposuction, the patient does not go under general anesthesia or intravenous anesthesia. Instead, a tumescent fluid is injected into the areas to be treated and acts as both the local anesthetic and the fluid forms part of the liposuction procedure.
The tumescent was a basic solution of saline with various doses of lidocaine and epinephrine. Although it is has been develop to include several other ingredients, these still remain the main medications used.
Fat is then suctioned out of the subcutaneous tissue, along with a certain volume of the solution. Some of the solution will remain in the body for several hours after the procedure and will slowly be drained out of the subcutaneous tissue.
Benefits of Tumescent Procedure
- Through the tumescent technique, liposuction can be performed without the need for hospitalization or blood transfusion. The patient can even go home in the same day, after the procedure, provided they do not drive themselves as the anesthesia may still leave them drowsy for several hours afterwards.
- In tumescent solutions containing epinephrine, this substance provides excellent haemostasis (inhibition of bleeding) provided by the vaso-constrictive effects of the epinephrine.
- As opposed to local anesthetic, the use of intravenous fluids or general anesthesia may lead patients to experience fluid overload with the possibility of pulmonary edema (fluid sac in the lung which could lead to respiratory failure).
- The percentage of blood removed along with the fat is as little as 1% or less.
- The slow absorption of the tumescent solution into the subcutaneous tissue allows for gradual intravascular volume replacement. This maintains equilibrium within the body throughout the procedure, minimizing the risk of complications.
- The anesthesia is slowly removed from the body, which means the patient is still anesthetized after the procedure, which reduced the need for too many additional medications, and thus risks of complications as well as additional costs are also reduced.
The Super-Wet Technique
The super-wet technique is another further development of the tumescent technique. This technique works in a similar fashion to tumescent technique with the main difference being in the volume and concentration of the fluid injected into the body region. The volume of the fluid injected is equal to the amount of fat being removed.
This method, although considered quicker than tumescent liposuction still incorporates general anesthesia. The blood lost in this technique is greater than that of tumescent liposuction, but less than that of the wet technique. The super-wet technique still remains an alternative to those unable to handle the higher amounts of lidocaine and other medications used in tumescent or to those preferring the benefits of general anesthesia.
Liposuction continues to be developed further every day to make it safer and more effective but it was the evolution away from the infamous dry technique that paved the way for liposuction procedures today to be more universally accepted as safe. At Toronto Cosmetic Clinic, liposuction is performed by a plastic surgeon using the Wet Technique. Most patients do use, SmartLipo™ which even though it is laser assisted is a form of the wet technique.