In the early years of liposuction, which started in Europe in the 1980’s, the procedure was performed under anesthesia without first inserting any fluid into the area. This was known as the ‘dry’ technique. As a result, there was considerably more blood loss both during and after the procedure with at least 20-30% of what was removed being blood. This significantly reduced the amount of fat that could be removed at a single setting simply because of the risk of significant blood loss with larger procedures compared to present day techniques.
The Tumescent Technique
Tumescent liposuction was popularized in the early 1990’s to reduce both pain and blood loss both during and after surgery. With the tumescent technique, after the short liposuction incisions are made, a very dilute solution of local anesthetic (Lidocaine, Xylocaine) with epinephrine is injected into the area that is going to be treated. The local anesthetic numbs the area to be treated so that some procedures can be done without general anesthesia and it significantly reduces pain after larger surgeries that are done with anesthesia.
The addition of epinephrine makes an even more dramatic change. Epinephrine causes small blood vessels in the skin and fat to constrict so that there is much less blood lost during the surgery allowing for safe removal of much larger volumes of fat than can be done with non-tumescent liposuction. Whereas removing 2000cc’s of fat and fluid used to be considered a relatively large liposuction with the ‘dry’ technique, that amount would now be thought of as a fairly small procedure with tumescence.
There is a limit, of course, to the amount of tumescent fluid that can be injected, as large amounts of both epinephrine and lidocaine can be toxic. Therefore, surgeons keep a close count on how much tumescent fluid is administered to ensure that a safe volume is used. By reducing pain during the surgery, less anesthesia can be administered; particularly less narcotic can be used which makes the surgery safer and lowers the risk on nausea after surgery.
Other Liposuction Techniques
Use of the tumescent technique does not prevent a surgeon from using other forms of liposuction such as ultrasonic or laser liposuction as they can be performed concomitantly. The use of tumescent fluid does not change the liposuction procedure with the exception of adding a little more time for the administration of the fluid; however, the reduced pain, blood loss and bruising far out weigh a small increase in procedure time.
Other Tumescent Uses
The tumescent technique has been so successful at reducing pain and bleeding that it is now also used for facelifts, breast augmentation, breast lifts, breast reductions, tummy tucks and more. It is surprising, however, how few plastic surgeons take advantage of this method as it only takes a few minutes of time and does not increase the cost of the procedure at all. Only surgeons who are willing to go ‘the extra mile’ for their patients to reduce pain and bleeding are ardent users of the tumescent technique.