Tumescent Liposuction

When it comes to tumescent liposuction, the first part is tumescent, meaning fluid is injected into the areas that will be treated. The fluid contains a saline-type solution as well as local anesthesia and adrenaline. The fluid acts to numb areas where the liposuction will be performed and the adrenaline acts to decrease bleeding. In fact, the tumescent technique is really what revolutionized liposuction back when liposuction was first starting.

Liposuction is then performed with a cannula, which is like a tube. It is attached to a suction device and the fat is suctioned out. It can be power-assisted which is motorized, or it can use ultrasound or laser. These different modalities of liposuction all work to achieve similar results, and they are all done using a tumescent approach.

TYPES OF LIPOSUCTION

Most patients do very well with standard liposuction but there are various types of liposuction they can choose from:

• Standard liposuction is basic suction where the surgeon uses his arms to go back and forth with the cannula.
• Power-assisted liposuction is liposuction that is motorized which makes the results smoother and the procedure easier for the surgeon to perform.
• Ultrasonic liposuction uses sound waves that are high-pitched to liquefy the fat in an area before it is removed. It can be used for areas that are harder to treat like the chest, back, and areas that have been suctioned previously.
• Laser liposuction uses laser energy to reduce the fat in a patient. The laser is applied through a cannula beneath the skin.

COMPLICATIONS

For liposuction in general the short-term complications are bleeding, infection, and wound healing problems. These complications tend to be very rare with liposuction. Bleeding and infections are uncommon Wound healing is rarely a problem because the incisions are so small. The main long-term complications are aesthetic complications because of abnormalities or asymmetries. For example, the left hip is always a little bit different than the right hip. Even after a liposuction procedure, the left hip may still be slightly different than the right hip. Sometimes one side has a little bit more fat left than on the other side.

Some modalities of liposuction have different complications than others. For instance, ultrasound has a bit of a higher risk of fluid collection. Laser has a higher risk of the skin being injured or some type of burn. These are relatively uncommon complications and they do not exist with the other types of liposuction.

LIPOSUCTION AS WEIGHT LOSS

Liposuction is not a treatment for weight loss and not an operation for weight loss. It is used to improve contour. The best patients for liposuction are those at a good weight for their height. Doctors use the BMI (body mass index) as a rough guide. Every patient has stubborn areas of excess fat that are resistant to diet and exercise. These are the best targets for liposuction. As patients get into the high overweight range, they become less of a good candidate for liposuction.

FAT REMOVAL

With most patients, the surgeon removes a few liters of fat. Removing less than five liters is most common, usually between two and three liters. Large volume liposuction is defined as five liters or more, but doctors can go as high as 10 or 12 liters. It depends on the size of the patient and the number of different body areas being treated.

Safety is a greater concern once the amount removed gets above five liters. The surgeon needs to take special precautions. As long as the surgeon is experienced with the amount of fluid being put in and the fat that is being removed, the procedure can be done safely. It is not that larger volumes are less safe, it is just that more attention needs to be paid to the procedure.

In other words, putting in too much tumescent in order to remove 10 liters of fat can cause the patient to suffer medical problems.

LIMITATIONS 

The main limitation of liposuction is the condition of the overlying skin. Many patients that have fat pockets or fatty areas also have stretched or loose skin. Although liposuction can achieve some skin contraction or tightening, the patient may still be left with loose skin. Sometimes liposuction leads to worsening of the skin because it gets too loose if too much fat is removed. There is a fine line between removing enough fat without removing too much.

RECOVERY 

Patients do not have much pain after liposuction. There will be some swelling and discomfort. Patients can be up and around almost immediately and are able to return to work in a few days. They may not feel up to doing much heavy activity although there are no specific restrictions because there is no large incision and no disruption of the muscle. Patients are often treated with a compressive garment that helps them move around better and control the swelling. Patients will not be 100% after the first week but they can be up and around and return to work.

Recovery time depends on the amount of liposuction performed. If someone has a very small amount of liposuction they can have it under local anesthesia, leave the doctor’s office, and be back to normal. The more liposuction performed on a patient, the more surgery it entails, and more total recovery time will be needed by the patient.

RESULTS 

After the liposuction is performed, the patient is swollen so they will not see the results immediately. The swelling will decrease over time and is mostly gone by six weeks. Many patients still notice subtle changes and decreased swelling even up to six months after the procedure. Patients may not see the final results for up to six months. Once they do see the results, the changes they see are permanent.

FINAL THOUGHTS 

It is important for patients to know that the fat does not come back and the fat does not go anywhere else. The fat cells are permanently removed during liposuction. There is a myth that the fat goes somewhere else if the patient gains weight after liposuction. They will gain weight in areas where the fat cells have not been removed. For example, if their belly is liposuctioned and they gain five pounds, they will gain less in their belly area and gain more in areas where no liposuction was performed. The fat does not come back to the area where the liposuction was performed.

The most dangerous words are “it’s just liposuction”. Liposuction is surgery and although very safe, can be dangerous if performed by a poorly trained or inexperienced physician. The most important thing is to find a plastic surgeon that is certified by the American Board of Plastic Surgery that has experience performing liposuction.

Written by Cosmetic Town Editorial Team- MA

Based on an exclusive interview with John A. Perrotti, MD in New York, New York