Tumescent Liposuction – A Marvel Of Modern Science

Tumescent liposuction is a relatively new technique pioneered as early as 1985, which allows for fat removal without some of the invasive surgery that had been used in the past. What follows is a general description of the technique which hopefully is fairly medical.  The word “tumescent” means swollen and firm. By injecting a large volume of very dilute lidocaine (local anesthetic) and epinephrine (capillary constrictor) into subcutaneous fat, the targeted tissue becomes swollen and firm, or tumescent.

The tumescent liposuction technique is a method that provides local anesthesia to large volumes of subcutaneous fat and thus permits liposuction totally by local anesthesia. This will technique eliminates both the need for general anesthesia and need for IV narcotics and sedatives. The tumescent technique for liposuction 1) provides local anesthesia, 2) constricts capillaries and prevents surgical blood loss 3) provides fluid to the body by subcutaneous injection so that no IV fluids are needed.

One of the reasons this procedure is so safe is that depending upon the clinical requirements, a tumescent anesthetic solution may contain a 5 to 40 fold dilution of lidocaine found in commercially available formulations of local anesthesia. Commercial solutions of lidocaine used by dentists and anesthesiologists typically contain 1 gram of lidocaine and 1 milligram of epinephrine per 50 milliliters of saline. In contrast, tumescent solutions of local anesthesia contain approximately 1 gram of lidocaine and 1 milligram of epinephrine in 1,000 milliliters of saline. This is a 20 fold dilution of the commercial version of lidocaine and epinephrine. This approach to tumescent liposuction by local anesthesia has proven to be extremely safe despite the use of unprecedented large doses of lidocaine and epinephrine. The explanation for this remarkable safety is the extreme dilution of the tumescent local anesthetic solution. Large volumes of dilute epinephrine produce intense constriction of capillaries in the targeted fat, which in turn greatly delays the rate of absorption of lidocaine and epinephrine. Undiluted lidocaine and epinephrine is absorbed into the bloodstream in less than an hour. Tumescent dilution causes widespread capillary constriction which causes the absorption process to be spread over 24 to 36 hours. This reduces peak concentration of lidocaine in the blood, which in turn reduces the potential toxicity of a given dose of lidocaine. Dentists typically use concentrated epinephrine which may cause a rapid heart rate if the epinephrine is rapidly absorbed. When very dilute tumescent epinephrine is used, the wide spread vasoconstriction slows the rate of epinephrine absorption, which in turn prevents an increase in heart rate.

Profound vasoconstriction (shrinkage of capillary blood vessels) results from the tumescent infiltration of a large volume of dilute epinephrine into subcutaneous fat. With the approach of tumescent liposuction the vasoconstriction is so complete that liposuction can be done with virtually no blood loss. In contrast, the older forms of liposuction used before the invention of the tumescent technique were associated with so much surgical blood loss that on the spot blood transfusions were often routine.  Because the vasoconstriction delays lidocaine absorption, the local anesthetic remains in place in the fat for many hours. This prolonged anesthesia permits surgery for up to 10 hours after infiltration, and provides 24 to 36 hours of significant postoperative lack of significant pain.

As is usual with all surgical operations is recommended that you consult your doctor extensively before attempting any type of liposuction surgery, but having said that, tumescent liposuction is one of the best approaches to this age-old problem. Under proper medical supervision, the rewards far outweigh the risks.