Liposuction, like all types of surgery, has evolved over the years. Earlier forms of the procedure were considered “dry” (since they used general, rather than local, anaesthesia) and patients had to consider the possibility of experiencing complications. At the time, liposuction often lead to uneven results (due primarily to extreme fluid shifts), long recovery times and an excessive amount of blood loss that often required transfusions.
In 1987, Jeffrey Klein, an American dermatologist, made a breakthrough that drastically improved on dry liposuction thereby increasing procedural efficacy and safety. Klein’s revolutionary “super wet” or tumescent technique cut down on recovery times, decreased pain, and eliminated excessive bleeding (along with the use of transfusions) by adding large amounts of diluted epinephrine and lidocaine to the patient’s body. Tumescent liposuction greatly decreases the risk of surgical complications, improves aesthetic results and allows for treatment of larger bodily surfaces. The introduction of the tumescent technique has also seen surgeons using very small operating instruments (called cannulae) that are far safer and much more accurate than older tools.
The massive advancements represented by tumescent liposuction have made it the standard for localized fat removal in modern aesthetic medicine.
LIDOCAINE AND EPINEPHRINE
Lidocaine: Lidocaine is an anaesthetic formulated with amide which works to inhibit the impulses that lead to experiencing pain. The toxicity of lidocaine is the main factor limiting its use as anaesthesia, but this is resolved in tumescent liposuction through dilution. When used in conjunction with epinephrine (which also provides vasoconstrictive benefits) lidocaine can be safely used in tumescent liposuction. Because it’s partially absorbed by subcutaneous fat during the procedure, larger amounts of the anaesthetic can be introduced to a patient’s body without danger, allowing for effective tissue treatment and anaesthesia.
Epinephrine: The use of vasoconstrictors alongside anaesthesia improves patient comfort and reduces bleeding during surgery. Epinephrine (or adrenaline) is the most commonly used liposuction vasoconstrictor. A vasoconstrictor works to temporarily narrow/constrict the small blood vessels of the operating area. When constricted, these blood vessels are far less likely to come into contact with surgical tools and, even if damaged, are able to clot more quickly. This leads to a drastic reduction in bleeding that, when mixed with anaesthetics like lidocaine, makes many surgeries possible where they would be too dangerous to perform otherwise (liposuction using epinephrine reduces bleeding by 90%).
ADVANTAGES OF TUMESCENT LIPOSUCTION
An enormous reduction in bleeding
The fluid removed during tumescent liposuction is only 1-3% blood with the use of a vasoconstrictor like epinephrine as opposed to 40% without.
The ability to use larger amounts of lidocaine anaesthetic
When coupled with a vasoconstrictor, lidocaine can be used in much larger volumes. This is because some of the substance absorbs into the fat (epinephrine also works to slow the absorption rate and increase the metabolism of the potentially toxic substance) and is then suctioned out of the body.
Simplified surgery and a lower risk of infection
With the tumescent technique, it’s no longer necessary for patients to receive intravenous fluid replacement during the procedure. The use of lidocaine decreases the risk of developing infections as well.
More accurate results
Surgeons can more easily detect areas that must be worked on during the procedure, ensuring that a single treatment can lead to accurate results. This makes a secondary liposuction procedure much less likely.
Longer Lasting Relief
The anaesthetic can provide up to 24 hours of comfort.
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