Tumescent Lipo Explained
Understanding the Structure of fat
Fat that resides underneath the skin is called subcutaneous fat. This layer of fat covers the muscles and provides shock absorption and insulation for the body. Subcutaneous fat is distributed in lobules, containing fat cells, that are separated by connective tissue (septae) blood vessels, nerves and lymphatics. Ropes of collagen throughout the layer of fat hold the fatty tissue in place. The larger blood vessels that supply food to smaller blood vessels are held in the dermis. The fat cells are stored here as an energy source.
Initial weight gain causes an increase in the size of fat cells. Continued weight gain increases the fat cell number because mesenchymal stem cells are converted into fat cells. Diet and exercise can reduce the size of fat cells but not the amount, which are known as "resistant fat." Image 1 shows the different stages of subcutaneous fat before and after a tumescent liposuction procedure: the first picture shows untouched fat cells; the second picture is of subcutaneous fat treated with tumescent fluid to give it a firmer, swollen appearance and composition; the third picture is of the fat with tumescent fluid containing fat tunnels for suction; the fourth picture is of the fat tunnels after the cells are drained of the majority of fat cells and tumescent fluid.
What is Tumescent Liposuction?
Tumescent Liposuction is a method of liposuction that involves injecting a large volume of diluted local anesthetic (lidocaine with epinephrine, a capillary constrictor) into the fatty areas of the skin, making the tissue swollen and firm. It can be used on the neck and jowels, arms, abdomen, buttocks, hips, inner and outer thighs, knees, legs, flanks (love handles) and enlarged male breasts. It is the most commonly performed version of liposuction.
Results of tumescent liposuction are typically prominent and permanent though the areas may change if the patient gains a massive amount of weight. The procedure can be done any time after two weeks to remove more excess fat tissue. Some areas, such as the abdomen, thigh or buttock, are not usually done in one session. Full results should be seen within 6-12 weeks.
The Process of a Tumescent Liposuction (steps)
Ideal patients for tumescent liposuction are those that have localized deposits of fat, are not grossly obese, do not have noteworthy medical issues, and have realistic expectations knowing the procedure is for improvement of shape, and that weight loss is incidental. There is no specific age or weight limit for patients to undergo tumescent liposuction.
A thorough medical analysis is done to find instances of drug history, bleeding diathesis, emboli, allergies, thrombophlebitis, caesarean section infectious diseases, poor wound healing and diabetes; patients with past history of these occurrences need to be examined and cleared by a doctor before undergoing the procedure. Evidence of scars, hernia or keloids should be checked out. Those with a history of severe cardiovascular disease and/or coagulation disorders (thrombophilia), lupus, collagen or connective tissue diseases, or are pregnant should not undergo liposuction.
Patients should be informed the surgical procedure, including potential postoperative complications. They should also know of different recovery management options, including the inclusion of diet and exercise. The patient should not expect to achieve perfect results. They should understand that cellulite is not improved as a result of the liposuction. Abdominoplasty or skin tightening may be necessary if there is a large amount of excess skin or muscle laxity after the procedure.
Taking the before pictures
Pictures are taken before the tumescent liposuction as a means of comparison. They identify problem areas, help plan appropriate surgical corrections, and help doctors and patients identify the body's original appearance. The photos can give the patient an objective idea of the proposed correction.
Preparing the patient
Preoperative procedures include routine blood investigations (blood counts, bleeding and clotting time, prothrombin time, blood sugar, HIV-ELISA, ECG, HbS Ag, and liver function tests); recommendations to stop smoking and oral NSAIDs (smoking increases likelihood of intraoperative bleeding); tranquilizers (such as diazepam or lorazepam) the night before the surgery to reduce anxiety; and Vitamin K injection to minimize postoperative bruising.
The day of the surgery, patients are giving preoperative antibiotics (like cephalexin), a tranquilizer (like oral lorazepam), and oral clonidine to prevent epinephrine-induced tachycardia. Baseline vital signs (including blood pressure and heart rate) are monitored as well as pulse oximeter checking. Medical staff preferably an anesthetist should be present.
Marking incision points on the area
The liposuction area is topographically marked with ink to map bulges and asymmetry. This helps the surgeon identify the areas to be worked on including access incisions and regions to be contoured based on the way the topographical marks are made. A patient's body changes appearance when they lie down, making the fat deposits harder to see. The markings and preoperative photos are important for the doctor in the operating room.
Numbing the incision points
Approximately 4-8 adits, small holes for insertion of the cannulae, are created with 1.5-2 mm dermal punches. The number of adits depends on the area involved.
Injecting the tumescent fluid
About 1-4 liters of tumescent fluid containing lignocaine (infiltrated anesthesia), sodium bicarbonate and epinephrine is administered. The tumescent solution deadens the area to feeling before and after the surgery. The procedure eliminates the use of general anesthesia, pain medication (in the form of IVs narcotics), and sedatives, and the constricted capillaries prevent surgical blood loss. The administration of tumescent fluid ballooning fat tissue and creating local anesthesia lasts 45-60 minutes. The fluid is allowed to penetrate all fat layers (known as detumescence) for 30 minutes.
Using the cannula to suction the fat
The surgeon inserts the cannula (a small, thin stainless steel tube) through small slits into the fatty tissue to suction it out of the body. Fluids are provided to the body through the cannula and the subcutaneous injection, which contain a saline solution to break apart fat, lidocaine as an aesthetic, and epinephrine to constrict capillaries.
The tissue is numbed while the fat separates so it can be removed through the microcannule, a 1.5-3 mm opening made by the cannula. This lasts for 1-1.5 hours. As the excess fat is removed, the remaining fat tissue is sculpted into smoother contours. The overall procedure lasts from 1-5 hours, and up to five pounds of fat is removed.
Because there is remaining tumescent anesthetic in the body after the procedure, this ensures anesthesia in the immediate postoperative period and minimizes the need for oral analgesics. It drains out in 3-5 days. After the procedure, tight pressure bandages aid in proper drainage of tumescent fluid.
Two layers of supportive pressure garment (with or without a board) are worn by the patent to maximize the liposuction results in the first two days. Dressings are removed on the first postoperative day and adits may be opened to entice drainage. Pressure in the dressings is reduced after three days and continued for a minimum of two weeks. The patient is informed to have the dressing re-administered for three days.
Most patients can go back to sedentary work within 1-2 days, though exercise and unnecessary exertion should be avoided for at least 10 days. Some surgeons advise the patient to seek massages for several weeks after the surgery to encourage draining of the area.
What are the differences between tumescent and traditional Lipo?
There are several differences between tumescent liposuction and traditional liposuction. The conventional form of liposuction requires general anesthesia for pain control, increasing the risk of complications and mortality and slowing recovery time. Tumescent liposuction uses local anesthesia, lowering the complication risks and allowing the surgery to be done as an outpatient procedure. One side effect of traditional liposuction is fat embolism, which can be fatal.
Tumescent liposuction has minimal blood loss in comparison to conventional liposuction because of the use of a smaller cannule and lesser amounts of fat (3-5 liters as opposed to 8-10 liters in traditional liposuction) drained. Conventional liposuction has greater blood loss, often requiring a transfusion. However, the use of the smaller cannule in tumescent liposuction means that the procedure is slower than traditional liposuction. Sutures are required for conventional liposuction patients; this is not the case for tumescent liposuction patients.
The postoperative care for tumescent liposuction is different than conventional liposuction. Being an outpatient procedure, tumescent liposuction does not require hospitalization unlike traditional liposuction, which adds to the overall cost and recovery time, and it exposes patients to infections in the hospital environment. Conventional liposuction patients only need pain relief up to 24 hours often minimal and consist of oral painkillers. Traditional liposuction patients need strong, parenteral painkillers because of the procedure's invasiveness.