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Tumescent Liposuction

© Michael McLaughlin

Liposuction, or suction assisted lipectomy, is the most common plastic surgery operation, with more than 170,000 procedures performed in the United States in 1998 alone. One of the important refinements in the operation has been the development of the tumescent technique, which involves infusion of fluid into the fatty area prior to suctioning. This procedure can remove deposits of excess fat from a variety of body areas to improve body contour. Healthy people with relatively normal weight, undesired pockets of excess fat in particular areas, and firm, elastic skin are the best candidates.

Where liposuction is performed depends on many factors, including patient health issues and the type of anesthesia required. The tumescent technique provides numbing medication to the area to be treated, which may provide sufficient anesthesia. Many patients require some form of sedation, and occasionally general anesthesia. An outpatient setting such as an ambulatory surgery center often provides convenience and reduced cost. Overnight hospitalization is generally not necessary, except in cases of very large volume aspiration or in patients with additional medical concerns.

Patients are marked preoperatively and then taken to the operating room. The operating time varies, but is usually less than two hours. Hollow tubes called cannulas attached to a suction pump are passed through multiple small incisions. The surgeon manipulates the cannula within the fat layers under the skin, breaking up the fat and suctioning it out.

The surgeon may use a "dry" technique, a "tumescent" technique, or a variation of these. In the tumescent technique, a dilute solution containing lidocaine, epinephrine, and intravenous fluid is injected into the areas of excess fat before liposuction is performed. This solution reduces the anesthesia requirements and minimizes blood loss. As a result, the tumescent technique can reduced bruising, swelling, and pain. The long acting effects of the anesthetic solution can also help to provide pain relief after the procedure and decrease the need for additional pain medication.

During the operation, patients lose fluid in an amount determined by the total aspirated volume and the technique used. These fluid shifts are reduced with the tumescent technique. It is crucial that this fluid be replaced to prevent dehydration. Fluids are administered intravenously in the operating room and recovery room. Patients are asked to continue drinking fluids during the postoperative period.

Problems such as blood clots, injury to vital structures, respiratory distress, and even death have been reported in patients undergoing liposuction. Luckily, such complications are rare. Occasional problems with fluid accumulation, skin damage, pigmentation, and contour irregularities can also arise and may require a second procedure. Infection and excess fluid loss can also occur. Some numbness frequently occurs but most often resolves within three to six months. Overall, liposuction is a generally safe procedure when well-selected patients have the surgery done in a safe setting by a qualified plastic surgeon.