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Tumescent Liposuction

Liposuction with the Tumescent Technique

The most significant refinement in liposuction over the last decade has probably been the development of the Tumescent Technique. The tumescent technique of liposuction involves the injection of relatively large volumes of a saline solution containing dilute local anesthesia and adrenaline into the fatty tissues, thus forming a safety cushion on which the cannulas can slide.

More importantly, these elements contribute to the loosening of bonds between the fatty cells, thereby facilitating their removal. As a result of the adrenaline there is a decrease in the bleeding from blood vessels thus allowing us to remove larger quantities of fat more safely. Less bleeding also means less bruising. The infiltration of large volumes of dilute anesthesia also allows the procedure to be performed under local anesthesia with or without sedation if desired.

What does the operation involve?

The following is a description of the vibro-liposuction method utilizing the tumescent technique. To begin the operation a number of tiny incisions (about 3-4mm) are made in the skin in the areas to be treated. These slit incisions are made, when possible in inconspicuous places.

Subsequently the areas are injected with the tumescent solution mentioned previously. The solution is then allowed to diffuse and take effect (about 10-15mins) throughout the target fat. As mentioned the solution will numb the areas as well as reduce bleeding by temporarily closing down the capillaries.

The appropriate cannulaes are inserted into the fat, the vibrations from the vibroliposuction blends and melts the fat which is then drawn off by a vacuum pump.

Since the fat is removed by suctioning small "tunnels" through the fat, the skin remains intimately connected to the underlying muscles by multiple attachments called fibrous septa. These can be described as being the body's "Velcro". It is this process and these structures, which assures that the skin will not hang in loose folds after Liposuction.

The fat is removed by doing as little damage to the septa, which also contain blood vessels, nerves and lymph vessels.

The entire process may take 2-5 hours depending on the amount of fats to be removed and the complexity of the condition.

After your surgery, depending on which area you've had treated, you will find that a snug elastic compression body stocking or garment will be in place. This must be worn over the treated area to control swelling and bleeding, and to help your skin shrink to fit your new contour. You will need to wear this garment compression continuously for two weeks (apart from taking it off for a shower) after surgery, then just in the daytime for a few weeks more.

Choice of anaesthetic

Liposuction can be performed successfully either with a local anaesthetic alone, local anaesthesia with mild sedation (twilight anaesthesia) or with a General anaesthetic (completely asleep). If you decide to have it done with a local anaesthetic, you will probably feel some vibration and friction during the procedure. You may also occasionally feel a stinging sensation as the cannulae moves closer to the muscle. You will not be aware of anything if you opt for the procedure to be performed under general anaesthesia.

The choice of anaesthesia depends on the number of areas treated, the amount of fat to be removed, any pre-existing medical conditions or unique circumstances and of course the individual patients desires.

Maximum safety limits

It is important to understand that there is a maximum safety limit to the amount of fat that can be extracted during any one operation. This is usually between 2.5 - 3 liters. In some instances the procedure will have to be repeated to allow more fats to be removed at another time. It is usually best to wait at least three months between procedures.

Amount of weight loss

Exact weight loss may be very little. Conversely, in the first few weeks after surgery there will be a slight increase in weight due to water retention. The reason that you don't lose much weight is because taking out up to 2.5 or even 3 liters of fat (which is the safe maximum limit) is not enough for you to see a significant drop in your weight. This is because fat cells don't actually weigh that much. On the other hand however, depending on the treated areas, there is usually a significant decrease in girth measurements.

Pain Factor

There are very few forms of surgery that are completely painless. Discomfort is a euphemism for pain and many doctors use these interchangeably. In the case of liposuction, the degrees of pain vary from patient to patient but this can be controlled by analgesics, which will be prescribed. The initial pain lasts around 1 week however there may be residual soreness in the treated area, mainly upon palpation, for up to 4-5 weeks. Along with the soreness you may experience some stiffness, which usually abates, as your mobility increases.

Will the Fat return?

The short answer to this is no. As fat cells have achieved their set number in any given part of the body by puberty, increased caloric intake will not lead to volume gains in the treated site. It is important nonetheless to maintain your weight afterwards by sensible eating and regular exercise. You must understand that if you do take in excess calories after surgery, you will then notice other areas of your body increasing in size.

Post Surgery

After the surgery you will notice that you will be draining some fluid from your tiny incisions. This is because there is almost always some fluid build up (usually bloody) that develops in the treated area in the first 24-36 hours postoperatively. Your incision sites therefore will act as "drainage holes" in this instance and are therefore invaluable in reducing overall post operative swelling and bruising.

Drainage of the fluid is possible because the incisions are very small and heal quickly on their own without the use of traditional stitching. The advantage of the non-stitching ensures that the ensuing scar is no different, if not better, compared to the use of stitches.

The down side of this practice is that during the first day or two, your dressings and clothing will usually get soaked quite quickly and therefore you will require regular changes, although this usually stops by the end of the first 48 hours after surgery.

Despite wound drainage, you are likely to experience swelling and bruising to varying degrees. Sometimes this bruising is quite spectacular. Bruising can take up to 3 weeks to disappear although very occasionally a light tinge of yellow can still be seen in the skin up to 2 months following treatment.

Tissue swelling, while expected, can last up to 4 weeks. In fact because of this swelling you will probably not notice any change in your size immediately after surgery. It is important to remember that when the abdominal area is treated, the swelling and bruising can migrate downwards to the groin and genital region.

In men this would mean substantial swelling, bruising and discomfort of the external genitalia. This usually lasts about 7- 10 days, and one may benefit from the use of support underwear instead of boxer shorts, in this instance.

At around 2-3 weeks after surgery, you will discover that the areas treated will feel hard and irregular. This is part of the normal healing response. The body starts to lay down scar tissue (which is hard in nature) in response to surgery in an attempt to "heal" itself. This scar tissue can also block lymph drainage channels temporarily and occasionally cause the skin overlying the treated area to look dimpled or take on an "orange skin" appearance.

The scar build up ceases and eventually resolves completely, along with its manifestation. However this period of hardening and irregularity can take up to 4 months to resolve. You will also experience sensory changes in the area treated. This may result in numbness of the skin or alternatively it may feel hypersensitive. Either way this is usually temporary and returns to normal in about 6-8 weeks.

Overall because of these effects, it's not unusual to feel depressed in the days or weeks following surgery. Try to keep in mind that this is normal and will subside as you begin to look and feel better.

Scars

Scars are not a complication but a normal event after any surgery. Scars in liposuction surgery are tiny. Depending on the area(s) needed to be treated, scars about 3-4 mm in length will form. These are usually placed in natural folds of the skin where possible. Generally about 3-6 incisions are required for any given area.

The scars in Liposuction are short and generally heal quite well, gradually fading with time. However it is important to keep in mind that this may take up to two years to complete. If you are of a darker skin type however, then expect your scars to be darkly coloured for a longer period of time (about 3 years).

Daily massage of the scars during this time period is advised to expedite and facilitate this process. This is a risk that the patient will have to undertake as there is no way to predict any scars formation in an individual.

What can go wrong?

All surgery carries some uncertainty and risk. Thus complications that can occur include thickened, deeply coloured or unattractive scars at the site of the small incisions; irregularities of contour or dimpling of the area treated; unevenness or

asymmetry between sides; prolonged numbness and swelling; haematoma or seroma formation (a collection of blood and fluid under the skin that must usually be drained by the surgeon), and infections.

In extremely rare cases, skin loss resulting in permanent scarring has been reported. Despite any surgeon’s best efforts, it is possible that a small number of patients may require a secondary tidy up procedure, usually after 9-12 months, to correct or improve any residual uneven contour or shape irregularity. This will be determined at the follow up checks.

Recovery and resuming activity

The recovery time varies with how many areas are treated and the type of activities the patient intends to resume. It is important to realize that although only tiny incisions are made, liposuction creates a large wound hidden under the skin and therefore as healing is a gradual process, adequate rest in the days after surgery will be required.

However you should start walking around as soon as possible to improve the circulation and avoid stagnation of blood, which could lead to the formation of blood clots. Most patients resume light activities within 2-3 days and depending on their work can be back between 5 -7 days.

Due to variations in swelling and bruising, this may be delayed up to 7 -10 days. Exercise is usually recommenced at about 10 -14 days.