TUCSON COSMETICS IS ONE OF THE FIRST TO OFFER TRUE TUMESCENT LIPOSUCTION UNDER LOCAL ANESTHESIA AS A SAFER ALTERNATIVE TO USING GENERAL ANESTHESIA.
Liposuction is has become the most commonly performed cosmetic procedure in the United States. Since it was first introduced in the United States in the early 1980s, many refinements have been made. The most significant improvement was the use of a diluted local anesthetic instead of general anesthesia. This improvement is referred to as the tumescent technique and was developed by dermato-surgeon Jeffrey Klein, M.D.
The tumescent technique utilizes a natural saline solution containing a precise amount of very local anesthetic (lidocaine) which is injected into the fatty tissue. The injected area then becomes anesthetized. With the tumescent technique, liposuction patients need no general anesthesia, as contrasted with the traditional/standard liposuction methods which do require general anesthesia with intubation, or deep intravenous sedation. 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 and anesthetized. The tumescent technique is a method that provides local anesthesia to large volumes of subcutaneous fat and thus permits liposuction totally by local anesthesia. The tumescent technique eliminates both the need for general anesthesia and the 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 4) has the best post-op pain control.
However, our patients may choose to be awake during the procedure or under twilight anesthesia (MAC anesthesia, conscious sedation). Many patients receive only minor sedation to help them relax, like ativan, and then they remain completely conscious and comfortable during the suctioning portion of tumescent liposuction surgery. After surgery, most patients may get up and walk out of the office without assistance. Patients return to their routine in a couple of days. With the tumescent technique, postoperative discomfort is significantly reduced since the local anesthesia remains in the treated tissue usually causing numbness and pain reduction for 16 hours or more after surgery. Patients frequently require only Extra Strength Tylenol to control the relatively minor discomfort that may occur after liposuction surgery that is performed using the tumescent technique.
At Tucson Cosmetics:
- Tumescent liposuction can reshape any part of the body by removing unwanted fat deposits.
- Liposuction cases can be handled safely and affordably using the tumescent method.
- The risks of general anesthesia are eliminated with tumescent liposuction (e.g., risks associated with endotracheal intubation, significant blood loss, hypoxemia and side effects from general anesthesia).
- The targeted fat compartments can be anesthetized individually with tumescent liposuction providing the most optimal postoperative pain control than standard liposuction.
- Vasoconstriction Prevents Blood Loss
- Profound vasoconstriction (shrinkage of capillary blood vessels) results from the tumescent infiltration of a large volume of dilute epinephrine into subcutaneous fat.
- Tumescent 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 autologous blood transfusions were often routine.
Smoother Liposuction Results with Microcannulas
A liposuction cannula is a stainless steel tube that is inserted into the subcutaneous fat through a small opening or incision in the skin. A microcannula has an outside diameter of fewer than 3 millimeters (mm). The diameter of microcannulas ranges from 1 mm to 3 mm. With special designs, microcannulas can remove fat very efficiently. The use of larger cannulas, for example, those having an outside diameter ranging from 3 mm to 6 mm require larger incisions which usually leave visible scars and more textural deformities. Smoother liposuction results can be achieved by using microcannulas which allow a more gradual and controlled removal of fat. This improves the ability of the surgeon to achieve smoother results. Larger cannulas are associated with an increased risk of liposuction producing skin depressions and irregularities. Larger cannulas may remove fat so quickly that there is a risk of removing too much fat. It is also more difficult to precisely control the direction of a large cannula. We get superior results with the microcannula.
Adits for Microcannulas
Adits are small holes in the skin made with round, skin-biopsy punches. Adits are used as access sites, in which the liposuction cannula is passed in and out of during the liposuction process. Adits also facilitate the drainage of the blood-tinged anesthetic solution after liposuction. Because of the skin’s ability to stretch, microcannulas can usually fit through a 1.0 mm, 1.5 mm, or 2 mm round hole made in the skin with a skin biopsy punch. Such tiny holes usually disappear without scars after liposuction. Adits are so small that it is not necessary to close them with sutures. Because adits are not closed with sutures, they promote copious postoperative drainage of blood-tinged tumescent anesthesia, which in turn reduces post-operative bruising, tenderness and swelling. Larger cannulas require larger incisions. When larger incisions are closed with sutures, there is delayed drainage, and prolonged swelling, bruising and pain after liposuction.
Other Advantages of Tumescent Anesthesia
Because tumescent local anesthesia lasts so long, tumescent liposuction is less painful and more pleasant than liposuction under general anesthesia or IV sedation. With tumescent local anesthesia, patients can avoid postoperative nausea and vomiting associated with general anesthesia. Tumescent anesthesia is so efficient at providing fluid to the body that it is unnecessary to use IV fluids. There is a risk of dangerous fluid overload if excessive IV fluids are given to a tumescent liposuction patient.
When you arrive at Tucson Cosmetics Aesthetics and Surgery you will be provided with a comprehensive consultation addressing all your questions regarding the procedure. You will be given a pre/post-operative folder with instructions for optimal surgical results. You will need a clearance with your medical physician to assure that you are healthy enough to undergo the procedure. Just remember to avoid aspirin, vitamin E, herbal supplements, advil, ibuprofen or other medications that the surgeon may limit, at least 2 weeks before surgery. You should expect to swell for a few days after the procedure. Most people return to their daily routine within a few days with tumescent liposuction. Also expect to have some bruising after the procedure which can last for up to 1-2 weeks post-surgery. We recommend arnica Montana, an herbal medication that decreases bruising and swelling 60% faster than a placebo.
You may not be a candidate for liposuction if you have significant other medical problems, or are on medications like coumadin that may cause excessive bleeding. Our medical Physician and our Surgeon will best be able to recommend treatment during a consultation.
If you are concerned about loose skin after liposuction, we can do combination therapy with Thermage skin tightening to help tone the skin if there is some residual skin laxity post-procedure.
We offer the following procedures:
- Facial liposuction of the cheeks, jowl and chin
- Liposuction of any body area
- Fat transfer to parts of the body by liposuction in certain fatty areas.
- Fat transfer to the face. Fat transfer to the buttocks.
Powered-Assisted Lipoplasty is the most widely used and preferred alternative to manual liposuction. Introducing a better way to perform liposuction. Using Power Assisted Liposuction and Tumescence!
What is Power-Assisted Liposuction (PAL)?
Surgical Instruments developed a power-assisted cannula that works by gently moving back and forth, at speeds that are barely visible to the eye, and which are gentle to the touch. This patented improvement allows the cannula to pass through tissue with remarkable ease and provides greater precision and control for the surgeon.
While the PAL innovation achieves the goal of making liposuction easier for the surgeon, it also provides meaningful patient benefits. PAL passes through tissue without damaging micro-vessels and leaves the fat cells, (called adipocytes), intact for autologous grafting to other areas of the body, if so desired.
Recently, attention is being paid to fat viability because of a new process called fat transfer, or fat grafting. In this procedure, a surgeon uses liposuction to harvest fat cells through a closed, sterile system that maintains the viability of the living cells within the fat. The surgeon can then re-inject a portion of the patient’s own sterile fat cells into other areas of the body or face to enhance areas that may have lost volume over time. PAL produces higher cell viability than heat-based methods that destroy the fat cells during liposuction.
Power-Assisted Liposuction is a more effective and safer way to eliminate unwanted deposits of fat from large or small areas and allows patients to achieve dramatically improved results with a faster recovery than ordinary liposuction
The PAL Solution
Use your imagination to picture the fat in your body as grapes on a grapevine and your connective tissue as the leaves and vines. PAL’s patented reciprocating action gently shakes the grapes loose, leaving the vines and leaves intact.
Heat-based methods such as laser, radio-frequency or ultrasonic methods cause the grapes to explode and may burn the vines and leaves. Traditional manual lipo procedures may tear apart the whole grape-bunch, and extract everything, including the vines and leaves. With these methods, the grapes are destroyed and the vines and leaves are damaged.
Using the PAL system, the grapes are gently plucked without destroying the vines. This means that the PAL procedure has some very worthwhile and unique advantages:
- Less bruising, swelling and trauma.
- Improved surgeon precision for body sculpting and contouring.
- Increased patient comfort and improved safety.
- The healing process is faster because connective tissue is not destroyed.
- Studies indicate that PAL produces high concentrations of adipose-derived stemlike cells, which hold great promise for a variety of medical therapies.
- Greater cell viability for autologous fat grafting and reinjection.
- PAL is not heat-based, so patient burns are not a concern.
Am I a Candidate for PAL?
Liposuction surgery may be used to treat areas of excess fat in the stomach, buttocks, hips, love handles, saddlebags, thighs, calves, ankles, back, arms, neck, and breasts (including male gynecomasty, or breast reduction). Liposuction is equally effective in men and women.
Dr. Rubbani is best suited to determine if you are a candidate for Power-Assisted Liposuction. But there are a few indications that may help you decide:
- You have “diet-resistant fat” that will not go away with diet or exercise.
- You have fat deposits that are out of proportion with the rest of your body.
- You have fat deposits in areas with minimal amounts of excess skin and good skin elasticity.
Power-Assisted Liposuction can be performed on overweight patients who want to remove large volumes of fat, or on patients simply looking for definition, contouring and body sculpting.
For patients seeking body contouring and definition, PAL is used to remove the thin subcutaneous layer of fat. Your surgeon can use PAL to perform exacting body sculpting on many areas of the body. PAL allows the surgeon precise control which can lead to better outcomes.
Local anesthesia with epinephrine and sterile saline is injected into the fat to numb the tissue and constrict the blood vessels which minimizes blood loss.
Aspiration / Suction
Fat cells are removed through a narrow stainless steel tube called a cannula.
How is PAL Surgery Performed?
Local anesthesia is frequently used for patients undergoing PAL surgery, although general anesthesia may be desirable in some instances. For your safety during the operation, various monitors are used to check your heart, blood pressure, pulse and the amount of oxygen circulating in your blood.
After sedation, your surgeon will “infiltrate” the area to be liposuctioned by injecting a solution of lidocaine (to numb) and epinephrine (to reduce bleeding) along with sterile saline. In addition to numbing and reducing bleeding, this solution is absorbed by the fat, causing the fat to puff up, making them easier to remove.
After the infused solution has been absorbed by the fat, your surgeon will make tiny incisions in inconspicuous areas, such as in natural skin folds and creases, or in your underwear line. The surgeon will insert the PAL cannula into these tiny incisions to aspirate (or suction) the fat.
The length of the aspiration process will vary according to the extent of the procedure and the patient type. For instance, a micro-sculpting procedure on an athlete might last a shorter time, while a more aggressive procedure on an overweight patient could last many hours.
Certain medications that increase the risk of bleeding such as aspirin, non-steroidal anti-inflammatory medications, and some vitamins/homeopathic regimens (including garlic) should be discontinued before undergoing liposuction surgery. Your surgeon will provide you with additional preoperative instructions.
What Can I Expect After Surgery?
Dr. Rubbani will provide you with complete post-operative instructions, however, some general guidelines are provided below.
In the first few days after surgery, you should rest quietly. Most patients will take pain medication for one or two weeks, but patients should consult with their doctor before taking aspirin or other anti-inflammatory medications. You can expect swelling and bruising to resolve over a few weeks.
We will leave the small incision sites open to allow drainage. The sites will drain, so you should plan to use absorbent pads and a compression garment after surgery. The small incisions will heal and fade over several months, usually becoming barely visible.
Compression garments should be worn for several weeks after surgery. This aids your skin in naturally reattaching to the underlying muscles. For your convenience in laundering the compression garments, it’s probably a good idea to have more than one.
In addition to the skin-healing promoted by the compression garment, we recommend that you avoid stationary positions (such as sitting at a desk or driving a long distance) in the first couple of weeks after surgery to prevent undesired skin adhesion, such as creasing. In some cases, daily stretches may be recommended.
Your recovery time will vary depending on the extent and location of your procedure. Some patients return to work within a few days; but for most patients, full activities can resume after a few weeks. Swelling is usually gone in four weeks, but it is important to note that the final results of your lipoplasty will not be fully apparent for several months.
*Individual Results may vary and no guarantees can be made.
**Results may vary. Unless noted otherwise, testimonials provided are patients of Tucson Cosmetics who have undergone completed treatment(s.) Before and after images reflect real results from real patients, although individual results may vary. Statements estimating treatment duration and the amount of treatments required are based on the typical experience of patients of Tucson Cosmetics, however, duration and amount of treatments needed may vary per client. A guarantee is neither provided nor implied.