Tumescent Liposuction

What is Liposuction?

Liposuction is the gentle removal of localized excess fat using 2-3 mm straw-like instruments called micro-cannulas attached to a suction machine. The result is a correction of bulging areas into attractive contours resulting in a more flattering silhouette. The new silhouette is permanent, providing the patient’s body weight does not increase significantly.

Liposuction is one of the most common cosmetic procedures performed in the world. With a highly trained physician and a carefully selected patient, the degree of aesthetic improvement can be remarkable.

What is Tumescent Technique Liposuction (TTL)?

Developed by dermatologic surgeons, tumescent technique liposuction is the safest and most accurate form of liposuction. The procedure is performed in an out-patient setting under local anesthesia. The tumescent technique uses large volumes of dilute local anesthetic (lidocaine), in combination with a drug (epinephrine) which temporarily shrinks blood vessels. This mixture is placed directly into the targeted fat compartment(s), numbing the fat almost painlessly. Gentle loosening and removal of undesired fat is then undertaken using micro-cannulas with minimal or no discomfort.

With the tumescent technique the risks of general anesthesia are removed. There is no post-surgical nausea, nor a feeling of having a “hang-over”. The epinephrine dramatically reduces bleeding, bruising, and swelling which reduces post-operative recovery time. Most patients return to work in 3-5 days. Micro-cannulas allow more accurate and complete fat removal leading to superior cosmetic results.

Why is Tumescent Technique Liposuction Best for Me?

Safety, recovery period, and final cosmetic results are maximal with TTL. The avoidance of general anesthesia (GA) eliminates post-operative nausea, drowsiness, and the feeling of been “hung-over”. The tumescent mixture dramatically reduces any bleeding and bruising. This in turn decreases post-operative recovery and encourages a faster return to normal home and work routines. Patients are up and walking the next day, return to work in 3-5 days, resuming more physical activities after one week. The micro-cannulas used allow for precise removal and sculpting of the fat. This leads to smooth, symmetric results in three dimensions. TTL is the liposuction technique least likely to cause any noticeable post-surgical irregularities of the skin. Having an awake patient allows the physician to assess the results in many patient positions ensuring contours are exact from all viewing angles.

Patients must ensure they are receiving true TTL True TTL is time and labour intensive and thus many surgeons use modifications of the TTL technique which can compromise safety and cosmetic results. If you have been told that a general anesthetic or intra-venous sedation or larger cannulas will be used, you are not receiving true TTL.

Who is a Suitable Candidate for Tumescent Technique Liposuction (TTL)?

Females or males in good general health, on few or no medications, with diet and exercise resistant localized fat deposits are ideal candidates. Age is not a limitation assuming all the other requirements have been met. Patients should be at a stable weight, cannot be pregnant or breast feeding and must have realistic expectations.

Liposuction can remove fat from almost any body area assuming the fat is localized and the skin tone is good. In some cases poor skin tone can prevent liposuction from achieving maximal results and in this case liposuction would not be recommended. Liposuction is not suitable as a weight reduction strategy or for eliminating cellulite (the subtle puckering of the skin that can occur on the thighs and buttocks).

Liposuction can also be used to reduce the size of male breasts, remove benign fatty growths called lipomas, and reduce excessive underarm sweating.

What Kind of Results Can I Expect?

In appropriately selected candidates, contour reduction and refinement can be dramatic. Preliminary changes are evident as early as one week, but final results cannot be assessed for 6 months. You must be patient! Assuming you maintain a stable weight (within approximately 20 lbs) the results will be permanent. Although results can be striking you should not expect perfection, your expectations must be realistic. However every patient is an individual and as such will heal differently than the next. You should not expect cellulite to disappear and large fat accumulations may require a second procedure for maximal results. In the vast majority of cases after liposuction the skin retracts completely and smoothly. Only rarely is there any need to have extra skin surgically removed, and in most cases this can be determined prior to beginning liposuction. If your skin elasticity is good prior to liposuction the look and feel of your skin after liposuction will be unchanged. Small (< ¼ inch) scars occur at entry sites for the cannulas. The scars stay colored for about 9 months before fading to fine white lines. In patients with darker skin the fading can take longer. Rarely do the scars remain pigmented.

How Safe is Liposuction?

TTL is the safest form of liposuction. All the risks of general anesthesia (GA) are removed. Several large studies conducted by various North American medical associations have documented the enviable safety record of TTL. Although infections, significant blood loss, collection of blood under the skin (hematoma), perforation of underlying structures, permanent loss of skin sensation, skin scarring, or skin irregularities are theoretically possible, these are extremely rare with TTL. Uncommonly, small collections of fluid form under the skin called seromas, which require drainage using small needles. Patients should expect temporary swelling, temporary reduction in skin sensation and minor contour imperfections.

Liposuction is only as safe as the surgeon performing the procedure. Patients must ensure the treating physician places safety as his/her number one concern. The doctor should have many years of experience and a thorough understanding of physiology and anatomy to maximize safety. The physician’s selection criteria in choosing appropriate patients must be very strict. Written safety protocols must be in place and be followed rigorously with extensive documentation. The surgical suite must meet all criteria established by the provincial College of Physicians and maintain full resuscitative equipment.

How do I Prepare for Liposuction?

The treating doctor will provide you with detailed pre-operative instructions. You must avoid aspirin or aspirin-like medications for 2 weeks prior to liposuction. Any change in your health or medication status must be brought to the doctor’s attention and she/he will assess these changes and determine their impact on your safety. Any change which compromises your safety will lead to the procedure being rescheduled.

What Happens on the day of Surgery?

Patients are generally provided with a detailed hand-out outlining the highlights of your procedure day. Preparation begins with picture taking, and recording vital signs. A mild sedative is usually given by mouth. Skin and fat are anesthetized using the Tumescent Technique. Liposculpture then begins using micro-cannulas. At the end of the procedure a pressure garment is placed and you are ready to go home. The entire procedure lasts from 4-6 hours.

How will I Feel After Liposuction?

A detailed handout of your post-operative course and instructions will usually be given to you. After liposuction you will feel tired, sore, and be draining some of the tumescent fluid. This is messy; therefore maxi-pads to hold the drainage are required. The drainage usually stops by the second post-op day. The soreness is similar to a deep muscle ache which occurs after too much exercise. Pain-killers are given, but in many cases are not required. By 3-5 days the discomfort is markedly improved and your energy levels are about 60% of normal. At this time most patients are ready to return to work. Patients are up and walking on the first post-op day and by 2 ½-3 weeks feel more or less back to normal. Bruising is always present to a mild or moderate degree and resolves by 1 ½-2 weeks.

Tell me about Ultrasonic, Powered, and Laser Assisted Liposuction.

Ultrasonic liposuction (UL) uses high frequency wavelengths to vibrate the end of a special cannula. These vibrations cause fat cells to literally explode, releasing their fat which is then suctioned away. UL was purported to offer additional safety over traditional TTL. This has now been found to be untrue. In fact UL may have more side effects and offers no cosmetic advantages to patients.

Powered liposuction uses an electric motor to rapidly oscillate a cannula tip which allows the cannula to assist in fat removal. This makes the procedure easier for the surgeon, but as yet does not offer any safety or cosmetic advantage to the patient.

Laser-assisted liposuction uses low level laser energy to create “pores” in fat cells allowing the fat to leak out and possibly increase the ease of fat removal. Laser-assisted liposuction may offer greater skin contraction in well selected patients.