Ever since the invention in the late 1980s of tumescence infiltration to facilitate liposuction procedures performed outside a hospital setting, various forms of the procedure have been introduced. I continue to use suction-assisted liposuction at my Toronto clinic, which relies on tumescence infiltration and produces consistently excellent results with a low rate of complications.
The tumescence solution used in the procedure is composed of a physiological solution, mixed with adrenaline (also called epinephrine), lidocaine (local anesthesia), and sometimes sodium bicarbonate (to neutralize the acidity of the solution).
The local anesthesia lidocaine (aka xylocaine) is the same local anesthetic used by your dentist. It reduces the amount of discomfort one might experience when the liposuction is done under local anesthesia (with or without sedation). But the lidocaine is also important when the liposuction is done under general anesthesia as it will also reduce the amount of narcotics required to control your pain while asleep. It is important to know that discomfort during a general anesthetic becomes obvious when the patient’s blood pressure and heart rate increase. And too much narcotics will increase nausea post-operatively, so the lidocaine is important even with general anesthesia.
The adrenaline is also important as it not only delays the reabsorption of lidocaine (hence a longer pain-control effect), it also powerfully vasoconstricts (shrinks down) the blood vessels, therefore minimizing the amount of blood lost. This latter function also allows your plastic surgeon today to liposuction larger volumes of fat, safely.
In order to get the full tumescence effect, your plastic surgeon must ‘tumesce’ the soft tissue significantly, until the tissues are swollen and firm, hence the term “tumescent”.
Few medications slows down the lidocaine metabolism, increasing the risks of lidocaine toxicity: those medications should be mentioned to your plastic surgeon and likely should be discontinued 2 weeks pre-surgery with your family doctor’s approval. Those medications are:
– clarithromycin, azythromycin and erythromycin (antibiotics)
– ketoconazole (anti-fungal medications)
– verapamil and diltiazem (blood pressure medications)
– amiodarone, quinidine (cardiac medications)
– some anti-viral HIV medications
Toxicity to lidocaine is rare and would appear 10-15 hours post-surgery; the signs of lidocaine toxicity are:
– nausea & vomiting
– impaired gait
In summary, the advantages of tumescence solution are:
- it allows localized liposuction procedure to be done under local anesthesia with and without sedation
- it reduces the amount of blood loss, therefore it is a safer technique
- the tumesced tissues allow for a more precise removal of fat
- it reduces the amount of required narcotics and sedation medications
- it reduces the amount of post-operative pain
Practically all our liposuction procedures are done with tumescence solution. At Visage Clinic, I use a combination of suction-assisted and power-assisted liposuction (SAL, PAL), I perform abdominal high-def etching and liposculpture for our Toronto patients.
By Dr. Marc DuPere