Life before Tumescent Liposuction
Before Tumescent liposuction was invented, every liposuction patient was given general anaesthesia. In those days, the diameter of the standard cannula was anywhere between 6mm and 10mm with a cross sectional area that was 9 to 25 times greater than the 2mm diameter cannulae we have today.
In the early 1980’s, Illouz and Fournier introduced the blunt-tipped cannula which reduced blood loss and damage to the nerves and blood vessels and led to fewer complications and cases of shock or death. They also found that recovery times were shorter and patients had less postoperative pain.
Techniques continued to be improved and in the late 1980’s surgeons started infusing more saline and mixing it with epinephrine, a drug that reduces bleeding by constricting blood vessels, and lidocaine, a local anaesthetic. Larger amounts of fluid were used and this came to be called the wet technique. Surgeons then started using even more saline/epinephrine/lidocaine fluid and called it the super-wet technique. The idea was to prevent major blood loss and reduce bruising and pain. The fluid would swell and engorge the fat to be removed and the area around it.
With the increasing popularity of liposuction, surgeons began to combine anaesthetic strengths and doing liposuction using general anaesthesia, epidural regional anaesthesia or heavy IV sedation supplemented by small amounts of local anaesthesia.
However, until the invention of the Tumescent technique, there were several cases of excessive bleeding and skin irregularities.
History of Tumescent Liposuction
In the Tumescent technique
for liposuction, a large volume of very dilute solution of local anaesthesia (lidocaine and epinephrine) is injected into the fat beneath the skin, causing the targeted area to become Tumescent, in other words, swollen and firm. Due to the small diameter of the cannula, the risks of excessive bleeding and skin aberrations are virtually eliminated, making this technique one of the safest liposuction methods. It was invented by Dr. Jeffrey Klein, a California-based dermatologist in 1985.
Myths associated with Tumescent liposuction
- By diluting the local anaesthetic solution which consists of lidocaine and epinephrine, the strength or effectiveness of the anaesthetic is compromised.
Fact: The dilution allows smoother flow and allows larger quantities of anaesthesia into the cannulae that can spread more widely and affect a larger area in the body.
- The micro cannulae slow down the process.
Fact: Although the micro cannula removes less fat per minute compared to traditional cannulae, these small diameter cannulae allow for removal of a greater total volume of fat and produce a much smoother end result.
- The patient will experience more pain with a local anaesthetic than a general anaesthetic.
Fact: In reality, patients that are administered general anaesthesia, upon awakening, require strong painkillers. On the other hand, when local anaesthetic is used, it lasts for several hours after the surgery practically eliminating the need for strong painkillers. At the most they may require over the counter painkillers like paracetamol.
The first Tumescent liposuction patient.
The first Tumescent liposuction surgery was carried out on April 5, 1985 by Dr. Klein. The patient had localised accumulation of fat on her lower abdomen and a hysterectomy scar. Dr.Klein used undiluted concentrations of local anaesthesia (500 mg of lidocaine and 1 mg of epinephrine in 50 ml.) As this was the first such surgery, less than 100 ml of fat was removed.
For the first time a patient undergoing a liposuction procedure experienced no pain during the treatment and no surgical bleeding primarily because the epinephrine caused capillary vasoconstriction. The high concentration of epinephrine did, however, cause a stinging sensation during administration and a rapid increase in heart rate also known as tachycardia.
The evolution of Tumescent liposuction
As Dr. Klein further developed this technique, he increased dilution levels of the anaesthetic solution for each subsequent patient. He noticed that as dilution increased, with no change in the anaesthesia concentration, both the stinging sensation previously felt by patients and the tachycardia or increased heart were dramatically reduced. Also, with increased dilution, he noticed that a greater area of subcutaneous fat was was reached. By the end of 1985, Dr. Klein had perfected this technique and an optimum level of anaesthesia was determined – 500-1250mg of lidocaine and 0.5-1.0mg of epinephrine per litre of solution.
Tumescent liposuction – shared with the world
The Tumescent liposuction technique was shared publicly for the first time by Dr. Klein in Philadelphia in June 1986 at a lecture. In January 1987, The American Journal of Cosmetic Surgery published the first ever article detailing the Tumescent Technique. (Klein JA, The Tumescent technique for liposuction surgery. American Journal of Cosmetic Surgery, 1987, volume 4, pages 263-267).
Tumescent liposuction today
The Tumescent technique has, over the years, been further refined and perfected. Liposuction is now done with extraordinary artistry and skill using just local anaesthesia. Gone are the days of stinging pain (the result of the acidic pH of commercially available lidocaine) by adding sodium bicarbonate to the solution to nullify the acidic effect. The increased heart rate has also been eliminated by giving the patient 0.1mg of clonidine orally before the surgery.