Features of the Tumescent technique
1. Dilution and Vasoconstriction
Typically, the Tumescent liposuction approach uses a diluted solution containing lidocaine and epinephrine. Despite these large volumes of local anaesthesia solution, this method has been deemed to be extremely safe. This is due to the extreme dilution of these two anaesthesia solutions and a constriction of capillaries in the area of fat which delays the absorption of lidocaine and epinephrine. In contrast, undiluted lidocaine and epinephrine is absorbed into the bloodstream in less than an hour. The increase in absorption time, spread over 24-36 hours, reduces peak concentration of lidocaine in the blood, which in turn reduces the toxicity of the dose of lidocaine. The use of dilute epinephrine prevents an increase in heart rate due to the delay in absorption caused by extensive vasoconstriction.
2. Prevention of Blood Loss
The injection of large volumes of dilute local anaesthesia causes a shrinkage of the capillary blood vessels. This has practically eliminated blood loss during or after the procedure; something that was common in older methods with the patient often needing a blood transfusion.
3. Reduction of postoperative pain
Due to the delay in absorption of lidocaine, the anaesthetic remains in the subcutaneous fat area for many hours. This extended effect of anaesthesia allows surgery for up to 10 hours and 24-36 hours of pain relief after the operation. The need for heavy-duty painkillers is more often than not eliminated.
4. Use of micro cannulae
During liposuction, a cannula is inserted into the fat layers just under the skin. In the older methods of liposuction, typically, cannulae were over 6mm in diameter, often causing extreme blood loss and postoperative skin disfigurations. The Tumescent technique uses micro cannula that have a diameter of less than 2.3mm resulting in dramatically less scarring and a smoother end result.
5. Use of Adits
Adits are tiny holes made in the skin through which the cannulae are passed in and out during the liposuction process. Postoperatively, adits allow for the drainage of blood-tinged residual local anaesthetic which dramatically reduces scarring and bruising, tenderness and swelling. The adits are so small that they do not require sutures and hence are able to facilitate drainage. The adits are made in the skin using skin-biopsy punches and because the skin is stretchable, micro cannulae can fit through these adits (usually anywhere between 1.0 to 2mm round).