Tumescent is a treatment administered just prior
to liposuction, during the same surgical session. This method of
liposuction is the oldest version that is still utilized today.
Tumescent involves utilizing the area to be
treated with sterile solution to help plump the fat cells and distinguish the fat
layer from the overlying soft tissue and underlying muscle and organs.
Essentially, tumescent magnifies the fat layer, making it technically easier to
remove. The saline is generally combined with the appropriate balance of lidocaine or some other local anesthetic
for the patient's comfort during and
immediately after liposuction, and epinephrine to constrict blood vessels and
reduce bleeding and bruising.
The Wet
Technique refers to the use of fluid injection prior to liposuction treatment.
The surgeon administers a small amount of fluid, less in volume than the amount
of fat to be removed. (which contains
epinephrine) directly into the tissue. The amount of fluid is
somewhere around six to eight ounces.
This solution contains:
lidocaine -
anesthetize the local area
epinephrine - constrict
the blood vessels to minimize bleeding
saline - helps separate the
tissues during the procedure
This injected fluid helps to loosen the fat cells and reduce bruising. This results in less blood loss
during the procedure and also will reduce the amount of patient discomfort after
surgery.
This technique is done with injecting a solution in which contains lesser amount
of anesthetics (lidocaine and epinephrine). This procedure requires either
IV sedation or general anesthesia.
Basically the
super-wet technique is similar to tumescent liposuction but introduces less
fluid into the area to be treated: Normally a 1:1 proportion of the fluid to
inject to the fat/fluid aspirated. Super Wet Liposuction is a safe method, and
some say safer than tumescent liposuction because of the fact there is a lower
risk of fluid overload.
There
is more blood loss with the super-wet method than with the tumescent technique.
It has been stated that eight percent of the fluid removed through "super wet"
is in fact blood - unlike the tumescent technique where only one percent of the
fluid removed is blood.
The benefits of the Super Wet Technique
is that the surgeon doesn't have to wait for swelling to go down before starting
the liposuction. The procedure takes approximately two hours and the
patient can also opt to have other procedures done at the same time. The
procedure time is much quicker than the tumescent method which could possibly
take up to four or five hours.
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Anesthesia used for Tumescent Liposuction
Tumescent liposuction fluid numbs the entire
surgical area - and the effects of the
tumescent fluid permits the patient to
remain comfortable for several hours after the procedure.
Tumescent liposuction can be done under the
following methods of anesthesia:
Tumescent Solution
is composed of Epinephrine, Lidocaine,
and Saline - which is injected into the surgical area where the liposuction is going to
be performed. Tumescent anesthesia with highly diluted lidocaine and
epinephrine has transformed lipoplasty from a highly vascular surgery to a
painless and bloodless procedure.
The area after injection
becomes swollen immediately which comes from the surrounding tissue absorbing
the medication.
How Tumescent Anesthesia
Works:
Saline helps separate
the tissues during the procedure – making the dissection much less traumatic
Epinephrine causes the
tiny blood vessels in the area to constrict, minimizing
bleeding and bruising.
Lidocaine numbs the
area to provide pain control.
With tumescent
anesthesia, large volumes of anesthesia are used in much lower
concentrations.
ADVANTAGES AND
DISADVANTAGES OF TUMESCENT
ANESTHESIA
ADVANTAGES OF TUMESCENT
ANESTHESIA
Several
advantages of the tumescent liposuction include the following:
Significant lessblood
is lost during the liposuction procedure.
Smaller
incisions are used on the patient.
General
anesthesia is not normally needed.
Lidocaine is the
safest for tumescent liposuction of all the available local anesthetic
drugs.
IV fluid replacement is not necessary.
Bacteriostatic
lidocaine *may* decrease the risk of infections.
Tumescence magnifies
defects – hence making the likelihood of needing a secondary procedure less.
Better
control of the area being sculpted.
Lipid-soluble
lidocaine sometimes is suctioned out with the aspirated fat.
Vasoconstriction
minimizes absorption.
The epinephrine may
increase the cardiac output, which increases the hepatic metabolism of the
lidocaine.
The duration of
anesthetic effect may last as long as 24 hours.
Less
discomfort for the patient.
The lidocaine may be
given safely up to 45 mg/kg and even higher in certain conditions.
Reduced
recovery time for the patient.
Reduced
swelling and bruising
Reduced post
operative bleeding.
Tried and
true method of liposuction
-
very versatile procedure.
DISADVANTAGES OF TUMESCENT
ANESTHESIA
The
three risks of tumescent liposuction are:
Lidocaine toxicity
from an
excessively high concentration of the drug in the blood
Injury from a needle
used to inject the local anesthetic drug.
Fluid accumulation (seromas)
- if this complication occurs, the fluid will need to be drained.
COMMON
SIDE EFFECTS FROM TUMESCENT ANESTHESIA OR SOLUTION
Common side effects of tumescent lidocaine that are not
considered signs of toxicity include:
Mild sleepiness
– some patients might experience some sleepiness during and
after tumescent liposuction, even if no sedatives are given.
Nausea and vomiting
– nausea and vomiting associated with tumescent local
anesthesia is not common, but it can occur. Other drugs that are given
during the procedure such as antibiotics, sedatives related to Valium, and
all narcotics can increase nausea and vomiting. Most medications
should be given on a full stomach, to minimize nausea.