Liposuction

Using The Safest and Most Advanced Technology for Removal of Unwanted Fat Deposits

  Tumescent Liposuction

The following information is adapted from Jeffrey A. Klein, M.D.'s patient handouts. Dr. Klein is the father of the Tumescent Liposuction Technique.

Thank you for your inquiry about tumescent liposuction totally by local anesthesia.

Our goal is to provide you with as much information as possible about liposuction. Making an informed decision about having liposuction surgery requires that you feel secure in your knowledge and understanding of the procedure.

Attached is a great deal of informative literature designed to answer questions commonly asked by persons who are considering liposuction. Please feel free to ask questions. We will try to answer all of them.

Tumescent liposuction is now recognized world wide as the technique permitting the greatest safety, the most rapid recovery, the least pain, and the best aesthetic results.

It is also the only technique that, in the hands of an expert surgeon, permits liposuction totally by local anesthesia, avoiding the dangers of general anesthesia, IV sedation and narcotic analgesics.

There are surgeons who prefer to simultaneously use general anesthesia and the tumescent technique. Some surgeons rely on general anesthesia because they do not have the skill to achieve complete anesthesia with the tumescent technique. Others recommend general anesthesia just because they prefer patients to be unconscious. Still others use general anesthesia because it permits liposuction to be completed more rapidly.

However, the use of general anesthesia ought not be based on what is most convenient for the surgeon, but rather what is best for the patient. Ultimately, the patient should choose the type of anesthesia.

Our staff shares our commitment toward helping you achieve your goals for self-improvement. Your consultation will be personal and private, or you can bring your spouse, or other friend if you wish.


1) LIPOSUCTION AND BODY SCULPTURE

Body sculpture by liposuction is literally a dream come true. Localized accumulations of fat, which are often inherited and frequently prove impossible to eliminate by exercise or dieting, can now be removed permanently by liposuction surgery, never to plague you again.


2) ABOUT FAT

Body fat of an adult tends to increase gradually over the years. After the age of 30, an individual tends to add fat according to a genetically predetermined pattern. This fat distribution is often resistant to exercising and dieting. An example of a genetically predetermined fat distribution which is resistant to dieting and exercise is the fat that appears on the abdomen and hips of a woman after pregnancy.

For many people who have inherited excessive accumulations of fat, liposuction is the only realistic means of changing the body’s silhouette. In effect, liposuction is equivalent to being able to focus the effects of dieting to specific areas of the body.


3) WHAT IS LIPOSUCTION

The concept of liposuction is surprisingly simple. Liposuction is a surgical technique that improves the body’s contour by removing excess fat from fatty deposits located between the skin and muscle.

Liposuction involves the use of a small stainless steel tube, called a cannula. The cannula is connected to a very powerful suction pump and is inserted through small skin incisions. The removal of fat is accomplished as the suction cannula creates tiny tunnels through the fatty layers. After surgery, these tiny tunnels collapse resulting in an improved body contour.


4) AREAS TREATED BY LIPOSUCTION

The most frequently treated areas in women are the abdomen, hips, thighs, knees, calves, ankles, and beneath the chin. In men the most commonly treated areas include the love handles, the abdomen, breast and the neck/chin area.


5) PERMANENCE OF RESULTS

Fat cells that are removed by liposuction do not grow back. As long as the patient does not gain excessive amounts of weight, the new, more pleasing silhouette is permanent. A woman who always tends to put weight on her thighs and knees, will find that after liposuction, these areas are less likely than other areas to accumulate fat when she gains weight. In fact a number of patients have had liposuction and have subsequently gained weight. The areas originally treated by liposuction have maintained their new desirable silhouette, whereas areas not treated by liposuction have been the sites of new deposits of fat.


6) WHO IS A GOOD CANDIDATE FOR LIPOSUCTION?

The best candidates for liposuction are in good health and have realistic expectations of liposuction. There is no definite age limit, nor weight limit for patients who are "good candidates" for liposuction. Most of our patients have localized accumulations of fat. However, some of the happiest patients have been individuals who are somewhat obese. It is important to emphasize that liposuction is not a treatment for general obesity. Liposuction surgery is not effective as a last resort for people who are unable to maintain a reasonable weight by dieting. However, an overweight person whose weight has been stable for many years and has certain problem areas of fat may be an excellent candidate for liposuction.


7) WHAT IS A SUCCESSFUL LIPOSUCTION SURGERY?

A liposuction surgery is a success when the patient is happy with the results. The surgeon’s goals is to achieve an optimal aesthetically appealing result rather than to maximize the amount of fat removed. The cosmetic success of liposuction relies on removing inches rather than pounds. For example, removing an amount of fat equivalent to a half-pound of butter from each outer thigh of a woman’s saddlebag area or from a man’s love handle areas would result in a dramatic change in silhouette, but would not significantly change the persons weight.


8) DEVELOPMENT OF THE TUMESCENT TECHNIQUE

Although liposuction is a relatively new form of cosmetic surgery, there have been several recent improvements in the technique. One of the most significant improvements has been the introduction of the Tumescent Technique, developed by Dr. Jeffrey A. Klein, M.D. in 1985. It permits liposuction totally by local anesthesia instead of general anesthesia. This technique is now considered the safest form of liposuction for removing very large amounts of fat because there is virtually no blood loss. Not only has the Tumescent Technique proven to be safer than the standard technique using general anesthesia but it also has proven to be less painful, has minimized post operative recovery time, and has produced optimal cosmetic results.

The Tumescent Technique was first presented by Dr. Klein in 1986 at the Second World Congress of Liposuction Surgery in Philadelphia. His article that first described the technique appeared in the American Journal of Cosmetic Surgery in 1987. Dr. Stickler has received training from Dr. Klein in the use of the Tumescent Technique.


9) LIPOSUCTION TOTALLY BY LOCAL ANESTHESIA

The word tumescent means swollen and firm. The Tumescent Technique uses large volumes of a dilute solution of lidocaine, a local anesthetic, in combination with the vasoconstrictive drug epinephrine, which temporarily shrink capillaries.

Local anesthesia used in the Tumescent Technique for liposuction is so effective that patients no longer need intravenous sedatives, narcotic analgesics, nor general anesthesia. Over the years, numerous patients who previously had liposuction with general anesthesia have had second treatments with the Tumescent Technique. Virtually every one of these patients has found the Tumescent Technique to be less painful, to provide better results and to result in more rapid healing and recovery.


10) VIRTUALLY NO BLOOD LOSS

As a result of the widespread capillary constriction caused by the epinephrine in the anesthetic solution, there is minimal bleeding during and after surgery. This is a major improvement in the liposuction technique compared to older methods that simply use general anesthesia.

Dr. Klein recently completed a study of large volume liposuction of 112 patients, each of whom had between 1,500 ml to 3,400 ml (1.5 quarts to nearly 1 gallon) of fat removed using the Tumescent Technique. None of these patients required a blood transfusion. In fact, the average patient lost approximately three teaspoons (15 ml) of blood. The Tumescent Technique is so effective at minimizing blood loss that the majority of patients with large volume liposuction lose less blood during the surgery than they do at the time of their routine pre-operative laboratory studies.


11) WHEN ARE BLOOD TRANSFUSIONS NECESSARY?

Because of the minimal blood loss associated with the Tumescent Technique, there is no need for blood transfusions.

Recently, a number of surgeons who use general anesthesia have begun to use the Tumescent Technique together with general anesthesia. Although these patients still must endure the risks and unpleasant side effects of general anesthesia, they do have the benefits of minimal blood loss associated with the Tumescent Technique.


12) RISKS OF GENERAL ANESTHESIA

The drugs that are used to produce general anesthesia are relatively dangerous compared to those used for local anesthesia. It is estimated that fatal complications associated with general anesthesia occur somewhere in the neighborhood between 1 in every 2,500 patients to 1 in every 10,000 patients. The severe complications associated with general anesthesia are eliminated as serious risk factors just by not using these medications. It is well recognized that local anesthesia is considerably safer than general anesthesia.


13) IS AN ANESTHESIOLOGIST NECESSARY?

Anesthesiologists are specially trained to use dangerous anesthetic drugs. Even with this expert training, dangers of general anesthesia persist. The safest approach is simply to avoid using these drugs altogether. An anesthesiologist is not necessary when dangerous general anesthetic drugs are not used, and local anesthesia is the only anesthetic.


14) SAFETY FIRST

With the Tumescent Technique, our patients have never required hospitalization, blood transfusions, nor have there been any infections or other serious complications.

It is Dr. Stickler’s philosophy that the safest approach is to avoid the most dangerous drugs, while at the same time being well prepared and trained to take care of any potential emergency.


15) TUMESCENT TECHNIQUE IS LESS PAINFUL THAN GENERAL ANESTHESIA

Some patients have had liposuction by another surgeon using general anesthesia prior to having liposuction by the Tumescent Technique. Virtually every one of these patients has said that liposuction by the Tumescent Technique is a dramatically less painful experience that with general anesthesia. With the Tumescent Technique, infiltrating the local anesthesia is associated with minimal discomfort. Once the area has been completely numbed, surgery in the area is essentially painless. In addition, because the local anesthesia persists in the treated area for more than 12 hours, there is no pain immediately after the surgery.


16) RISKS OF ANY SURGERY

As with any surgical procedure, liposuction is associated with certain common side-effects such as bruising, swelling and temporary numbness. Although irregularities of the skin are possible following liposuction, this side-effect is minimized by the Tumescent Technique. When using larger cannulas occasionally there were patients with an irregularity of the skin. Since using micro cannulas, noticeable irregularities are very rare.

Because of the slow resolution of post surgical swelling, the ultimate results following liposuction usually require 12 to 16 weeks to become fully apparent. Nevertheless, patients can usually see dramatic improvements within two to four weeks after surgery.

Although the results of liposuction are often quite spectacular, it is not realistic to expect perfection. Liposuction of the thighs, while improving the silhouette, does not necessarily eliminate the subtle "puckering" of the skin that is often referred to as "cellulite." Liposuction with the Tumescent Technique does reduce the degree of cellulite but it is unlikely to eliminate it.

As judged by current world-wide experience, liposuction is amazingly safe. To the best of our knowledge, there have never been any reported serious complications using the Tumescent Technique for liposuction totally by local anesthesia.

Rare problems that can potentially occur with any surgical procedure include infections, bleeding and nerve injury. The Tumescent Technique minimizes these risks.


17) DECREASED RISKS OF INFECTION WITH TUMESCENT TECHNIQUE

Infections are extremely rare, irrespective of whether or not the anesthetic technique is that of general anesthesia or local anesthesia. Although there have been reports in the medical literature of patients who have had serious infection following liposuction surgery, to the best of our knowledge there has never been any patients who have had an infection following liposuction totally by local anesthesia using the Tumescent Technique. Lidocaine, the local anesthetic that is used for the Tumescent Technique kills bacteria. With the Tumescent Technique the areas that are being treated surgically are exactly the areas that will receive the local anesthetic that kills bacteria.


18) BETTER AND SMOOTHER RESULTS

The large volumes of dilute local anesthetics infiltrated into the fatty tissue causes the tissue to become swollen and firm, or tumescent. The Tumescent Technique magnifies the fatty area that is to be treated by liposuction. If there is an area that has not been completely treated, this is more easily detected because the area is swollen and enlarged. Thus the risk of post-surgical irregularities and unevenness is minimized.

With the Tumescent Technique very small cannulas are used. This permits a more delicate and gentle approach to liposuction. The liposuction cannulas which have been specifically designed for the Tumescent Technique are 2.5 and 3.1 mm in diameter. These micro cannulas require a minimal amount of force in order to advance them into the fatty tissue. As a result, surgery is much more gentle and the surgeon can control the direction and position of the cannula with greater accuracy. The ultimate result is a greatly reduced risk of inadvertently approaching too close to the under surface of the skin and unintentionally causing irregularities.


19) ARE SCARS VISIBLE?

Because the Tumescent Technique uses very small cannulas, only tiny incisions are required. The incisions are so small that no stitches are used. The wounds heal by themselves and all most disappear with time.


20) HOW IS THE SKIN AFFECTED?

The degree of skin change after liposuction is the same as one would expect if it were possible to lose an equal amount of fat in these localized areas simply by dieting. Because the small cannulas simply make small tunnels through the fat, there remain multiple connections between the skin and the underlying tissue. These fibrous connections contract with the healing process and maintain the skin in its natural position. After liposuction by the Tumescent Technique, one does not have to worry about excessive folds of the skin in the areas treated by liposuction. This effect is so dramatic that many patients who previously would have required a surgical excision of skin, called a tummy tuck, can now have excellent results simply by having liposuction.


21) DECREASED BRUISING

There is dramatically less bruising using local anesthesia for liposuction as compared to general anesthesia. There are two reasons for this significant decrease in bruising. First, because there is so little bleeding with the Tumescent Technique, there is almost no blood that remains beneath the skin after surgery to cause bruising.

The second reason for decreased bruising is that with the Tumescent Technique there is a considerable amount of post-operative drainage of the anesthetic solution which is slightly blood tinged. Because the incision sites are so small and do not require stitches, these wounds are slightly open for two to three days after the surgery and permit most of the residual anesthetic solution and blood to drain out. This minimizes bruising and swelling and accelerates the rate of healing.


22) IMMEDIATE POST-OPERATIVE RECOVERY

After liposuction by general anesthesia, patients must be observed in a recovery room until it can be determined that they have not lost too much blood, and that the post-operative nausea and vomiting is not too profound. With the Tumescent Technique, there is virtually no blood loss and with local anesthesia there is rarely any nausea.

Because it does take additional time to inject the local anesthesia with liposuction by the Tumescent Technique the patient does remain on the surgical table longer than with liposuction by general anesthesia. However, because the recovery time is so short, the total amount of time that the patient is in the surgical facility is much shorter with the Tumescent Technique than with general anesthesia. After completion of liposuction by the Tumescent Technique, patients are discharged home in about 30 minutes.


23) QUICK RETURN TO NORMAL ACTIVITIES

By not using stitches to close incision sites, there is an acceleration in the rate of healing. Open incision sites permit drainage of the slightly blood tinged anesthetic solution. This has had a dramatic effect in minimizing bruising. Most patients now notice that bruising is almost entirely absent one week after surgery.

Because the Tumescent Technique eliminates bleeding and because the residual anesthetic solution drains out so quickly, there is less inflammation and the healing process is significantly accelerated.

Because of the significant decrease in swelling and decrease in inflammation and pain after the surgery, patients are able to return to normal physical activities very soon after surgery. There is no limitation to physical activity other than what common sense would dictate. Some patients are able to return to jogging, golf, light aerobic exercise within a day or two after surgery. Some patient do find the soreness after surgery more significant than others, but on the average, most patients are quite surprised at how quickly they are able to return to normal activity.


24) WHICH SPECIALISTS DO LIPOSUCTION?

Liposuction is a type of surgery that is appropriately performed by surgeons from several different specialties. The specialists who most commonly perform liposuction are dermatologic surgeons (dermatologists), cosmetic surgeons, gynecologist, and plastic surgeons.

Dermatologic surgeons and plastic surgeons are taught liposuction surgery during their residency training. Besides receiving liposuction training form Dr. Klein, Dr. Stickler also received training in the Tumescent Technique liposuction while a dermatology resident at New York University School of Medicine.


25) WHY DON’T OTHER SURGEONS USE THE TUMESCENT TECHNIQUE?

From the surgeon’s point of view, it takes much less time to do the surgery when general anesthesia is used. This is probably one of the most significant factors in determining which technique the surgeon will use. There are other factors involved as well, however.

Almost all dermatologic surgeons who perform liposuction use local anesthesia by the Tumescent Technique. Most American cosmetic and plastic surgeons use general anesthesia. Currently, there is an increasing trend toward the use of the Tumescent Technique by all specialties.

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