Tumescent Microcannula Liposuction  

Body contouring by liposuction is the most commonly performed cosmetic procedure in the USA. Why has this operation skyrocketed to number one in the decade since its first introduction in America? The answer is simple. Most (or perhaps almost all) of us have localized areas of fatty deposits that defy all attempts at dieting, nutritional supplements, and exercise. Liposuction is the only method to get rid of these unwanted passengers, absolutely, once and for all!!

The problem varies with age and sex. Men tend to accumulate fat around the waist – the so-called spare tire, love handles, or if more substantial, the “beer belly.” Even slender, “in shape,” physically fit young males can be plagued by this rim of redundant fat. There is scientific evidence to suggest that this area of fat deposit results in an increased health risk of heart and blood vessel disease.

In the female anatomy, the problem areas of fat collection are in the abdomen, hips, thighs, buttocks, and sometime the legs. Again, this can be a problem even in the youngest and most physically fit women.

You may have thought about liposuction in the past, but may have been to afraid of the risks often attributed to the traditional liposuction technique, which uses larger instruments and general anesthesia. Now, there is a new liposuction technique that truly revolutionized the way we can remove fat from the body, permanently! This new method of body contouring via microcannula tumescent liposuction is an excellent technique to remove localized deposits of fat.

Tumescent liposuction is performed under local anesthesia with very small suction tubes, called cannulas, that are used to sculpt the arms, thighs, knees, back, hips, waist, and the abdomen. The amount of actual fat removal can range from as little as five ounces from each knee, to as much as six to ten pounds from the waist, hips, and abdomen. It is remarkable how smoothly the skin is able to contract and re-drape after removing the underlying fat. This skin contraction occurs even in patients over the age of 70. By using local anesthesia and very small suction cannulas (less that 1/8 inch) there is far less trauma to the tissues and the recovery is much more easily tolerated.

Older liposuction techniques utilize general anesthesia and large bore cannulas. The results were often unsatisfactory, with uneven removal, skin ridges and irregularity, and enough blood loss to require a blood transfusion. Although irregularity can occur with the tumescent microcannula liposuction technique, the chances of this happening are much, much less. The risks of undergoing general anesthesia are excessive blood loss, blood clot or fat embolus to the lung, or inflammation of the veins, any of which would require hospitalization. In a recent study in the Journal of Dermatologic Surgery, July 1995, which followed 15,000 patients undergoing the tumescent liposuction technique, NONE of these complications presented themselves.

The microcannula, local anesthesia liposuction technique allows most patients to resume normal activities in a surprisingly short period of time. As you would expect, the more extensive the fat removal the longer the recovery. Still, most people are back at work within the week. Some can return to work in as few as three days, continuing with a normal exercise routine. Many patients require nothing more that Tylenol for post-operative discomfort.

Dr. Jeffrey Alan Klein, a dermatologist and scientists, is the originator of this revolutionary liposuction technique. Dr. McMenamin and his physician assistant (PA), Catherine Lown, learned this technique from him during a visit to his facility in San Juan Capistrano. Since their visit in 1994, Dr. McMenamin has successfully sculpted most parts of the body with excellent results including the ankles, knees, thighs, arms, and the most popular abdomen, hips, and waist. Results from these liposuction procedures have been overwhelmingly satisfying to patients who are getting back into clothes they haven’t been able to wear in a while and are planning to wear a bathing suit without self-consciousness in public for the first time in years. Of course, results vary from person to person.

How Tumescent Liposuction Works

Actually, it’s quite simple. Large amounts of a very dilute local anesthetic solution are infused (pumped) into the areas to be liposuctioned. This causes the fatty tissue to swell, or “tumesce.” The anesthetic used is lidocaine, a numbing medication, along with epinephrine (adrenaline), which causes blood vessels to constrict so there is very little bleeding during the procedure.

Dr. McMenamin, who may be assisted by his physician assistant (PA), makes a tiny incision, less than a quarter of an inch long, and inserts a thin, straw-like instrument called a “cannula” (about the size of an ink pen refill). The cannula is passed between the top layer of fat, just under the skin, and the fascia, the connective tissue that lies above the muscle. The injected anesthetic numbs and swells the fat, making it easier to remove. It also shrinks the blood vessels to the point that most patients lose 2-3 teaspoons of blood in an abdominal liposuction. Dr. McMenamin, assisted by the PA, repeatedly slides the cannula into the fat and out again, removing fat cells with every pass. Your surgeon does all the final contouring and sculpting to attain as close to perfect a result as your body will allow.

Some information and ideas for this publication were taken from Self Magazine, November, 1995, and Cosmopolitan Magazine, December, 1995.

Liposuction - Frequently Asked Questions

How safe is tumescent liposuction?

According to an issue of the Journal of Dermatologic Surgery, the results of a survey of 15,000 tumescent liposuction patients confirmed the procedure’s safety. In all those patients surveyed, there were no deaths, no blood transfusions, and no complications requiring hospitalization. None of the complications often seen using the non-tumescent liposuction technique (blood clot to the lung, fat embolus to the lung, or inflammation of the veins) were seen following the new tumescent technique.

Do I have to lose weight before liposuction surgery?

Prior to liposuction, you should be at your usual, everyday weight, a weight that can be maintained without unhealthy dieting. Some of us will never be at what we consider to be our “ideal” weight. Liposuction can help by reducing the real “trouble spots” to allow our clothes to fit better, our bodies to look better, and for us to feel better about our overall body image.

Will the fat come back if I gain weight?

The fat cells that are removed will never come back. If you do gain weight, the gain will be evenly distributed over your entire body as predetermined by your genetic makeup. Because there are much fewer fat cells remaining in the areas of removal, there will be less weight gained in that area. Many patients have been so excited with their results and they have used it as a stimulus to reduce their weight even more to enhance their new shape and appearance.

Is liposuction a good way to lose weight?

Liposuction is a body contouring, spot reduction technique. It is not a weight reduction procedure. In addition, you must reduce the number of calories you eat per day by 10 calories per pound of fat removed. For instance, if 5 pounds of fat are removed during the procedure, you must reduce your calorie intake or increase your activity level by 50 calories per day to retain that weight loss.

Can liposuction be done on the face and neck?

Liposuction is excellent to remove fatty deposits on the face, jowls, under the chin, and on the neck. Age and skin condition sometimes necessitates the removal of excess skin to get an optimal result.

Can fat removed during liposuction be transferred to another area of the body?

Fat removed during liposuction can be used to correct facial grooves, to fill out lips, and to augment other areas of the face. In certain circumstances, the fat can be used to augment other areas of the body.

How much fat can be removed at one time?

The amount of weight or fat that is removed is not nearly as important as the reduction in inches that can occur as the area(s) of treatment heal and contract down. The amount of fat that can be removed at one time is limited by the amount of anesthetic solution that can be used (which is based on the patient’s weight) and on the variability of each patient’s tissues. It is not possible to predetermine the exact amount of fat that can be removed. Occasionally, a second session is required for optimal results.

Will I have to have any skin removed?

It is rare that even those patient’s who may have been told that they needed a “tummy tuck” will actually require one for the result they want following liposuction. Even elderly and obese patients can expect their skin to shrink and contract after having undergone fat removal.

We hope this handout has been informative to you. Please feel free to call our office if you have any questions. We look forward to the opportunity to serve you. Please call us at (916) 564-8888.

Some information and ideas for this publication were taken from Self Magazine, November, 1995, and Cosmopolitan Magazine, December, 1995.

Liposuction - Important Information
by the Tumescent Microcannula Technique

One of the most significant improvements in liposuction surgery has been the use of local anesthesia instead of general anesthesia. The Tumescent Technique for liposuction using local anesthesia with sedation is so effective that liposuction patients no longer need general anesthesia. Postoperative discomfort is minimized since the local anesthesia remains in the surgically treated areas for approximately 18 hours after surgery. Patients frequently require nothing more than plain Tylenol for discomfort after surgery.

The Tumescent Technique uses large volumes of a dilute solution of lidocaine, a local anesthetic, in combination with the drug epinephrine that temporarily shrinks capillaries. This combination dramatically reduces both the bleeding during surgery, and the post-operative bruising and swelling as compared to liposuction by general anesthesia with larger cannulas. In fact, there is so little blood loss with the Tumescent Microcannula Technique that patients usually lose more blood for pre operative laboratory tests (about 6 - 8 teaspoons) than during the actual liposuction surgery. Minimal bleeding reduces post-operative recovery time. Most patients can return to work and begin exercising again within a week after surgery. An elastic support garment is worn for up to 1 to 2 months.

About 90% of patients can actually see at least some improvement in their silhouette by one week after surgery. However, because of slow resolution of post-surgical swelling, the ultimate results following liposuction usually require 12 to 16 weeks to be achieved.

The fat cells removed by liposuction do not grow back. However, if you regularly consume more calories than you expend--with or without liposuction--you WILL gain weight and the fat cells that remain in your body will get larger. Usually, this weight gain will be distributed proportionately over the entire body. Since there are still a  percentage of fat cells left in the liposuctioned area(s), a significant amount of weight gain (say 20-30 lbs.) will be apparent in the areas you had liposuctioned.  It will always be less than what you would have noted before the liposuction.

The change of body shape produced by liposuction is similar to that of dieting but it affects only the specific treatment areas. The effects on the overlying skin varies by skin type.  Since the fat is removed by suctioning small "tunnels" through the fat, the skin remains intimately connected to the underlying muscles by multiple fibrous attachments. As healing occurs after surgery, these fibrous strands contract and pull the skin into close proximity with the muscles.  It is this process which assures that the skin will not hang in loose folds after liposuction surgery.  Because the surgeon is careful to leave a thin blanket of fat attached to the skin, the skin will usually look and feel normal after the liposuction. By magnifying the fatty compartment, the Tumescent Microcannula Technique permits more accurate removal of fat, with a greater assurance that the liposuction cannula will not cause postsurgical irregularities.

Rarely, skin irregularity, mottling, or unevenness will result due to the preexisting condition of the skin or the patient’s particular mode of healing. This can often be improved with a second procedure at a later date.

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 often called "cellulite". Cellulite results from the pull of fibrous tissue that connects skin to underlying muscle. Liposuction with the Tumescent Microcannula Technique may reduce the degree of cellulite, but it is unlikely to eliminate it.

As with any surgical procedure, liposuction is associated with certain expected side effects. These include bruising, swelling, and temporary numbness. Although irregularities of the skin are possible following liposuction, this side-effect is minimized by the Tumescent Microcannula Technique.  As judged by current worldwide experience, liposuction by this technique is amazingly safe.  Serious complications such as blood clots, infection, and allergic reactions are extremely rare.  Most of the dangers associated with surgery are related to the type of anesthesia that is used. Surgery of the skin and subcutaneous fat is safest without using general anesthesia.