Tumescent Liposuction Pain

Whenever dust is thrown up in the air to confuse matters, it is always best to "clear the air", define the terminology and make sure we are all addressing the same question.

TUMESCENT LIPOSUCTION is nothing but the universally performed pre-liposuction infiltration of the fat to be suctioned with a dilute solution of a local anesthetic (lidocaine, marcaine etc) and Adrenaline (Epinephrine) which increases the accuracy of fat removal, largely reduces blood losses AND increases patient comfort.

EVERYBODY (Plastic surgeons / ENT's or Dermatologists) uses Tumescent solution. The arguments and sand kicking in the air start over the issue of HOW is tumescent liposuction SUPPLEMENTED - Oral sedation (Valium etc), Intravenous sedation (propofol, ketamine, valium etc) or General Anesthesia.

To assert that ALL liposuction cases should be ONLY done with but one mode of anesthesia is at best short-sighted and should make you, the lay person, ask yourself if that make sense. If all you needed in your tool box was a hammer and a single screw driver - WHY do stores like Lowe's or Home Depot even exist? OBVIOUSLY, a competent liposuction surgeon should be able to choose the best anesthesia technique suited for each individual patient instead of imposing his / her hospital placed restrictions and limitations on the patients.

Dermatologists are often precluded from and do not have Plastic Surgery privileges (including Liposuction) in hospitals and many Medicare certified outpatient surgery centers. As a result, they commonly cannot offer their patients ALL the anesthesia options that accompany Tumescent Liposuction. As a result, some, not all, choose to spin this limitation by needlessly maligning general anesthesia.

On the other hand, a MUCH smaller minority of Plastic surgeons, who CAN choose to perform their tumescent liposuction with Oral or IV sedation MAY prefer to do it under general anesthesia. That too is regrettable if the cases could be done equally well or better without resorting to general anesthesia.

The anesthesia supplementing Tumescent liposuction SHOULD be tailored to the areas liposuctioned, the size of the patient, his/her pain threshold and any other anticipated or combined procedures. It should ALWAYS be tailored TO the patient's needs - not imposed on the patient.

Finally THE PAIN depends on which areas were treated, how the liposuction was done and the type and dilution of the local anesthetic in the tumescent solution.

Dr. P. Aldea

There is very little pain with tumescent anesthesia. The local anesthetic in the injected fluid eliminates most discomfort. There is usually no reason to have liposuction done under general anesthesia. This only increases the chances of complications and makes the recovery longer.

I have performed tumescent local anesthesia on thousands of patients who have gone back to work in two or three days, without difficulty.

The whole reason that tumescent liposuction was invented by a dermatologist was to avoid the risks of general anesthesia. Believe me, if you get it done this way you are losing all the good parts of tumescent (less pain, less bruising, less recovery time) and getting all the bad stuff of general anesthesia.

General anesthesia has problems with death rates just from the process, so why in the world would you want to do that when you can have the safest form, tumescent, done by a dermatologist or cosmetic surgeon and get all the benefits. Keep in mind that what you surgeon is referring to as 'tumescent' is a total lie as tumescent, by definition, is done without general anesthesia.

You may want to check out this website to see how Dr. Klein invented this method and why what your surgeon is considering is crazy. Good luck and don't worry about any pain with tumescent. If you go to a good dermatologist, they won't cause you pain and the recovery will be great! Good luck.

                  It’s important to realize that significant misinformation seems to permeate this discussion because of individual agendas.  It’s safe to say that tumescent liposuction involves infusing fluid into the subcutaneous tissue.  This fluid is rich in epinephrine and local anesthetic and offers significant advantages when performing liposuction.  Patients have less bleeding and less post-operative pain with this technique.

                  It’s also true that Dr. Klein initially described the technique with local anesthesia alone.  As with everything else in medicine advances are made and techniques change over the course of time.  A large number of surgeons feel that in some cases general anesthesia in combination with tumescent technique offers significant advantages over local anesthesia alone.

                  There’s no question that there’s risk associated with general anesthesia.  It’s also fair to say that there’s risk associated with just about everything we do as surgeons.  In fact there’s risk associated with lidocaine toxicity when practitioners are overly exuberant in their efforts to avoid general anesthesia.

                  It’s important to be honest when presenting the facts.  The best option for anesthesia varies from patient to patient and depends on the patient’s aesthetic goals and anatomic findings.  For some patients general anesthesia is a good option.  When this technique is utilized patients actually have less pain during and after the procedure. 

The word tumescnt  means to make firm with fluid, With tumescent liposuction, a fluid is instilled intot he areas to be liposuctioned. The fluid contains lidocaine, an anesthetic, and epinethrine, which has two effects: less pain over about 18 or so hours, and it constricts the blood vessels. The latter prolongs the anesthetic effect and reduced the bleeding during the procedure, thus also reducing the post-op bruising,

Pure tumescent liposuction can eliminate a general anesthesia and the post op pain relief is prolonged. Most patients only take Tylenol after surgery.

The cost of the procedure is generally less, since an anesthetist is not necessary,

To answer your question directly, the pain is minimal with tumescent liposuction. Generally a Tylenol is only necessary, but our patients have stronger medications if they need them.

Since there is very little discomfort at all with tumescent liposuction under local anesthesia and you get better results with faster recovery, why would anyone ever let themselves be talked into general anesthesia with all its risks and problems! Our patients are comfortable, get to watch 3D movies or listen to soothing music and get up and walk out afterwards as if nothing happened except they got a new fabulous body and are back to work in only 2 days and exercising in 1 week. If you trust your doc completely and he/she really really wants to still use general anesthesia, then do it for him but know that there are unnecessary risks with gen. anesthesia you will be taking.  Sincerely,

David Hansen,MD