What is Tumescent Anesthetic?

Tumescent anesthetic makes surgery safer, usually more accurate, and results in easier recoveries. It can be used for most cosmetic surgery.

I believe that tumescent anesthetic is one of the biggest advances in modern cosmetic surgery. Without it, we would not be able to perform many of the procedures described in this book without heavier anesthesia and its possible side effects, such as nausea and vomiting or worse. Without tumescent, there would be more bleeding during surgery, more post-operative discomfort, and more bruising during recovery.

Tumescent anesthesia is a saltwater solution which is injected into the fat tissue located directly under the skin. It's taken into the rest of the body slowly, and provides a localized effect. It's not injected into the bloodstream as many other types of anesthesia are.

Tumescent anesthesia's primary active ingredient is lidocaine, a standard anesthetic which numbs the area into which it's injected. It's similar to the Novocaine® that was once used in dentists offices (they use lidocaine now). The numbing sensation you feel in your mouth when you have a tooth filled is the same kind of numbing you feel with tumescent. The lidocaine is mixed with a salt water solution similar to your body fluids.

A second medicine called adrenaline (or epinephrine) is added to the lidocaine solution. This is a "vasoconstrictor," a chemical which causes blood vessels to constrict, or close down. When the vessels are closed, less blood flows through them, so there's less bleeding during the surgery.

The mix of lidocaine and adrenaline is varied by different doctors for different procedures. The concentration we use for liposuction has just a small amount of active ingredients per volume of salt water, just enough to numb the fat and minimize bleeding. For hair transplants, we use more adrenaline, because the scalp has a lot more blood vessels and needs more constriction to prevent bleeding. For facial or breast surgery, we again use a somewhat higher concentration of lidocaine and adrenaline.

We often use tumescent in combination with other medicines. For example, in some cases, when preparing patients for surgery, we'll give them an oral sedative such as Valium to help them relax. This is important when patients are nervous. Most times we'll also give the intravenous medicine (described above) to relax them even further. This helps them to be less aware of what's going on around them, and enables them to drift off to sleep. One of the advantages of keeping the patient relatively awake is that he or she can change position for the doctor so the doctor can see just what is happening to the "sculpture" during the procedure. We use a sterile sheet to help us roll the patient when this isn't possible. After the medicines are shut off briefly, our patients can even stand at the end of the process to check the result. This isn't as easy when general anesthetic is used.

When the tumescent fluid is injected into several sites of the area to be treated, it spreads throughout the fat tissue, numbing everything in its path and constricting the blood vessels. Because it's a liquid, it literally fills up the area under the skin, creating a bloated look. After the surgery, the remaining fluid which was not suctioned out drains through whatever openings were made in the skin. This drainage is mixed with a small amount of blood, which tinges the fluid with a pink or light red color. Many patients are concerned when they see this drainage because they think their bleeding might be serious. However, it's just the tumescent fluid draining out, with a small volume of blood mixed in. Without tumescent, there often would be a lot of blood loss. Because the adrenaline inhibits bleeding, the tumescent technique also produces less bruising (a bruise is just blood collected under the skin). In the past, before tumescent, bruising frequently could last a month after liposuction. Some cosmetic surgeons still don't use tumescent anesthesia, and their patients experience more bruising, longer recovery times, and more commonly need blood transfusions. Tumescent is an amazing tool. When used properly, it is one of the safest ways to operate. The next chapter describes these safety issues.