Liposuction (Tumescent Technique)
Overview: Facial and Body Sculpturing: The Tumescent Technique
Facial and body sculpturing by liposuction is a proven technique that recontours bulging fat deposits in both men and women. Accumulations often are inherited and can be resistant to even the most dedicated diet and exercise regime. Liposuction can now permanently remove localized deposits of fat cells, effectively sculpturing those persistent areas.
** All liposuction photos below are the procedures done by Jeffrey Binstock, MD
Liposuction surgery is a conceptually elegant and simple method of body sculpturing. A special fat extractor (a thin, hollow stainless steel tube), or cannula, is inserted into the fatty areas between the skin and muscle, through small skin incisions. The extractor creates tiny tunnels, breaks up the fat cells, loosening them so that they can be removed by a high-pressure vacuum attached to the end of the cannula. This technique can be performed in a specially-equipped doctor’s office using local anesthesia and the recovery is usually rapid.
Liposuction of neck and jowls
Dr. Binstock was one of the first surgeons to perform liposuction in America, starting in 1987. He trained in the United States and refined his technique with Dr. Yves-Gerard Illouz, the inventor of the procedure, at the Spontani Clinic in Paris, France in 1984 and later worked in Paris with Dr. Pierre Fournier who greatly refined the procedure. Dr. Binstock has successfully performed thousands of liposuction procedures on satisfied patients, ages sixteen to eighty-two, over the last twenty-two years, with an outstanding safety record.
Outer thighs and buttock
In 1996, Dr. Binstock received hands-on instruction in ultrasonic-assisted liposuction with Maurizio Viel, M.D. in London, England and Yves-Gerard Illouz, M.D. in Paris, France, both pioneers of the ultrasonic technique.
Who is a potential candidate?
There are no definite age or weight limits. Most patients have localized fat deposits and some of our happiest patients are within twenty to thirty pounds of their ideal weight, and have been stable at that weight for years. Some patients have certain bulges irrespective of their weight and others are content with their weight, but would be more comfortable if certain bulges were recontoured. The best candidates for liposuction are in good health and have realistic expectations of the benefits of liposuction.
Hips, inner thighs, and abdomen
Is liposuction a treatment for obesity?
Liposuction is not an effective treatment for obesity and is not an alternative to dieting.The procedure works best on those whose weight is stable and/or have localized areas of fat deposits.
Liposuction neck & jowls, fat transfer to cheeks and chin
What areas of the body can benefit from this technique?
The most frequently treated areas in women include the waistline, abdomen, outer thighs, inner thighs, buttocks, knees, ankles, and neckline. In men, the most commonly treated areas are the love handles, breasts, abdomen, and neckline.
How is fat removed from the bulge areas?
A cannula—a hollow tube with an opening near its blunt end—is inserted through small incisions beneath the skin into the fatty tissue overlying the body’s musculature. This cannula breaks up the fatty tissue creating a honeycombing of the fat. A vacuum pump connected to the other end of the cannula then evacuates the loosened fat cells underneath the skin surface through a series of openings at the tip end of the cannula. The smaller the cannula, the smaller the tunnels and the more even the reduction. The cannulas that Dr. Binstock uses are generally 1.3 to 4.0 mm in outside diameter. In contrast, other surgeons often use cannulas 6.0 mm or larger in size. After surgery, these tiny tunnels collapse, resulting in an improved body contour.
Liposuction of jowls, lipo-fat transfer to cheeks and chin
How are the benefits of liposuction measured?
The cosmetic success of liposuction relies on removing inches rather than pounds. Little weight is actually removed and yet dramatic change in silhouette is possible. Most important is the patient’s satisfaction and increased self acceptance.
Abdomen, waist, and hips
What is the tumescent technique?
The tumescent technique is the most significant advance/improvement in liposuction. With it, liposuction can be performed under local anesthesia, thus allowing patients to avoid general anesthesia. The technique is considered the safest form of liposuction, as blood loss is greatly reduced, post-operative recovery time is reduced, and the cosmetic results are optimized. The tumescent technique was developed and refined by a dermatologist in 1985.
Abdomen, inner thighs, outer thighs, and knees
What does tumescent mean?
The word “tumescent” means swollen or firm. This technique is accomplished by injecting a large volume of a dilute solution of lidocaine, a local anesthetic and of epinephrine, a vasoconstrictive drug which shrinks capillaries. Patients have found local anesthesia so effective that they have reduced pain post-operatively and, in addition, no longer need IV sedation or general anesthesia.
Can the procedure be performed in an office setting?
Liposuction is performed in our specially equipped in-office operatory. The tumescent technique means liposuction can be performed totally by local anesthetic. Single areas, i.e., neck, abdomen, knees, outer thighs, etc., or multiple areas can be treated in a given session, depending on the number and size of the areas. General anesthesia is administered, when necessary, by an anesthesiologist (not by a nurse anesthetist) in a surgery center or hospital, where Dr. Binstock has privileges to perform liposuction surgery.
Hips, outer thighs, inner thighs, and buttock
Does the tumescent technique affect blood loss?
Yes, blood loss is greatly reduced. The epinephrine in the anesthetic solution causes diffuse capillary constriction that results in minimal blood loss during and after the surgery. 1% of what is extracted is blood; without the tumescent solutions 25% of what is removed is blood. Not only is recovery time reduced, i.e., your oxygen carrying capacity is preserved, but blood transfusions are virtually unnecessary.
Chest, abdomen, and flanks
What happens during the recovery period?
There is generally a quick return to normal activities. Home rest is necessary for the first 24 hours and then a light work schedule may be resumed. If sculpting is more extensive and performed in several areas, several days of recuperation may be necessary. A special elastic garment must worn for one week after surgery. The rate of healing is accelerated as a result of the drainage of blood tinged anesthetic solution the first day or two after the procedure. This drainage minimizes bruising, reduces inflammation, and significantly accelerates healing. Appropriate exercise can be initiated after five days to help you develop a better platform upon which your skin will drape and heighten the improvement of body contouring.
How will the skin look after surgery?
Stretch marks, dimples, and ripples remain unchanged following surgery. The changes following liposuction are analogous to those one would expect if it were possible to lose an equal amount of fat in localized areas by dieting alone. Smaller cannulas allow the fibrous connections between the skin and body to remain. These contract or shorten during healing. For this reason, excessive skin folds are rare and in fact, many patients who would have previously required surgical excision of skin can have excellent results with liposuction alone.
Are there any scars as a result of the procedure?
The tumescent technique uses very small cannulas, which result in smaller incisions. Incisions are generally not sutured closed and heal with less marking than those sutured. When possible they are concealed in natural body creases; such as the end of the buttock fold, the umbilicus, under the chin, or in the pubic hair. Sutures, if used, will dissolve by themselves or be removed in our office following surgery.
Will there be bruising?
Bruising is greatly reduced because the local anesthetic solution contains epinephrine, which constricts blood vessels and reducing bleeding and therefore bruising. The drainage of anesthetic solution following the tumescent technique further reduces bruising as it contains blood cells that would otherwise remain under the skin and appear as a bruise. By minimizing bruising and swelling, tumescent liposuction accelerates the rate of healing.
Can fat reaccumulate in the contoured areas?
Fat cells are permanently removed, as fat cells are thought not to multiply after puberty. As long as the patient does not gain excessive weight, the new silhouette is permanent. Fat removal, however, does not allow for abuse of diet later. Patients, after liposuction, have sometimes found that areas treated by liposuction retain the new contour, whereas areas not treated have been new sites for fat development. If one gains weight, the size of the individual fat cells will increase and too much weight gain may mask the benefit. The benefit will show when the extra weight is reduced. People with prior weight problems still have to watch their weight and exercise.
Is general anesthesia or IV sedation ever used?
General anesthesia and IV sedation have inherent risks greater than those of local anesthetic alone. Fatalities associated with general anesthesia are estimated to be one in ten thousand patients. However, these modalities are available if desired by the patient, or if Dr. Binstock feels they are indicated. General anesthesia is administered by a trained and experienced anesthesiologist in a hospital setting.
What complications may occur?
Surgical complications of liposuction are quite rare. As with any surgical procedure, liposuction is associated with common side effects such as bruising, swelling, and numbness. Skin irregularities have been greatly reduced because Dr. Binstock uses very small cannulas that produce a more even and less traumatic reduction.
An article published in the Journal of Dermatologic Surgery and Oncology in 1995 reviewed the complications of 15,336 patients, all of whom had their liposuction performed totally by local anesthesia. Side effects seen in this study included: infection 0.34%, skin irregularities 0.26%, allergic reaction 0.12%, persistent post-operative swelling 0.09%, scrotal or labial swelling 0.38%, hematoma or seroma 0.17%, focal subcutaneous fat inflammation 0.2%, permanent nerve damage 0.03%, excessive blood loss requiring transfusion 0%, anemia 0%, any complications involving hospitalization 0%, death 0%, shock 0% pulmonary embolism 0%, phlebitis 0%, toxic reaction to IV sedative or narcotic 0%.
Rare but significant complications can occur with any surgery and include serious infection, necrotizing fascitis, pulmonary embolism (secondary to blood or fat embolism), fluid imbalance, excessive blood loss, anesthesia complications, perforation of an internal organ, and death.
This information is not intended to frighten you, but rather to enable you to make your decision whether or not liposuction surgery is for you. Following surgery, you should immediately report any signs of infection, bleeding around the incisions, or anything else that causes you concern.
Who performs liposuction?
Liposuction is a surgical technique that has been embraced by dermatologic surgeons, cosmetic surgeons, and plastic surgeons. In fact, dermatologic surgeons as well as plastic surgeons are taught liposuction during their residency training programs. The tumescent technique was invented by a dermatologist!
Why don’t more surgeons use the tumescent technique?
One of the most significant factors in determining which technique a surgeon will use is time. From a surgeon’s point of view, the surgery will take less time when a general anesthetic is used. Plastic and cosmetic surgeons commonly use general anesthesia.
Dr. Binstock performs 99% of liposuction using local anesthetic by the tumescent technique. In years past, he performed hundreds of procedures under general anesthesia and hundreds more with heavy IV sedation. Dr. Binstock feels the tumescent technique is the best and safest way to undergo liposuction sculpturing.
What about the costs of liposuction?
Costs vary depending on size and number of areas in question. Dr. Binstock’s fees reflect the attention and expertise he brings to this artistic procedure. During your consultation, you will receive a written quote which will outline the anticipated costs, including the surgical fee, procedure room fees, and anesthesia fees if performed in a hospital instead of our office.
Is liposuction right for me?
The best way to decide is to speak with a surgeon who has a large experience and specializes in liposuction and facial and body sculpturing. It is important to find a surgeon who has an artistic touch and sensibility. Speak frankly, ask questions, and explain your expectations. Having done thousands of liposuction procedures, Dr. Binstock can answer your questions and address your goals and expectations regarding facial and body liposuction. During your consultation, Dr. Binstock will provide you with the facts to enable you to make the decision that’s right for you.
Although cosmetic surgery may not achieve perfection, its ultimate goal is to achieve a natural, improved appearance. And while liposuction does improve facial and body contours, it does not improve cellulite or other surface irregularities.
What’s new in liposuction? What about laser-assisted liposuction?
Right now, the buzzword is laser-assisted liposuction. To date, there have not been any studies directly comparing laser-assisted to regular tumescent liposuction, despite the fact that many laser machines are being aggressively marketed to physicians. The reason may be that there is not any advantage to this approach. Until a head-to-head study shows a distinct advantage of laser-assisted liposuction, Dr. Binstock will keep the cost and time necessary to perform the procedure down (i.e., shorter operative time for you, the patient), by not making this investment.
Dr. Binstock has also used external laser-assisted liposuction, and did not find any difference or benefit with this technique.
What about ultrasound-assisted liposuction?
Dr. Binstock no longer performs internal ultrasonic-assisted liposuction, as he found the benefits do not warrant the increased risks, costs, and time associated with the procedure. This was the conclusion that had been reached by most European surgeons who abandoned the technique several years ago, at the same time it was beginning to become popular in the United States.
External ultrasonic-assisted liposuction, an American adaptation of this technique wherein the ultrasound is applied externally before, rather than internally during, the procedure, has failed to provide any significant benefit or advantage over tumescent liposuction alone. Dr. Binstock has abandoned this technique as well.
What is power-assisted liposuction?
Power-assisted liposuction utilizes a regular type of liposuction cannula that oscillates (moves back and forth) a few millimeters at 5,000–8,000 times per minute. It does not melt or liquefy the fat, as is the case in the ultrasound-assisted procedure. The power-assisted method was supposed to enhance and improve the thoroughness of the removal of the fatty tissue. However, Dr. Binstock has found that the benefits of this new procedure are minimal, and no longer uses the power-assisted unit as part of his regular liposuction procedure.
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of various procedures.
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