When first introduced, liposuction was performed under general anesthesia. Historically, general anesthesia for any procedure incurs certain risk—but statistically, only one in eighty thousand patients will die from general anesthesia. This mortality rate increases significantly with general plastic surgery, which shows an approximate mortality rate of six in five thousand. What causes this mortality rate in association to liposuction? Excessive bleeding and the risk of perforating an organ with a cannula.
The safety profile for liposuction changed in 1986 when Dr. Jeffrey Klein introduced the tumescent liposuction technique. Tumescent liposuction is an outpatient procedure, without the use of general anesthesia. It involves injecting a large volume of diluted local anesthesia into the fat beneath the skin. This causes the targeted area to become swollen and firm (tumescent), minimizing surgical blood loss and replacing the need for general anesthesia.
Typically, in the United States, you will find two distinct groups of surgeons performing liposuction using different anesthetic approaches. Plastic surgeons almost always perform liposuction under general anesthesia, because they are used to operating on patients that way. The second group of surgeons, is a dermatologic surgeon, like myself. We perform liposuction using tumescent local anesthesia, paired with twilight sedation. The patient is coherent and comfortable throughout the procedure.
Tumescent liposuction has proven to be more effective, safer and less painful than traditional liposuction, with shorter recovery times and optimal cosmetic results.
The use of tumescent anesthesia forces the surgeon to stay within a safe treatment plane, where the fat is—avoiding the risk of going too deep and perforating an organ with the cannula.
When a patient is intubated under general anesthetic, the body is flaccid with loose muscle tone. This can lead to difficulties removing the fat circumferentially—and a poor result.
With the tumescent liposuction technique and twilight sedation, the patient is comfortable and can adjust their positioning and tighten their muscles, providing stability of the fat layer for effective removal and superior results.
