The gold standard in liposuction surgical procedure is the use of tumescent local anesthesia and vibration-assisted liposuction devices with fine cannulas. Over the past decade I have performed 150 such procedures annually for a total of over 1500. The Hirslanden Klinik Meggen offers optimal conditions for liposuction with modern surgical suites, an experienced anesthesia team and personalized inpatient care during the first 24 post-operative hours from our experienced nursing team. Patient safety is always the first goal of the entire liposuction team.
Tumescent local anesthesia
Tumescent local anesthesia (lat. tumescere: to swell) is a special approach which is ideally suited both for producing anesthesia and preparing the fat tissue for removal via liposuction. The fat tissue is filled with an extremely dilute solution of local anesthetic and isotonic saline to the point where it expands and is homogenized. General or twilight anesthesia is not required for liposuction. To make the procedure more pleasant for you, both tranquilizers and pain medications can be administered intravenously before and during the procedure. At the end of the infiltration phase, after 30-60 minutes, the tissue feels tense and firm. After waiting another 30 minutes to allow the anesthetic agent to achieve full effect, the areas to be treated are numb. The patient is able to assist during the operation by assuming the ideal position on the operation table and tightening the appropriate muscles as needed. These are the ideal conditions for an effective, pain-free therapy session and excellent results.
The fat is removed using relatively thin (2 - 4 mm Ø), 15 – 30 cm long hollow cannulas, which are driven by an electric motor to vibrate at a high frequency. This vibration-assisted liposuction technique under tumescent local anesthesia makes possible a gentle and uniform removal of the excessive fat cells. The cannulas are passed through the skin via a few small incisions (3-5 mm) and then pushed in and out of the fat tissue parallel to the skin surface in a fan-like pattern. The suction separates the fat cells from the adjacent tissue and removes then through a tube. The fat cells wind up along with a small part of the anesthetic solution in a sterile container. In one session, up to 75% of the fat cells or as much as 4 liters of pure fat can be removed. The connective tissue fibers which hold the fat cells in place remain behind and are instrumental in the process of tissue shrinkage during the healing phase. During liposuction one experiences a rubbing or scratching sensation under the skin; this is caused by the vibration of the cannula and the tugging on the connective tissue fibers. Some patients also describe an almost pleasant feeling of an „internal massage“. If any of the sensations become too unpleasant, it is possible to administer medications to relieve the symptoms. In any case, the entire procedure which lasts 30-60 minutes is well-tolerated by almost every patient.
After the procedure
The tiny skin incisions are not sutured after the liposuction but covered with sterile dressings. The local anesthetic solution still left in the tissue leaks out of these holes; the fluid flows rapidly for the first few hours and then more slowly. This post-operative drainage is somewhat unpleasant but highly desirable. The saline solution containing the medications is not completely taken up by the body, reducing the amount of anesthetic the liver must metabolize. Because of this drainage, bruises are less common after liposuction done under tumescent local anesthesia as compared to other techniques. Furthermore, the tissue is almost completely pain-free in the first hours after the procedure.
Highly-absorbent diapers help keep the patient dry. They are held in the appropriate sites with special compression garments. The compression exerts a mild pressure to insure that the excess fluid flows outwards, but at the same time insures close contact between the now somewhat loose skin and the underlying tissues. The adhesion of the multiple tissue layers in exactly the right position is one of the critical factors in determining the success of a liposuction procedure. The compression garments should be worn around the clock for a week, and then during the day for another 2-3 weeks. Patients can shower on the first day - without the garments. When the neck is treated, patients must wear a collar-like compression dressing for a short period of time - one day around the clock - and then for the rest of the week only at home and during the night.
Immediately after the operation and in the next few days, the patient should be active and drink a lot (3-4 liters daily). This is good for the circulation and the best prophylaxis against thrombosis (blood clots). In addition, low-molecular weight heparin is administered subcutaneously once daily for 5 days to further protect against thrombosis, while an oral antibiotic (cephalosporin) is also prescribed for 5 days to protect against infection. Pain medication (ibuprofen) can be taken as needed; it also provides an anti-inflammatory action and reduces swelling. The complaints following liposuction are probably best described as „really sore muscles“ and are normally well-tolerated.
Staying one night in the Hirslanden Klinik Meggen is medically wise after larger procedures or when facing a long trip home; our experienced nursing team does everything possible for the patient's comfort. The nurses take care of the frequent absorbent dressing changes required initially. Then on the next morning, after a shower, post-operative check, and new dressings, patients can travel home well-rested and relaxed. You will be given my emergency cell phone number - I will be always available to answer questions or assist in any case of problem.
The first follow-up exam occurs on the morning after the operation. After everything is checked and questions are answered, the dressings will be changed. In those sites where drainage has already stopped, Steri-Strips are applied to bring the tiny wound edges together. They should be left in place for 7-10 days. The normal wound healing process leads to a slight collection of fluids and swelling during the first 4-6 weeks after the liposuction. Although this is often somehow frustrating, it is inevitable and simply reflects fluid uptake during the normal healing process.
Patients usually can return to work in 3-7 days depending on their occupation. Sports and excessive physical activity should be avoided for 2 weeks, while tub baths, swimming, saunas and solaria should be avoided for 4 weeks. Showering is allowed on the first day after the operation.
A second follow-up exam after around 14 days is wise. Manual lymph drainage massages administered by an experienced physical therapist are also very helpful, as they lead to a more rapid reduction in swelling and speed wound healing. It is also very helpful to regularly massage the treated areas yourself using a gentle body cream or lotion.
The cosmetic results can first be evaluated after 4, or even 6 months. One needs this much healing time before one can sensibly discuss the changes. Even after 12 months, one sees continuous improvements in body contours, as well as in smoothness and proper skin tension. Photo documentation after 6 months will make clear the improvement - and comparing the before and after pictures makes not only the patient happy.