There are many terms used when researching the special lymph-sparing liposuction that is required with lipedema, as outlined below.
An adit is a small hole in the skin made with round, skin-biopsy punches. Adits are used as access sites, in which the liposuction cannula is passed in and out of during the liposuction process. They also facilitate the drainage of blood-tinged anesthetic solution after liposuction. They are so small that it is not necessary to close them with sutures. Because adits are not closed with sutures, they promote copious postoperative drainage of blood-tinged tumescent anesthesia, which in turn reduces post-operative bruising, tenderness and swelling. Larger cannulas require larger incisions. When larger incisions are closed with sutures, there is delayed drainage, and prolonged swelling, bruising and pain after liposuction.
A liposuction cannula is a stainless steel tube which is inserted into subcutaneous fat through a small opening or incision in the skin. A microcannula has an outside diameter of less than 3 mm. The diameter of microcannulas range from 1 mm to 3 mm. Larger cannulas, those having an outside diameter ranging from 3 mm to 6 mm, require larger incisions which usually leave visible scars.
Power assisted liposuction (PAL) features devices that are easier for surgeons to control, allowing for more precise and thorough fat removal. These devices produce rapid, small vibrations to break up fat so that it can easily be suctioned out through a special cannula which uses tiny, rapid vibrations to break up fat cells so that they can be suctioned out of the body. This vibration actually makes liposuction gentler on the body’s tissues because it loosens fat cells and allows them to be easily suctioned away. This specialized cannula allows for smaller incisions and reduced recovery time compared with other liposuction techniques. The vibrating tip used in PAL allows for safer liposuction because of its small, precise motions. Surgeons can target specific areas without damaging surrounding tissue and do not need to use as much force during a power assisted liposuction because the vibrating cannula helps release fat cells from the body.
The word “tumescent” means swollen and firm. By injecting a large volume of very dilute lidocaine (an anesthetic) and epinephrine (a vasoconstrictor) into subcutaneous fat, the targeted tissue becomes swollen and firm, or tumescent; this is tumescent anesthesia. Tumescent liposuction is a method that provides local anesthesia to large volumes of subcutaneous fat and thus permits liposuction totally by local anesthesia. Vasoconstriction (shrinkage of capillary blood vessels) results from the tumescent infiltration of a large volume of dilute epinephrine into subcutaneous fat. Tumescent vasoconstriction is so complete that liposuction can be done with virtually no blood loss. Because vasoconstriction delays lidocaine absorption, the local anesthetic remains in place in the fat for many hours. This prolonged anesthesia permits surgery for up to 10 hours after infiltration, and provides 24 to 36 hours of significant postoperative analgesia. Because tumescent local anesthesia lasts so long, tumescent liposuction is less painful and more pleasant than liposuction under general anesthesia or IV sedation. With tumescent anesthesia, patients can avoid the post-operative nausea and vomiting associated with general anesthesia. Tumescent anesthesia is so efficient at providing fluid to the body that it is unnecessary to use IV fluids.
Sodium bicarbonate is added to reduce the pain of infiltration and to increase the antibiotic action of lidocaine. The tumescent technique has several advantages, as it hydrodissects the fat, facilitating its removal; it protects the underlying organs, bringing up the skin; it reduces bleeding and the possibility of fat embolism by the collapse of the vessels and the vasoconstrictor action of epinephrine; and it reduces the possibility of infection, increasing the antibiotic effect of lidocaine.
Water (jet) assisted liposuction (WAL) uses a slightly pressurized stream of saline to dislodge fat and simultaneously remove the cells. Instead of destroying fat cells, this type of liposuction loosens the fat cells to facilitate more gentle removal. WAL injects tumescent fluid into the body part being treated, and once the anesthesia has taken hold, a cannula is then introduced into the tissue to irrigate and then simultaneously suction the loosened fat cells from the body. The procedure is considered gentle and minimally invasive, and the force seen in traditional liposuction methods is not needed when using jet-assisted liposuction. There is usually very little bruising or swelling, and water jet assisted liposuction often has a very short recovery time, partially because the use of water means that there is less tissue trauma to the body.
Einstein Medical. (2015). Power Assisted Liposuction. Retrieved from https://www.docshop.com/education/cosmetic/body/liposuction/power
Gadelha, A., & Leao, T. (2009). Rule of four: a simple and safe formula for tumescent anesthesia in dermatologic surgical procedures. Surgical & Cosmetic Dermatology, 1(2), 99-102.
Kassardjian, N. (2017). Tumescent Liposuction. Retrieved from https://www.liposuction.com/tumescent-technique-html
Kassardjian, N. (2017). Water Jet Assisted Liposuction. Retrieved from https://www.liposuction.com/water-jet-assisted-html
For a list of surgeons, please consult the Fat Disorders Research Society.
Before & After Surgery
In preparation for surgery and also postoperatively, it is important to continue with lymphatic support measures, such as compression and complete decongestive therapy, in order to minimize lymphedema. These treatments assist the lymphatics in draining residual tumescent fluid after liposuction. It is also important that patients continue with healthy lifestyle choices, including good eating habits and exercise.
Buck, D., & Herbst, K. (2016). Lipedema: A relatively common disease with extremely common misconceptions. Plastic Reconstructive Surgery Global Open. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5055019/pdf/gox-4-e1043.pdf
Preparing for surgery – Dr. Karen Herbst