Under his proposal, patients would volunteer to undergo both laser-assisted liposuction and the standard surgical procedure, called tumescent liposuction. One technique would be used on the patient’s left side, the other technique on the right.

In each case, the patient and a surgeon would evaluate the results without knowing which side was which.
Klein called laser liposuction “The Emperor’s New Laser,”implying that it lacks merit, although it is widely praised. That praise includes, for example, an 80 percent approval rating for Smart Lipo from patients visiting the cosmetic-medicine site RealSelf.com.

Laser companies’ direct-to-consumer marketing materials state that laser lipo is better than “traditional liposuction,” which is only true if that refers to a “dry liposuction” technique that hasn’t been used since the early 1990s, Klein said.
Laser companies’ direct-to-consumer marketing materials state that laser lipo is better than “traditional liposuction,” which is only true if that refers to a “dry liposuction” technique that hasn’t been used since the early 1990s, Klein said.

In that older technique, physicians sucked fat out of the body through a tube that they inserted through an incision.

In Klein’s tumescent-lipo procedure, which superceded dry lipo in the early 1990s, physicians inject liquid containing local anesthetic into the surgical site before sucking out the fat.

In laser lipo, a laser melts fat before it is sucked out of the body or, in a variation, is left to be removed gradually by the body’s natural processes. Klein also said manufacturers inaccurately claim that laser lipo helps tighten patients’ skin.

That’s based on a misreading of a 2006 study that found new collagen in skin cells from laser-lipo patients, he said.

Klein, who is an associate clinical professor in UCI’s Department of Dermatology, did not decry laser-assisted liposuction as a hazardous technique, but he said he was suspicious because no information about complications has been published, even though he has heard of some.

This post is based on Klein’s presentation at the “What’s the Truth?” cosmetic-medicine conference Oct. 10-12 at Harvard Medical School. I would welcome comments by e-mail from patients, physicians and laser makers as I prepare for a more in-depth column on the subject.

Excisions, Mohs surgery, lipoma removal, breast reduction, and intravascular vein ablation all lend themselves well to the use of tumescent anesthesia, according to the discoverer of the technique.

Besides providing long-lasting and profound local anesthesia, bactericidal protection, and elevation of tissues for delicate procedures, the tumescent technique offers “exquisite hemostasis,” said Dr. Klein, a dermatologic surgeon in San Juan Capistrano, Calif., who is credited with revolutionizing the safety of liposuction anesthesia by pioneering the use of dilute concentrations of lidocaine and epinephrine in saline with sodium bicarbonate.

“I’m really impressed at how little blood loss there is,” he said.

In laser and radiofrequency procedures, tumescent liposuction acts as a heat sink. For excisions or Mohs surgery on the neck or face, it can lift lesions safely away from superficial nerve branches, he pointed out.

It can be used in conjunction with dissection with blunt liposuction cannulas to separate fibrous, multilobular lipomas from surrounding tissue so they can be easily excised. In Germany, it is being used to perform sentinel lymph node biopsies on melanoma patients.

Dr. Klein outlined examples of numerous dermatologic procedures he has performed with tumescent liposuction, from the extraction of excess glandular tissue through the nipple of a patient with male gynecomastia to the excision of a large melanoma down to fascia.

Mohs surgery of a large, recurrent basal cell carcinoma can be accomplished as “essentially a painless procedure” during which the patient remains awake, he said.

The lack of infections seen following liposuction–just 1 in more than 6,000 procedures performed by Dr. Klein–suggests that “there must be a very substantial bacteriocidal effect” of tumescent solution, he said.

Obviously, much smaller volumes of tumescent fluid are utilized in these other procedures than are needed in large liposuction cases, but the ratio of the ingredients in the formula remains the same. (See “Small-Volume Tumescent Recipe“.) Once the area is infiltrated, “you need to allow time for detumescence to occur,” said Dr. Klein.

In large abdominal liposuction cases, this process ideally should occur over the course of an hour. For smaller dermatologic surgery cases, the procedure should be delayed for at least 15-30 minutes for fluids to drain away and the architecture of the lesion to be restored.

Recovery following cases in which tumescent anesthesia is used is remarkably quick, with patients most likely able to return to work within a day, even following large excisions.

Dr. Klein noted that tumescent anesthesia has been widely adopted by other specialties and is commonly used in stem cell harvesting and vein, breast, burn, craniofacial, and rectal surgery.

BY BETSY BATES
Los Angeles Bureau

Small-Volume Tumescent Recipe
A 100-mL formulation of tumescent local anesthesia (TLA) consists of approximately 0.25% lidocaine and epinephrine 1:400,000. To prepare this formulation, use:
* 100-mL bag of sodium chloride 0.9%.
* 300 mg lidocaine and 0.3 mg epinephrine (30 mL of 1% lidocaine with epinephrine 1:100,000).
* 3 mEq sodium bicarbonate (3 mL of 8.4% sodium bicarbonate).
On the day of surgery, a nurse prepares and labels the bag of TLA immediately after the patient arrives. For safety reasons, TLA should never be mixed 1 or more days before the day of surgery. Every bag of TLA should be well labeled at the time of its preparation.
Source: Dr. Klein