Tumescent and SmartLipo

Dr. Berman often gets asked this question, the short answer is that tumescent is a part of the liposuction or SmartLipo process, not a type of liposuction. This common misconception is caused when people research on the internet without the appropriate background knowledge to fully understand all the terms and considerations. Personal research is always advised, however it is important to ensure that it is through reputable sources qualified to provide the necessary information. It is always helpful to have the background knowledge to put it all in context.

Many people read the term “tumescent” in the context of liposuction, regardless of what type of liposuction is being done. However, it can get confused with regards to the true meaning of the term. First some brief history. When liposuction was first discovered/created (in France), as with any new discovery, no one really knew what they were doing. On the first attempt, the patient was placed under general anesthesia and the fat was liposuctioned out. However, there was a lot of bruising, some blood loss and significant discomfort. 

Fast forward with more time and experience, it was discovered that if a combination of saline, lidocaine, marcaine and epinephrine there will be almost no blood loss, less bruising generally and greater comfort during and after the procedure. This combination works best due to the properties of these formulations assisting one another. A significant amount of saline (saltwater, which makes up majority of our body composition) was mixed with lidocaine (an aesthetic agent that is widely used but acts for a fairly short period of time) and marcaine (which is a longer lasting anesthetic) are combined along with epinephrine (a vasoconstrictor, which significantly decreases any blood loss and also prolongs the effect of both the lidocaine and the marcaine). The reason this works as a solution is that the lidocaine works fast but wears off quickly and the marcaine takes more time to start working but lasts longer. Dr David Berman also adds bicarbonate which makes the solution much more comfortable to infuse since it brings the pH up to 7.4, to match the physiological pH level. 

This means tumescent is not a type of liposuction, but rather, it is the preparation which is done immediately before the liposuction procedure. Every plastic surgeon does some variation of tumescent infusion prior to any type of liposuction. The exact amount of fluid infused may vary somewhat, as will the exact combination and amount of each additive, but the overall effect is similar. 

Addressing the question of which is better between regular liposuction versus Smartlipo, this is most clearly understood by contrasting the properties of each. It is important to understand that Smartlipo is a type of liposuction. Smartlipo is an evolution in the technique of liposuction. A good analogy may be between a gas car and an electric car. The electric car is still a car with the same goal of getting you from point A to B. However, the electric car offers certain advantages and is an evolution from the gas car. 

REGULAR LIPOSUCTION VERSUS SMARTLIPO

• Regular liposuction – General anesthesia; Smartlipo – Local anesthesia with oral sedation
•  Regular liposuction – Performed in the operating room; Smartlipo – Performed in the office
• Regular liposuction – Usually requires 4-5 days off of work for recovery; Smartlipo – Over 90% of patients return to work the next day
• Regular liposuction – Continues to improve for 3-4 months; Smartlipo – Continues to improve for 6 months.
• Regular liposuction – More prone to bruising and irregularity.; Smartlipo – Less prone to bruising and irregularity. This is because the laser coagulates small blood vessels and results in a smoother finish due to the small size of laser fiber.
• Regular liposuction – Some skin tightening; Smartlipo – More skin tightening due to heat of laser (however, if you have a lot of loose skin no laser can treat this and the skin will need to be excised to achieve a tight look)
• Regular liposuction – Requires paying for anesthesiologist, operating room and the surgeon.; Smartlipo – Only need to pay for the board certified plastic surgeon and the office operating which is less than a main operating room.
• Regular liposuction – As with all general anesthesia surgeries there is a small but real risk of DVT (blood clots in the calves) which can infrequently lead to pulmonary embolus (blood clots to the lungs) and even death (very uncommon but does happen).; Smartlipo – As the procedure is not performed under general anesthesia, there should be no increased risk of DVT and pulmonary embolus.
• Regular liposuction – Greater discomfort after procedure with most patients needing 7-10 days before returning to exercising. ; Smartlipo – Laser causes the sensory nerves to be numb for several days, so almost always less discomfort post surgery. Almost all patients will resume exercising with no restrictions in 5 days.

From Dr. Berman’s perspective, there is no downside to Smartlipo and has some significant advantages over regular liposuction, so it is his preferred type of liposuction. In fact, the only time Dr Berman chooses to perform regular liposuction over Smartlipo, is when a patient is already under general anesthesia for another procedure, – such as a tummy tuck, breast augmentation/reduction or gynecomastia.