Montreal — With all the debate concerning measures needed to guard patient safety, experts say tumescent local anesthesia deserves a second look. Since the method was developed 20 years ago, it remains a gold standard, but modifications may have resulted in its misuse, according to dermatologist Jeffrey Klein, developer of the tumescent anesthesia method and associate clinical professor of dermatology, University of California, Irvine.
Dr. Klein tells Cosmetic Surgery Times that carefully researched and implemented modest changes have not had a dramatic impact on safety outcomes, but more fundamental changes have.
"The people using general anesthesia have sort of misused tumescent anesthesia. When you look at the results of that, a couple of published articles that look at the rates of deaths associated with liposuction, they are virtually all associated with general anesthesia or IV sedation. When liposuction is done the way I do it, totally by local anesthesia, no IV sedation ... the patient is awake. At least to my knowledge, there have never been any deaths," he says.
Problems that have arisen as a result of modified tumescent techniques have unfairly given the procedure a bad rap, according to Patrick McMenamin, M.D., a board-certified facial plastic surgeon and cosmetic surgeon in Sacramento, Calif., and a member of the Cosmetic Surgery Times editorial advisory board.
"People bastardize it, do it with general anesthesia, do it with many other medications on board," Dr. McMenamin says. "Change (Dr. Klein's) technique and then bad things happen, and then they come back and say, 'See, it's not my fault.' Even though they've changed it, or they'll say, 'See, this technique is so difficult.'"
Benefiting from the safety of the tumescent technique, experts say, means either sticking to Dr. Klein's formula or making only minor changes that have been shown in the scientific literature to be safe.
"I think the vast majority are doing it safely," Dr. Klein says, "but there's a small minority who are disregarding common sense safety. That's what allows there to be such a large safety gap between the two procedures. It's not that general anesthesia is unsafe; I do not think that general anesthesia is unsafe. I think that it can be used and abused."
Experts said liposuction under local anesthesia was not possible before 1985, when the tumescent method was introduced. The first description of the technique was published in the January 1987 issue of the American Journal of Cosmetic Surgery.
The tumescent technique markedly improved the safety of liposuction. The risks of general anesthesia were avoided, blood loss virtually eliminated and, in Dr. Klein's hands, even intravenous (IV) sedation was not necessary. It has become a preferred anesthesia approach for several cosmetic and dermatologic procedures.
"Tumescent local anesthesia radically changed liposuction," says Alastair Carruthers, M.D., clinical professor of dermatology at the University of British Columbia, Vancouver and vice president of the American Society for Dermatologic Surgery (ASDS).