What is Tumescent Liposuction (PAL)?

The tumescent technique is a power assisted technique (PAL) that involves injecting a rather large amount of anesthetic liquid into the excess fat being treated. This fluid injection causes the fat pockets to swell, thereby leaving a pathway between the excess fat and the muscle tissue.

Tumescent Liposuction (PAL) is generally referred to as “traditional lipo”, lipoplasty, suction-assisted lipectomy and liposculpture.  It is the most commonly performed cosmetic surgery today. Since its inception in 1974, great methodological and technological advances have created more options for patients. One of the most utilized techniques in liposuction is the tumescent technique.

In the past, liposuction required patients to have pre-operative blood transfusions, since the loss of blood was so significant. The tumescent technique is still considered one of the safest options in liposuction; this technique can greatly reduce the swelling, pain, and bruising usually associated with the surgery. Though not completely risk-free, the tumescent method is a good option for many patients.

Benefits of Liposuction

A newly trim body – arms, thighs, hips, abdomen, can provide a psychological lift and an extra incentive to exercise regularly and maintain fitness. Many patients even find physical activity more pleasurable after shedding extra fat, and they also find that clothes tend to fit better after liposuction.

Are you an ideal candidate?

In most cases of young healthy patients with excellent skin tone and much localized areas of fat deposits, skin re-draping is almost always excellent. The skin has an amazing property of being able to retract and shrink down to its new position without creating any overhang in your skin. The analogy is much like when you are 10-20 pounds overweight and you embark on a weight loss program. When you reach your final goal you are usually not left with loose skin that overhangs but rather a slimmer, trimmer you with perhaps more body definition.

However, if you are overweight by 60 or 70 pounds, you are older, or you already have loose skin, then when you lose the weight, you may see some changes to the skin that indeed would leave some overhang and skin irregularities. This would also be true with liposuction.

These are, of course generalities and like everything in life there are exceptions. Much of your particular case will depend on your skin type, if you have fluffy, loose skin to begin with and perhaps you have stretch marks then this is the type of skin that has lost its elastic properties and will not retract as well as we would like. These cases are usually patients that have had children or have been through extreme changes in body weight either by weight loss or weight gain. In these cases it is best to combine liposuction with some sort of skin reducing procedure. This is the why your consultation will be crucial. You may believe you want liposuction in the abdominal area, but you may learn that an abdominoplasty, or tummy tuck, may meet your goals more effectively.

Preparation for Tumescent Liposuction

Before you undergo liposuction, it is important for you to discuss any medical conditions that you have and to tell your surgeon about any medications that you are taking including any herbal or other non-prescription ones. If your surgeon decides that you can have liposuction, discuss the procedure thoroughly with him or her before deciding if you want to go through with the procedure. Even though your surgeon says that you may does not mean that you must decide to have liposuction. You may still change your mind even after discussing the procedure with your surgeon.

Your consultation with the surgeon will give you a detailed understanding of the treatment – the extent of surgery, your health evaluation, your expectations and exactly what parts of the body will be treated. When you are happy with what has been discussed, you will sign a booking form for the operation.

Your surgeon should be able to answer any questions that you have about liposuction including questions about what to expect during and after liposuction and the complications or problems that sometimes occur with liposuction. You may also take information from this website to your appointment to discuss with him.

You will then have another consultation with the surgeon when you arrive at your destination, where he will have a physical evaluation of the areas to be treated. At this appointment you and your surgeon will discuss your goals, and last queries you have and finalize the plan for surgery.

Surgical procedure

On the day of the surgery, your surgeon will mark your body with a pen to indicate where the fat is to be removed.

Our surgeons practice the tumescent technique, which is a relatively new liposuction method that can reduce post-operative bruising, swelling and pain. Because blood loss is minimized during tumescent liposuction, use of the technique reduces the chance that a blood transfusion will be needed.

In the tumescent technique, areas of excess fat are injected with a large amount of anesthetic liquid before liposuction is performed. The liquid causes the compartments of fat to become swollen and firm or “tumesced.” The expanded fat compartments allow the liposuction cannula to travel smoothly beneath the skin as the fat is removed.

Other surgeons use local anesthesia and a sedative that can be taken by mouth or injected from a syringe. Still others prefer to use general anesthesia that is to use anesthesia that will put you to sleep during the procedure. General anesthesia is usually done in a hospital.

Once the anesthesia is working, the surgeon will make an incision (0.5 cm cut) in the area (usually in skin lines or folds so it is camouflaged) where the liposuction will be performed. A cannula, a hollow tube that is about the size and shape of a skinny pen, will be inserted into the incision. The surgeon moves this cannula back and forth to suction out the fat. The fat, and liquid that has been injected, are collected in a flask. The surgeon will monitor the amount of fluid and fat that are removed. Because you will be losing liquid and fat from your body, it may be necessary to replace some of that fluid. This is done with an intravenous (i.v.) line for the replacement of fluid. The surgeon then moves to many different areas, keeping the number and size of incisions to a minimum.

Recovery and Post-op care

Depending upon the amount of fat removed, you may leave the hospital soon after the surgery unless you need to spend the night at the hospital. Ask your surgeon how long it will be before you should be able to return to your normal level of activity.

The cuts where the surgeon inserted the cannula may be leaky or drain fluids for several days. In some cases, the surgeon may insert a drainage tube to drain fluid away from the wound.

You will wear special tight garments (compression garments) to keep your skin compressed after the liposuction procedure. Your surgeon will tell you how long to wear these. Sports and driving may need to be restricted during the recovering period and a compression garment is worn for up to 6 weeks to help with the skin remodeling. We partner with a local supplier to provide these compression garments should you need to purchase them.

Your surgeon will give you some after-surgery instructions. This will include information about wearing compression garments, taking an antibiotic if that has been prescribed, and the level of activity that is safe for you after your liposuction procedure. You should also have information about signs of problems that you should be aware of, for instance the signs of infections or other problems that you need to know about.

When the anesthesia wears off, you may have some pain. Pain varies from patient to patient, but extensive liposculpture can be painful initially. If the pain is extreme or of a long duration, you should contact us or your surgeon. You will also have some swelling after the surgery. In some cases, this swelling will remain for weeks or even months. If you have pain and swelling, this may be the sign of infection and you should contact your surgeon. But in most cases, you will start to feel better after about a week or two.

You will have minimal, almost invisible scars where the physician cuts your skin and inserts the cannula to remove fat tissue.

The effects of the liposuction will not be seen for some time, after the swelling reduces.

We provide excellent post-care support, with follow-up visits and programs to assist your recovery. If you have any questions or concerns, please let us know and we will schedule an appointment with the surgeon.

Recommended length of stay on holiday

10-14 days.

Other recommended procedures with Liposuction

Many people who travel for Cosmetic surgery have more than one procedure because of the cost advantages and also for a more balanced look. Almost any other procedure can be done in conjunction with liposuction.

Your new look

You will see a noticeable difference in the shape of your body quite soon after surgery. Don’t be surprised if your clothes don’t fit you for the first two weeks. Even though the unwanted fat has been removed, and your body looks thinner, you are swollen. After two weeks this swelling begins to come down and you will feel more yourself. However, it will take a month before you are back to normal. Improvement will become even more apparent after about four to six weeks, when most of the swelling has subsided. After about three months, any persistent mild swelling usually disappears and the final contour will be visible. Liposuction is permanent – when fat cells are removed, they cannot grow back.

If your expectations are realistic, you will probably be very pleased with the results of your surgery. You may find that you are more comfortable in a wide variety of clothes and more at ease with your body. And, by eating a healthy diet and getting regular exercise, you can help to maintain your new shape.

Research shows that people who have liposuction are three times more likely to gain weight if they don’t follow a healthy diet after liposuction and four times more likely to pile on the pounds without regular exercise. But those who follow a healthy diet are twice as likely to lose weight after liposuction. Consequently people are much more likely to be happy with their long term results after liposuction if they make other healthy lifestyle changes.

We recommend viewing before and after photos of patients who have undergone similar procedures.

Preconditions and Risks

We minimize risks and complications by selecting patients carefully and always having the most skilled surgeons, physicians and nurses carry out procedures.

It is therefore crucial that you seek a surgeon who is well qualified and Board Certified (as all our surgeons are), or has extensive training in liposuction. However, it’s important to keep in mind that even though a well-trained surgeon and a state-of-the art facility can improve your chance of having a good result, there are no guarantees. Liposuction is usually performed in very young and healthy patients therefore it is very safe, however, like anything in life even though precautions are taken and safety measures instituted, though they are rare, complications can and do occur. Special care has to be taken whenever more than 5 litres of fat are to be removed and multiple areas or procedures are being performed. The complications are the following:

Skin sensory changes: Numbness is normal. These sensation changes are because the nerves are regenerating and it may take up to six months to go away. The number of patients that have had permanent sensory changes is extremely rare. Certain exercises that may help with the hypersensitivity changes. The theory is that you need to over-stimulate the body so that the body gets accustomed to the normal touch. Therefore you need to use a variety of materials, i.e. cotton balls, t-shirts, towels, napkins, the hand and constantly touch the body with these materials. You will notice that after some time these things will not bother you and the sensation improves. Other medicines that may help are Vitamin B6, B12, Niacin, but consult with your physician.

Hyper or Hypo-Pigmentation: Immediately after your liposuction you will have bruising and this will last for 4-5 weeks. The bruising can be improved with the use of Arnica creams and pills. You need to take this immediately after your surgery and continued for 3-4 weeks. (Consult your physician before using). If you have very pale skin this can last for up to 6 weeks. However after two months if your skin has persistent discoloration then it’s possible that you have hyper-pigmentation. This is the darkening of the skin and this occurs most often in Hispanics, Afro-Americans and patients with olive colored skin. Although it may occur in very pale patients. This is essentially a result from the skin retracting and taking on a darker color. This discoloration may improve but it will take up to one year. Please consult the physician for more information.

Skin Irregularities or waviness: The skin has an amazing way of redistributing itself, and especially in the beginning because of all the swelling it will difficult to see your final result. You may help speed up your recovery with therapies like massages, and Endermology. Endermology which is a special machine that gives massages, we have found to be a tremendous help in reducing the swelling and speeding up recovery. If skin dimpling or bagginess develops it can be permanent, this occurs more in poor quality skin like patients with stretch marks or cellulite. In these cases it may require fat transfer to the affected area or a tummy tuck to correct the problem.

Body Asymmetry (one side different than the other): This is a very common complaint; in actuality everyone has one side of the body that is very different than the other. We just don’t notice it anymore because we have been looking at our bodies for so long that we no longer see the difference. If you saw your before pictures, you may see the differences that you did not see before. In the beginning when both sides of the body heal at different rates, there is almost always more swelling on one side than the other and you just need to give it time to heal. Liposuction results take at least 6 months to be finalized.

Infections: This is very rare but if it does occur it is usually resolved with oral antibiotics.

Poor Scar Quality: This is rarely an issue since the incisions are very small and well hidden. In some patients they can develop keloid, hypertrophic scars or wide scars. Usually, a simple scar revision can improve the scar. (Unless it is a keloid.)

Reaction to the lidocaine or epinephrine: This is extremely rare, it could create heart arrhythmia. Lidocaine and epinephrine are the key ingredients in our tumescent fluid. These medicines are crucial in helping with pain control and controlling bleeding during liposuction. It is used cautiously, this medicine can be given in certain doses, if higher doses than recommended are used it can create heart arrhythmia.

Though most of these complications are rare, we believe every patient has a right to know and make an educated judgment. Please read the preconditions and risks page before embarking on any surgery.

Common Q & As

If you have questions other than those listed here, please view our complete page for Q & A.