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Step One: Tumescent Anesthesia

My process for performing liposuction begins with preparation of the tissue with tumescent anesthesia. This technique involves injecting a dilute solution of local anesthetic combined with epinephrine and sodium bicarbonate into tissue until it becomes firm (tumescent) and white in color. This is an important preparatory step as the epinephrine paired with the pressure of the fluid causes the blood vessels to constrict (vasoconstriction). This creates a bloodless field, for a safer procedure with less bleeding—as there is significant blood stored in fat. In addition, the fluids from the tumescent anesthesia hydrodissect the treatment field, helping to release and break apart the subcutaneous layer, preparing it for the next step.

Step Two: Debulk and Mechanical Release

Using a sonic vibrational device, such as power assisted liposuction, I release and break apart the fibrous connective tissue in the fat layer. This step is of particular importance for both revision liposuction and lipedema patients as it helps to break up the fibrous scar tissue common in these patients.

Step Three: VASER

VASER liposuction uses ultrasonic vibration, or “vibration amplification of sound energy at resonance” (VASER) to further emulsify the fat layer and further release the fibrous connective tissues. The emulsification of the fat, creates an oily, slippery substance that protects the skin, helping it to retract back in a more even fashion.

Step Four: Fine Sculpting

Fine Sculpting uses smaller cannulas to perform precise sculpting of the tissue as the layer gets thinner. The cannulas are always kept parallel to the skin surface in a precise plane—I never jab into the skin from underneath. This step assists in the even contraction of the skin without causing ripples.

Step Five: Skin Tightening

Depending on the individual, I may add the additional step of skin tightening using radio frequency Body Tite or JPlasma, which is ionized helium gas. This is not necessary for patients with outstanding skin elasticity.

David Amron, MD

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