What is Tumescence?

Tumescence refers to any object that is in a swollen or turgid state. Physicians have used artificial swelling as a surgical technique for over one-hundred years. By swelling the area of operation with a liquid solution, the nerves and blood supply are cushioned from any surgical incisions made with needles and blades. As a 1998 federal overview notes, this method was originally called “hard infiltration”, and underwent a wide variety of medical trial-and-error episodes that experimented with different instruments, techniques, and liquid solutions. In its current form, made popular by Dr. Jeffrey Klein and Dr. Ed Hamacher, the technique is called “tumescence anesthesia”.

Tumescence Anesthesia and Hair Surgery

This form of surgery is sometimes performed during strip surgeries, which is where a strip of flesh is removed from the donor area (usually the occipital scalp), dissected, and re-grafted onto the area in need of hair (recipient scalp). Here is how any basic strip surgery procedure can utilize tumescence anesthesia:

The anesthesia solution, that has been extremely diluted, is injected into the donor area.

  1. Since this area is going to be surgically removed, a physician will typically use more lidocaine in the donor area than they will use on the recipient scalp.
  2. The nerves and blood supply under the swollen donor area are somewhat protected from the surgeon’s scalpel during the removal. The donor strip is removed from the donor area and dissected as normal.
  3. During this stage, follicular units are removed from the strip and reformed into hair grafts. Much like the first step, the anesthesia solution is injected into the recipient scalp.
  4. This protects the nerves and blood supply from the scalpel while making recipient site incisions. The hair grafts are grafted onto the recipient scalp as normal.

Tumescence Anesthesia and Epinephrine

A physician may choose to combine lidocaine and epinephrine if they so desire. Epinephrine is a form of synthetic adrenaline that can restrict the blood flow when operating. This can be a useful way to minimize bleeding during the hair transplant. However, doing so also increases the risks of the tissue being denied oxygen for too long and dying. This complication can progress and develop into necrosis.

Potential Complications of Using Tumescence Anesthesia

Tumescence anesthesia is considered to be relatively safe, and complications typically arise only when the patient has an unknown sensitivity towards lidocaine or other anesthesia when used, or if the doctor gives the patient an incorrect dosage. These complications usually present themselves within minutes of the initial injection, though delayed reactions are known to occur. Potential complications may include the following:

  • Unusual circumoral (mouth) sensations such as numbness, prickling, or burning. These sensations may occur in the tongue as well. The patient may also develop a metallic taste in their mouth.
  • Dizziness, or a feeling of being lightheaded.
  • Visual disturbances (for example, blurriness, or a lack of focus)
  • Audial disturbances (such as tinnitus, a condition marked by a persistent ringing in the ears)
  • Confusion
  • Lethargy
  • Involuntary muscle twitching (including convulsions)
  • A loss of consciousness or a coma
  • Respiratory problems
  • Cardiovascular problems
  • Chest pains
  • Heart palpitations
  • A change in blood pressure

Tumescence is also used in some clinics to increase their ability to “dense pack” hair grafts, typically in the hairline region. When the forehead and hairline area are inflated via tumescence the tissue is expanded. This expansion lasts between ten to thirty minutes before the tissue returns to normal. When incisions are made into the inflated tissue they are made at a safe distance apart from each other. If incisions are made too close the tissue in between the incisions can disintegrate leaving larger incisions than were intended. This can lead to excessive trauma to the tissue and subsequent tissue death (necrosis) or graft failure. After incisions are properly and safely made into tissue that has been tumesced the incisions move closer and closer until the tissue has completely returned to normal. It is similar to making dots on an expanded balloon with a marker then deflating the balloon. This allows the incisions to eventually be very close to each other without causing undue trauma.

In FUSS, tumescence works in a similar manner. When tumescence is applied to the donor zone the follicular bundles are spread apart by the tissue expansion. This creates a much more visible path for the physician’s scalpel to pass in between the follicular units without transection.

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