At first, you might think that liposuction has very little to do with varicose veins treatment and removal. Well, in fact, the modern era of vein treatments was made possible by a Californian dermatologist called Dr Jeffery Klein. In 1997, he invented a new local anaesthetic technique for liposuction called Tumescent Local Anaesthetic – TLA for short. In a matter of just a few years, it changed a dangerous, brutal operation performed under general anaesthetic with big cannulas into a gentle, precise outpatient procedure performed under local anaesthetic. Dr Klein also introduced microcannulas so that the excess fat could be removed through tiny punctures only a few millimetres in size.
In 1995, the first reports of vein removal with TLA were published in the medical literature. The powerful advantages of TLA were soon recognised by vein specialists world-wide and now modern phlebologists can treat all vein problems under local anaesthetic as a walk in, walk out procedure in a clinic rather than in a hospital and without general anaesthetic.
So what is TLA? Dr Klein invented the use of large volumes of very dilute local anaesthetic to which adrenaline has been added. Most people recognise adrenaline as the hormone released by the adrenals in the “fight and flight” response. When used in local anaesthetics, it causes the blood vessels to constrict – so the action of the anaesthetic is prolonged (lasting 10 hours or more) and there is no bleeding during procedures. In vein treatments, TLA causes the veins to collapse and they are easier to remove. As with liposuction, TLA has revolutionised vein treatments from a brutal, surgical operation, into a precise, gentle procedure performed in a few hours.
The Advantages of Vein Treatments under Local Anaesthetic
I first used TLA in my vein practice in 2002. I was one of the first surgeons in the UK to perform phlebectomy using TLA and in 2008 I invented a new technique of phlebectomy that doesn’t leave a surgical scar. As a vascular surgeon, I was used to performing vein procedures in a hospital operating theatre under general anaesthetic, so TLA took a bit of getting used to! However, with in a few months, the advantages were very clear to me. In the last 8 years, I have only performed a vein treatment under general anaesthetic once and this was for a lad of 18 years old, who was too nervous for TLA. I am amazed that most vascular surgeons in the UK still treat people with varicose veins under a general anaesthetic. Only this month a patient came to me who had been told by a Harley Street surgeon that a “proper job can only be done under a general” and yesterday I treated the varicose veins in both legs of a lady in Bristol who had been told by a professor of surgery that her veins could only be done under a general anaesthetic. What nonsense!
There are many advantages of TLA for varicose vein removal and here are a few
- Faster recovery
- Less bruising
- More precise technique
- Fewer complications
- No need for hospital
- Less risk of infection
- Less costly
So why don’t all vein specialists use TLA?
With an impressive list of advantages, you would think that all vein treatments would be performed under local. Well, there are some disadvantages and they all relate to the surgeon:
- Patience and extra time are needed for the local anaesthetic to work
- The patient is awake and the surgeon may need to talk to him or her
- Not all surgeons have the right temperament for TLA
- A gentle technique is needed
- A nervous patient will need reassurance and kindness
General Anaesthetics for vein procedures are really for the benefit of the surgeon, not for the benefit of the patient.
What if I am nervous?
Most people are nervous about having anything “surgical” done and most people don’t like needles. My team and I understand that, so we will treat you with a gentle technique, reassurance and kindness. I am confident that at the end of the procedure you will be pleased you chose TLA rather than GA.
If you have only been offered vein treatment under a GA, challenge this and ask about TLA instead.
Contact me today for a confidential chat
If you would like to know more about vein treatments under TLA or if you’re worried about your veins and would like a confidential chat please do get in touch. I am happy to offer simple advice by telephone and email for free and without obligation.
Klein JA. Tumescent technique for liposuction surgery. Am J Cosmetic Surg 1987; 4: 263-7
Cohn MS, Seiger E, Goldman S. Ambulatory Phlebectomy using the tumescent technique for local anesthesia. Dermatol Surg 1995; 21: 315-18 http://www.ncbi.nlm.nih.gov/pubmed?term=Cohn%20tumescent%20phlebectomy