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Tumescent Liposuction



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Wet Method of Liposuction

Tumescent is a treatment administered just prior to liposuction, during the same surgical session.  This method of liposuction is the oldest version that is still utilized today.

Tumescent involves utilizing the area to be treated with sterile solution to help plump the fat cells and distinguish the fat layer from the overlying soft tissue and underlying muscle and organs.  Essentially, tumescent magnifies the fat layer, making it technically easier to remove.  The saline is generally combined with the appropriate balance of lidocaine or some other local anesthetic for the patient's comfort during and immediately after liposuction, and epinephrine to constrict blood vessels and reduce bleeding and bruising. 




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Tumescent is also referred to as:




The Wet Technique refers to the use of fluid injection prior to liposuction treatment.  The surgeon administers a small amount of fluid, less in volume than the amount of fat to be removed. (which contains epinephrine) directly into the tissue.   The amount of fluid is somewhere around six to eight ounces.



This solution contains:

  • lidocaine - anesthetize the local area

  • epinephrine - constrict the blood vessels to minimize bleeding

  • saline - helps separate the tissues during the procedure

This injected fluid helps to loosen the fat cells and reduce bruising.  This results in less blood loss during the procedure and also will reduce the amount of patient discomfort after surgery. 






This technique is done with injecting a solution in which contains lesser amount of anesthetics (lidocaine and epinephrine).  This procedure requires either IV sedation or general anesthesia


Basically the super-wet technique is similar to tumescent liposuction but introduces less fluid into the area to be treated: Normally a 1:1 proportion of the fluid to inject to the fat/fluid aspirated.  Super Wet Liposuction is a safe method, and some say safer than tumescent liposuction because of the fact there is a lower risk of fluid overload. 


There is more blood loss with the super-wet method than with the tumescent technique.  It has been stated that eight percent of the fluid removed through "super wet" is in fact blood - unlike the tumescent technique where only one percent of the fluid removed is blood.


The benefits of the Super Wet Technique is that the surgeon doesn't have to wait for swelling to go down before starting the liposuction.  The procedure takes approximately two hours and the patient can also opt to have other procedures done at the same time.  The procedure time is much quicker than the tumescent method which could possibly take up to four or five hours.






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  • Anesthesia used for Tumescent Liposuction

Tumescent liposuction fluid numbs the entire surgical area - and the effects of the tumescent fluid permits the patient to remain comfortable for several hours after the procedure. 

Tumescent liposuction can be done under the following methods of anesthesia:





  • Tumescent Solution

Tumescent Solution is composed of Epinephrine, Lidocaine, and Saline - which is injected into the surgical area where the liposuction is going to be performed.  Tumescent anesthesia with highly diluted lidocaine and epinephrine has transformed lipoplasty from a highly vascular surgery to a painless and bloodless procedure.

The area after injection becomes swollen immediately which comes from the surrounding tissue absorbing the medication.


How Tumescent Anesthesia Works:

  • Saline helps separate the tissues during the procedure – making the dissection much less traumatic

  • Epinephrine causes the tiny blood vessels in the area to constrict, minimizing bleeding and bruising.

  • Lidocaine numbs the area to provide pain control.

  • With tumescent anesthesia, large volumes of anesthesia are used in much lower concentrations.

  • The risk of Lidocaine toxicity is greatly reduced.







Several advantages of the tumescent liposuction include the following:

  • Significant less blood is lost during the liposuction procedure.

  • Smaller incisions are used on the patient.

  • General anesthesia is not normally needed.

  • Lidocaine is the safest for tumescent liposuction of all the available local anesthetic drugs.

  • IV fluid replacement is not necessary.

  • Bacteriostatic lidocaine *may* decrease the risk of infections.

  • Tumescence magnifies defects – hence making the likelihood of needing a secondary procedure less.

  • Better control of the area being sculpted.

  • Lipid-soluble lidocaine sometimes is suctioned out with the aspirated fat.

  • Vasoconstriction minimizes absorption.

  • The epinephrine may increase the cardiac output, which increases the hepatic metabolism of the lidocaine.

  • The duration of anesthetic effect may last as long as 24 hours.

  • Less discomfort for the patient.

  • The lidocaine may be given safely up to 45 mg/kg and even higher in certain conditions.

  • Reduced recovery time for the patient.

  • Reduced swelling and bruising

  • Reduced post operative bleeding.

  • Tried and true method of liposuction - very versatile procedure.



The three risks of tumescent liposuction are:

  • Lidocaine toxicity from an excessively high concentration of the drug in the blood

  • Injury from a needle used to inject the local anesthetic drug.

  • Fluid accumulation (seromas) - if this complication occurs, the fluid will need to be drained.






Common side effects of tumescent lidocaine that are not considered signs of toxicity include:

  • Mild sleepiness – some patients might experience some sleepiness during and after tumescent liposuction, even if no sedatives are given.

  • Nausea and vomiting – nausea and vomiting associated with tumescent local anesthesia is not common, but it can occur.  Other drugs that are given during the procedure such as antibiotics, sedatives related to Valium, and all narcotics can increase nausea and vomiting.  Most medications should be given on a full stomach, to minimize nausea.





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