eMedicine Specialties > Clinical Procedures > none

Tumescent Liposuction

Author: Ron M Shelton, MD, Assistant Professor, Department of Dermatology, Mount Sinai School of Medicine; Director, The New York Aesthetic Consultants, LLP
Coauthor(s): Cameron K Rokhsar, MD, Assistant Clinical Professor, Department of Dermatology, Albert Einstein College of Medicine
Contributor Information and Disclosures

Updated: Mar 6, 2008

Introduction

Liposuction is the most commonly performed cosmetic procedure in the United States. It is also referred to as liposculpture, lipoplasty, and suction-assisted lipectomy. The ideal candidate is physically fit and eats well-balanced meals but is unable to reduce a fatty deposit that is well localized and often seems to involve a genetic susceptibility.

In the past, the surgery required blood transfusions because blood loss in the aspirate was significant. Dr Jeffrey Klein, a dermatologic surgeon, is credited as the originator of the tumescent technique, which has allowed liposuction to be performed with the patient under local anesthesia while minimizing blood loss and the risks of general anesthesia. Since its inception, liposuction performed with the tumescent technique has had an excellent safety profile.1

History

In 1921, Dujarrier, a French surgeon, curetted a ballerina's knees to create a better shape, but the patient developed gangrene and required an amputation. In 1964, Schrudde developed curettage and suction. Georgio and Arpad Fischer, Italian surgeons, developed cannulae and an internally rotating planatome and cellusuctiontome. Other cannulae were developed by Kesselring and Meyer and Illouz, the latter also developed the wet technique. Fournier favored the syringe technique and instructed physicians to use the cross-tunneling technique. The dry technique uses general anesthesia without any preoperative infiltration of vasoconstrictive solution. The wet technique achieves a moderate reduction in blood loss by using a small amount of epinephrine.

Dermatologic surgeons began performing liposuction since its evolution, and the number of dermatologists performing liposuction increased as studies showed the safety provided by the tumescent technique and the physiologic basis for the benefit of the procedure. As the number of cases performed increased, surveys of physicians corroborated its safe track record.

Advantages

The several advantages of the tumescent approach include the following:

  • Less blood is lost.
  • Intravenous fluid replacement is not necessary.
  • Bacteriostatic lidocaine may decrease the risk of infections.
  • Tumescence magnifies defects; therefore, the likelihood of needing a secondary procedure may be less.
  • Lipid-soluble lidocaine is somewhat suctioned out with the aspirated fat.
  • Vasoconstriction minimizes absorption.
  • The epinephrine may increase the cardiac output, which, in turn, hastens the hepatic metabolism of the lidocaine.
  • The duration of anesthetic effect may last as long as 24 hours.
  • The lidocaine may be given safely up to 45 mg/kg and even higher in certain conditions.

Indications

  • Liposuction is generally performed for the reduction of fatty deposits that are well localized and often seem to involve a genetic susceptibility.
  • Other situations exist that may benefit from tumescent liposuction. These include lipoma removal,9,10 Madelung disease, axillary hyperhidrosis,10 axillary bromhidrosis,11 evacuation of hematomas, pseudogynecomastia,10,12 and the controversial staged liposuction for persons who are morbidly obese.

Contraindications

  • Unrealistic patient expectations
  • Poor physical health of patient
  • Patient who underwent crash dieting immediately prior to consultation
  • Morbid obesity (megaliposuction controversial due to higher risk of mortality from fluid shifts)

More on Tumescent Liposuction

Overview: Tumescent Liposuction
Treatment & Medication: Tumescent Liposuction
Multimedia: Tumescent Liposuction
References
Further Reading
[ CLOSE WINDOW ]

References

  1. Bernstein G, Hanke CW. Safety of liposuction: a review of 9478 cases performed by dermatologists. J Dermatol Surg Oncol. Oct 1988;14(10):1112-4. [Medline].

  2. Hanke CW, Bernstein G, Bullock S. Safety of tumescent liposuction in 15,336 patients. National survey results. Dermatol Surg. May 1995;21(5):459-62. [Medline].

  3. Klein JA. The tumescent technique. Anesthesia and modified liposuction technique. Dermatol Clin. Jul 1990;8(3):425-37. [Medline].

  4. Klein JA. Tumescent technique chronicles. Local anesthesia, liposuction, and beyond. Dermatol Surg. May 1995;21(5):449-57. [Medline].

  5. Klein JA. Tumescent technique for local anesthesia improves safety in large-volume liposuction. Plast Reconstr Surg. Nov 1993;92(6):1085-98; discussion 1099-100. [Medline].

  6. Klein JA. Anesthesia for dermatologic cosmetic surgery. In: Coleman WP III, Hanke CW, Alt TH, Asken S. Cosmetic Surgery of the Skin: Principles and Techniques. Philadelphia, Pa: BC Decker; 1991:39-45.

  7. Klein JA. Tumescent technique for regional anesthesia permits lidocaine doses of 35 mg/kg for liposuction. J Dermatol Surg Oncol. Mar 1990;16(3):248-63. [Medline].

  8. Prado A, Castillo P, Gaete F. Does vacuum pressure extraction of fat affect the infranatant cellularity of liposuction specimens?. Plast Reconstr Surg. Nov 2005;116(6):1832-3. [Medline].

  9. Alexander RW. Liposculpture in the superficial plane: closed syringe system for improvements in fat removal for lipomas. J Dermatol Surg Oncol. 1985;11:1070-4.

  10. Coleman WP 3rd. Noncosmetic applications of liposuction. J Dermatol Surg Oncol. Oct 1988;14(10):1085-90. [Medline].

  11. Seo SH, Jang BS, Oh CK, Kwon KS, Kim MB. Tumescent superficial liposuction with curettage for treatment of axillary bromhidrosis. J Eur Acad Dermatol Venereol. Jan 2008;22(1):30-5. [Medline].

  12. Ramon Y, Fodor L, Peled IJ, Eldor L, Egozi D, Ullmann Y. Multimodality gynecomastia repair by cross-chest power-assisted superficial liposuction combined with endoscopic-assisted pull-through excision. Ann Plast Surg. Dec 2005;55(6):591-4. [Medline].

  13. Katz B, McBean J, Cheung JS. The new laser liposuction for men. Dermatol Ther. Nov-Dec 2007;20(6):448-51. [Medline].

  14. Asken S. Refinements in the technique of liposuction. J Dermatol Surg Oncol. Oct 1988;14(10):1165-72. [Medline].

  15. Coleman WP. Evaluation of the patient for liposculpture. J Dermatol Surg Oncol. 1991;17:740.

  16. Stegman SJ, Tromovitch TA, Glogau RG, eds. Cosmetic Dermatologic Surgery. 2nd ed. Chicago, Ill: Year Book Medical Publishers; 1990:251-75.

  17. Field LM. The dermatologist and liposuction--a history. J Dermatol Surg Oncol. Sep 1987;13(9):1040-1. [Medline].

  18. Klein JA. Anesthesia for liposuction in dermatologic surgery. J Dermatol Surg Oncol. Oct 1988;14(10):1124-32. [Medline].

  19. Klein JA. The tumescent technique for liposuction surgery. Amer J Cosm Surg. 1987;4:263-7.

  20. Lillis PJ. Liposuction surgery under local anesthesia: limited blood loss and minimal lidocaine absorption. J Dermatol Surg Oncol. Oct 1988;14(10):1145-8. [Medline].

  21. Matarasso A. Superficial suction lipectomy: something old, something new, something borrowed.... Ann Plast Surg. Mar 1995;34(3):268-72; discussion 272-3. [Medline].

  22. Nguyen PV, Merszei J, Patel R, Truong LD, Ramanathan V. Acute renal failure after liposuction. Ren Fail. 2005;27(6):787-90. [Medline].

  23. Nordstrom H, Stange K. Plasma lidocaine levels and risks after liposuction with tumescent anaesthesia. Acta Anaesthesiol Scand. Nov 2005;49(10):1487-90. [Medline].

  24. Rothmann C, Ruschel N, Streiff R, Pitti R, Bollaert PE. [Fat pulmonary embolism after liposuction]. Ann Fr Anesth Reanim. Feb 2006;25(2):189-92. [Medline].

  25. Skouge JW. The biochemistry and development of adipose tissue and the pathophysiology of obesity as it relates to liposuction surgery. Dermatol Clin. Jul 1990;8(3):385-93. [Medline].

[ CLOSE WINDOW ]

Keywords

tumescent liposuction, tumescent anesthesia, tumescence, tumescent liposculpture, suction lipolysis, superficial liposuction, suction lipectomy, lipoplasty, suction-assisted lipectomy, tumescent technique

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Ron M Shelton, MD, Assistant Professor, Department of Dermatology, Mount Sinai School of Medicine; Director, The New York Aesthetic Consultants, LLP
Ron M Shelton, MD is a member of the following medical societies: American Academy of Cosmetic Surgery, American Academy of Dermatology, American College of Mohs Micrographic Surgery and Cutaneous Oncology, American Medical Association, American Society for Dermatologic Surgery, American Society for Laser Medicine and Surgery, American Society of Lipo-Suction Surgery, International Society for Dermatologic Surgery, New York County Medical Society, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Coauthor(s)

Cameron K Rokhsar, MD, Assistant Clinical Professor, Department of Dermatology, Albert Einstein College of Medicine
Cameron K Rokhsar, MD is a member of the following medical societies: American Academy of Cosmetic Surgery, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for Laser Medicine and Surgery, American Society for Liposuction Surgery, and American Society for MOHS Surgery
Disclosure: Nothing to disclose.

Medical Editor

Shobana Sood, MD, Assistant Professor, Department of Dermatology, University of Pennsylvania Hospital
Shobana Sood, MD is a member of the following medical societies: American Academy of Dermatology and American Society for Dermatologic Surgery
Disclosure: Nothing to disclose.

Pharmacy Editor

Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University School of Medicine; Consulting Staff, Mountain View Dermatology, PA
Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

John G Albertini, MD, Consulting Staff, Dermatologic Surgery, The Skin Surgery Center; Program Director, ACGME accredited Fellowship in Procedural Dermatology
John G Albertini, MD is a member of the following medical societies: American Academy of Dermatology and American College of Mohs Micrographic Surgery and Cutaneous Oncology
Disclosure: Nothing to disclose.

CME Editor

Joel M Gelfand, MD, MSCE, Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania
Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology
Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds Investigator; Genentech Grant/research funds investigator; Centocor Consulting fee Consulting; Abbott Grant/research funds investigator; Abbott Consulting fee Consulting; Novartis  investigator; Pfizer Grant/research funds investigator; Celgene Consulting fee DMC Chair; NIAMS and NHLBI Grant/research funds investigator

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.