The Tumescent Technique for Lipo-Suction Surgery

The tumescent technique of lipo-suction is a modification of the wet technique. A large volume of very dilute epinephrine is infiltrated into a targeted fat compartment prior to lipo-suction, producing a swelling and firmness. This tumescence of fat permits an increased accuracy in lipo-suction and minimizes postsurgical irregularities or rippling of the skin. Epinephrine-induced vasoconstriction minimizes blood loss, bruising, and postoperative soreness. Safe, rapid infiltration of large volumes of solution is achieved using a closed sterile system featuring a newly designed blunt-tipped, 30-cm-long, 4.7-mm-diameter needle having a hollow handle that accommodates a 60-cc syringe. Attached to a liter bottle of anesthetic solution by an intravenous line, the needle is inserted via the same incision and deposits the solution along the same path as that intended for the lipo-suction cannula. Thus, the solution is infiltrated exactly where it is needed for hemostasis or local anesthesia. Used in conjunction with general anesthesia, the tumescent technique saves time in achieving maximal vasoconstriction of the targeted fat compartment. If dilute lidocaine (0.1%) is added to the solution, the technique permits lipo-suction of more than 2 liters of fat totally by local anesthesia. Twenty-six patients, having received a mean lidocaine dose of 1250 mg (18.4 mg/kg or 8.5 mg/kg/hr) infiltrated into subcutaneous fat, had a mean serum lidocaine level of less than 0.36 μg/ml 1 hour after completion of the infiltration.