How Much Tumescent Volume can be used During Liposuction

How Much Tumescent Volume can be used During Liposuction

A 21 year old male who had high definition liposuction of his abdomen, flanks, and lower back.

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What is tumescent solution?

Tumescent solution volumes have evolved throughout the last half of the 20th century. You might be surprised to know that in 1960 no tumescent solution was utilized at all, termed dry lipo. Tumescent liposuction was first introduced in 1982 and intended to provide two functions. The first role of tumescent was to provide pain control. This was achieved with the addition of Lidocaine which remains a numbing, or local anesthetic. The addition, of bicarbonate to this solution  serves to change he pH of the solution to allow for quicker onset of lidocaine which is able to traverse the cell membrane of nerve cells in more basic conditions. Both of these were added to a large lactated ringers solution, a solution that mimics the physiologic fluid in your body, as a means of expanding the tumescent fluid volume so that it can cover a larger area.  Surprisingly, tumescent solution components have changed minimally until  the advent of ultrasound assisted VASER liposuction in 1995 that led to the advancements in body contouring, termed high definition liposuction. High definition VASER liposuction ruotinely utilizes the maximum safe volume of infiltrate since it employs 360 degrees of liposuction. High definition liposuction by definition must create a body contour for clients that is masterful in appearance, almost like a glorified sculpture. As a result all concern areas must be addressed in order to meet high definition  body contouring results. In the state of California, the maximum allowed tumescent liposuction volume of infiltration and aspiration remains 5 Liters. This is under the assumption that wet liposuction technique is utilized using a 1 to 1 infiltration and aspiration volume. In contrast, Laser liposuction was developed in 2006 that uses a superwet liposuction technique with infiltration to aspiration volumes of 3 to 1. In this scenario, smaller overall volumes of aspiration are utilized since out of the maximum 5 Liters infiltrated only 1/3rd of that or 1.6 Lilters of aspirate can be harvested. 

Several modifications of the tumescent solution have been made with the advent of high definition liposuction. The first involves using ½% Lidocaine rather than 1 % lidocaine. This is because of the routine maximum volumes of tumescent liposuction used and an effort to minimize the risk of Lidocaine toxicity. This is tolerated since patients that undergo high definition liposuction are placed under general anesthesia in contrast to awake liposuction with Laser liposuction. Another modification involves the use of transamenic acid which minimizes blood loss. Another measure taken to avoid unnecessary blood loss is the addition of Clonidine to decrease local pressures which will increase local blood pressure and increase blood loss. Finally, the addition of dexamethasone, a steroid, allows us to minimize the inflammatory response. This is important since high definition liposuction utilizes more comprehensive fat removal which can result in more tissue irritation. The use of a steroid will act to taper the inflammatory response that can promote soft tissue scarring. 

If you are interested in the volume of tumescent and exact makeup of the solution that will be utilized in your case, we encourage you to make a consultation with one of our SurgiSculpt coordinators today.

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