Liposuction Techniques
Various categories of liposuction techniques are described in this page. The major features that distinguish the various liposuction techniques are:
- the amount of solution that is injected under the skin before liposuction
- the use of any additional devices to assist routine liposuction
Dry Technique
Dry Technique (no longer used) required general anesthesia. The dry technique derived its name from the fact that it did not use injections of local anesthesia into the fat before liposuction. This technique was abandoned because of the excessive blood loss it caused. Blood composed approximately thirty percent (30%) of the tissue that was removed by liposuction using the dry technique.
Wet Technique
Wet Technique also required general anesthesia. The wet technique required the injection of approximately 100 milliliters of local anesthesia containing epinephrine. Although the wet technique caused less blood loss than the dry technique, blood loss with the wet technique was still excessive and dangerous. Blood composed approximately 15% to 20% of the tissue removed by liposuction using the wet technique.
Super Wet Technique
Super Wet Technique also requires general anesthesia. The super wet technique requires the injection of a volume of dilute local anesthesia that is less than half the volume used for the tumescent technique. Surgical blood loss with the super wet technique is greater than the tumescent technique but significantly less than the wet technique. Approximately eight percent (8%) of the fluid removed by super wet liposuction is blood.
Tumescent Technique
Tumescent Technique (Tumescent Liposuction) requires an injection of a large volume of very dilute solution of local anesthesia containing lidocaine and epinephrine. The volume of dilute local anesthesia is usually sufficient to cause the targeted fat to become tumescent (swollen and firm). The tumescent technique is the only technique that permits liposuction totally by local anesthesia. Approximately one percent (1%) of the fluid removed by tumescent liposuction is blood.
Ultrasonic Assisted Liposuction (UAL)
Ultrasonic Assisted Liposuction (UAL) requires the use of a large volume of tumescent fluid and uses either a metal probe or metal paddle to deliver ultrasonic energy and heat into subcutaneous fat. Internal UAL is the term used to describe the technique where a long metal probe, which may be solid or hollow, is inserted into fat through a large incision. Among those surgeons who do internal UAL, most rely on the use of general anesthesia or heavy IV sedation. Internal UAL has largely been abandoned because of the risk of full-thickness skin burns and severe scaring. The initial reports of internal UAL were unrealistically enthusiastic. Some authors did not report their complications, and others have learned of major UAL complications after publishing their articles. External UAL requires the use of tumescent fluid and uses a metal paddle applied to the skin and directs ultrasonic energy into subcutaneous fat. External UAL does not improve liposuction results and can cause burns to the skin. Because there is insufficient proof of the safety of UAL devices, the FDA (Food & Drug Administration) has never given approval for marketing and advertising of UAL devices to be specifically used for liposuction.
Power Assisted Techniques (PAL)
Power Assisted Liposuction (PAL) devices have recently become available. PAL devices use power supplied by an electric motor or compressed air to produce either a rapid in-and-out movement or a spinning rotation of an attached liposuction cannula. Advocates of PAL assert that it makes liposuction easier for the surgeon. While some liposuction surgeons have expressed enthusiasm about PAL, many others remain skeptical about any advantages of PAL. There are no objective scientific publications to support the enthusiastic claims made by manufacturers of PAL devices.
Comparing Dry and Tumescent Techniques
The following two abstracts are excerpts from two articles published in the Plastic and Reconstructive Surgery Journal, and are provided to help you compare the differences in blood loss associated with the dry technique and the tumescent technique for liposuction. With the older dry technique for liposuction every patient required hospitalization, general anesthesia and blood transfusion because of the significant blood loss. The newer tumescent technique permitted liposuction in an office setting, totally by local anesthesia, and without any blood loss.
- Large-Volume Suction Lipectomy: An Analysis of 108 Patients (by Eugene H. Courtiss, M.D., et al., Division of Plastic Surgery, Department of Surgery, Harvard Medical School, Boston, MA).
We have treated 108 patients who had over 1500 ml of material removed. All patients were treated in the hospital; 44 percent were admitted after surgery. A total of 227 units of autologous and 2 units of homologous blood were transfused. As measured by a computerized monitor, the average amount of blood in the material removed from thighs was 30 percent; from abdomens, the blood loss was 45 percent. No complications were encountered. A few patients developed undesirable sequelae, the most common of which was seroma formation, which occurred in 19 percent of those who had suction of abdominal-wall fat. (Plastic and Reconstructive Surgery, volume 89, pages 1068-1079,1992). - Tumescent Technique for Local Anesthesia Improves Safety in Large-Volume Liposuction (by Jeffrey A. Klein, M.D., Capistrano Surgicenter, San Juan Capistrano, CA).
The tumescent technique for local anesthesia improves the safety of large-volume liposuction ( 1,500 ml fo fat) by virtually eliminating surgical blood loss and by completely eliminating the risks of general anesthesia. Results of two prospective studies of large-volume liposuction using the tumescent technique are reported. In 112 patients, the mean lidocaine dosage was 33.3 mg/kg, the mean volume of aspirated material was 2657 ml, and the mean volume of supranatant fat was 1945 ml. All patients were treated as outpatients. There were no hospitalizations. There were no transfusions. There were no complications. There were no seromas. The mean volume of whole blood aspirated by liposuction was 18.5 ml. For each 1000 ml of fat removed, 9.7 ml of whole blood was suctioned. In 31 large volume liposuction patients treated in 1991, the mean difference between preoperative and 1-week postoperative hematocrits was -1.9 percent. The last 87 patients received no parental sedation.(Plastic and Reconstructive Surgery, volume 92, pages 1085-1098,1993).