What is wet liposuction, and how is the wet technique different from dry?

Wet liposuction, or the wet technique, is one of the four main types of liposuction that a 2011 article in an anaesthesia journal sorts by the volume of infiltration or wetting solution injected: dry, wet, superwet and tumescent[1]. In that classification, dry and wet liposuction are separate types that differ in the volume of infiltration or wetting solution injected[1]. A 1994 study concluded that blood loss with the tumescent or superwet technique is dramatically reduced compared with the dry or classical “wet” technique[2].

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What is wet liposuction?

Wet liposuction is a name for one of the four main liposuction techniques listed in a 2011 anaesthesia journal article, which groups them by the volume of infiltration or wetting solution injected[1]. The four techniques in that article are dry, wet, superwet and tumescent[1].

In the 2011 article, the wetting solution used in the tumescent technique is described as large volumes of dilute local anaesthetic injected into the fat[1]. The same article describes the tumescent technique as one of the most common liposuction techniques[1].

A 2006 prospective study noted that different infiltration practices, such as the wet, superwet and tumescent techniques, require different fluid management guidelines[3].

If the names are confusing, ask your surgeon which of these techniques they plan to use.

How is the wet technique different from dry liposuction?

In the classification used by the 2011 article, dry and wet liposuction are separate types, defined by the volume of infiltration or wetting solution injected[1].

A 1994 study grouped the dry technique with the classical “wet” technique when it concluded that blood loss is dramatically reduced with the tumescent or superwet technique[2]. The measurements in that 1994 study came from 25 consecutive cases done with the tumescent or superwet technique[2].

Read our page on the dry technique.

Why is fluid injected before liposuction?

According to the 2011 article, large volumes of dilute local anaesthetic are injected into the fat in the tumescent technique to facilitate anaesthesia and decrease blood loss[1]. A 2009 randomized trial described the objective of tumescent solution containing lidocaine as diminishing postoperative analgesic needs and blood loss[4].

The authors of that 2009 trial wrote that the use of tumescent solution containing lidocaine to infiltrate the fat before surgery has been accepted as the standard of care for these procedures[4]. They also wrote that the role of that solution in hematocrit reduction was not clear at the time[4].

A 1997 report described 85 consecutive lipoplasty patients who had liposuction under epidural anaesthesia after the fat was perfused with a wetting solution containing epinephrine and lidocaine[5]. Those authors used the wetting solution in their practice only for control of blood loss and postoperative pain[5]. They found that the solution provided an inadequate level of anaesthesia for many of their patients, and their anaesthetic of choice for liposuction was the epidural block technique[5].

Does what is in the fluid matter?

In a 2009 randomized, double-masked trial, 70 consecutive women having liposuction as a single surgery were randomly assigned to two groups[4]. The study group received tumescent solution containing lidocaine and epinephrine, while the control group received tumescent solution containing only epinephrine[4].

In that trial, the mean hematocrit reduction was 10.8% in the lidocaine and epinephrine group, compared with 8.8% in the epinephrine-only group[4]. The authors concluded that lidocaine in the tumescent solution significantly increases postoperative anaemia compared with epinephrine infiltration alone[4].

What do studies report about blood loss with fluid infiltration?

In the 1994 study of 25 consecutive cases using the tumescent or superwet technique, the mean fall in postoperative hemoglobin was 5.4%[2]. Hemoglobin was also measured in the fluid fraction of the aspirate in that study[2].

A 1993 report stated that the tumescent technique for local anaesthesia improves the safety of large-volume liposuction by virtually eliminating surgical blood loss[6]. In 31 large-volume liposuction patients treated in 1991 in that report, the mean difference between preoperative and one-week postoperative hematocrits was -1.9 percent[6].

A 2012 prospective study of 322 consecutive patients having superwet ultrasonic liposuction and/or abdominoplasty and other combined procedures concluded that estimated blood loss is higher than previous estimates based on lipocrits[7]. The authors of that study wrote that blood loss has been underestimated using the small volumes present in the aspirate[7].

In a 1999 report on 181 patients who had large-volume liposuction, blood loss was calculated in 45 patients from hematocrits taken before surgery and five days afterwards[8]. In those calculations, there was no correlation between the aspirate volume and the calculated blood loss, and the majority of the calculated blood loss was not in the canister[8].

The 2011 article noted that assessment of blood loss is difficult, as the blood is mixed with the aspirated fat[1].

How does wet liposuction relate to superwet and tumescent liposuction?

In the 2011 article, wet, superwet and tumescent are three of the four main liposuction techniques, separated by the volume of infiltration or wetting solution injected[1]. A 2010 review described tumescent liposuction as a local anaesthesia technique and superwet liposuction as a systemic anaesthesia technique, and called them the most common methods[9].

The 2010 review described the safety profile of both the tumescent and superwet methods as excellent, and noted that local anaesthesia avoids the specific risks associated with general anaesthesia[9]. Read our page on the tumescent technique.

A 1997 study measured adipsin/factor D, a serine protease present in high amounts in fat tissue, in 22 patients having syringe-assisted liposuction with the superwet or tumescent technique[10]. Only a very modest increase in adipsin/factor D was found during liposuction, and all values were within the range found in healthy blood donors[10].

What do safety reviews say about the wet technique?

A 2019 systematic review of 24 safety studies listed the use of the (super)wet technique among the factors that contributed to increased serious complication and mortality risk[11]. The same review also listed the use of systemic anaesthetics, especially general anaesthesia and intravenous sedation, and combination with other procedures among those factors[11].

The authors of the 2019 review concluded that liposuction using tumescent local anaesthesia has been shown to be the safest method of fat removal, especially if no or only minimal systemic anaesthesia is used[11]. They added that, regardless of physician specialty, knowledge and training on the execution of the tumescent procedure are vital to ensure optimal safety[11].

You can read more in our article on liposuction safety studies.

How does fluid infiltration affect anaesthesia and fluid balance?

The 2011 article stated that, as a large volume of wetting solution is injected into the tissue under the skin, intraoperative fluid management has to be carefully titrated along with haemodynamic monitoring and temperature control[1]. The same article stated that small volume liposuction may be done under local or monitored anaesthesia care, while large-volume liposuction requires general anaesthesia[1].

Two other sources describe large-volume liposuction without general anaesthesia[12][6]. A 2008 series of 870 liposuction cases preferred regional anaesthesia with conscious sedation, except for liposuction above the subcostal region or when the patient so desired[12]. In the 1993 report on large-volume tumescent liposuction, the last 87 patients received no parenteral sedation[6].

In a 2006 prospective study, 580 consecutive patients had liposuction using an average infiltrate-to-total aspirate ratio of 0.38, which the study’s title describes as lower than used for the superwet technique[3]. The authors presented a fluid management guideline based on those 580 patients, but cautioned that the calculated volumes from all the formulas should be viewed as educated guesses and that clinical judgment is essential[3].

The background of that 2006 study noted that surgeons have undertaken aspirations with larger volumes and that the potential complications of hypovolemia and fluid overload have materialized[3]. For more on anaesthesia choices, see our page on the risks of general anesthesia.

Talking to a surgeon

A board-certified surgeon can explain which approach they would use for you and why. These questions may help you start that conversation:

  • Which technique do you plan to use: dry, wet, superwet or tumescent?
  • How much fluid do you plan to inject, and what will it contain?
  • What type of anaesthesia will I have, and why do you recommend it?
  • How will you monitor my fluid balance and blood loss during and after surgery?
  • What risks apply to the technique you plan to use?

If you develop chest pain, shortness of breath or heavy bleeding after liposuction, contact your surgeon or emergency services right away.

Frequently asked questions

What is wet liposuction?

Wet liposuction is one of four main liposuction techniques that a 2011 article in an anaesthesia journal groups by the volume of infiltration or wetting solution injected: dry, wet, superwet and tumescent[1].

Is wet liposuction the same as tumescent liposuction?

A 2011 article lists the wet and tumescent techniques as separate types in its classification by the volume of infiltration or wetting solution injected[1]. A 2006 study also named the wet, superwet and tumescent techniques as different infiltration practices that require different fluid management guidelines[3].

Does wet liposuction cause less bleeding than dry liposuction?

A 1994 study concluded that blood loss with the tumescent or superwet technique is dramatically reduced compared with the dry or classical “wet” technique[2]. The measurements in that study came from 25 consecutive cases done with the tumescent or superwet technique[2].

What anaesthesia is used with superwet and tumescent liposuction?

A 2010 review described tumescent liposuction as a local anaesthesia technique and superwet liposuction as a systemic anaesthesia technique[9]. That review noted that local anaesthesia avoids the specific risks associated with general anaesthesia[9].

References

  1. Liposuction: Anaesthesia challenges. Indian journal of anaesthesia. 2011. PubMed 21808392
  2. Blood loss during liposuction using the tumescent technique. Aesthetic plastic surgery. 1994. PubMed 8017219
  3. Fluid resuscitation in liposuction: a prospective analysis of infiltrate-to-total aspirate ratios lower than used for the superwet technique. Aesthetic plastic surgery. 2006. PubMed 17093883
  4. Effect of subcutaneous lidocaine infiltration on blood loss secondary to corporal lipoaspiration: a prospective, randomized, double-masked clinical trial. Aesthetic plastic surgery. 2009. PubMed 19484178
  5. Use of preoperative subcutaneous "wetting solution" and epidural block anesthesia for liposuction in the office-based surgical suite. Plastic and reconstructive surgery. 1997. PubMed 9393487
  6. Tumescent technique for local anesthesia improves safety in large-volume liposuction. Plastic and reconstructive surgery. 1993. PubMed 8234507
  7. Prospective study of lidocaine, bupivacaine, and epinephrine levels and blood loss in patients undergoing liposuction and abdominoplasty. Plastic and reconstructive surgery. 2012. PubMed 22929254
  8. Large-volume liposuction in 181 patients. Aesthetic plastic surgery. 1999. PubMed 10022931
  9. Liposuction. Obstetrics and gynecology clinics of North America. 2010. PubMed 21093746
  10. Modest release of adipsin/factor D by liposuction when using the superwet or tumescent technique. Plastic and reconstructive surgery. 1997. PubMed 9145127
  11. Safety Studies in the Field of Liposuction: A Systematic Review. Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.]. 2019. PubMed 30702445
  12. Liposuction. Indian journal of plastic surgery : official publication of the Association of Plastic Surgeons of India. 2008. PubMed 20174540

Liposuction.com Editorial Team.