Analysis of Tumescent Liposuction: How to Achieve Minimal Bleeding and Highly Effective Localized Weight Loss

Tumescent liposuction:

The tumescent method involves the local injection of a large amount of low-concentration local anesthetic and saline solution, which reduces bleeding and prolongs anesthesia.

The indications, preoperative examinations, instruments, and complications of the tumescent method are basically the same as those of wet liposuction.

Clinical studies have shown that with the tumescent method, the peak absorption of lidocaine in serum occurs 12–24 hours after infiltration anesthesia. This delayed absorption indicates that larger doses of lidocaine can be used.

The maximum safe dose of lidocaine in tumescent liposuction is 35 mg/kg, approximately five times the standard lidocaine dose (7 mg/kg), with an average of 28 mg/kg. Its local anesthetic effect can last for 18 hours, avoiding the need for postoperative analgesia. The prolonged and deepened effect of local anesthesia may be due to the sufficient exposure of sensory nerve axons, resulting in lidocaine blockade. Simultaneously, the diluted adrenaline solution infiltrates and diffuses throughout the surgical site, causing vasoconstriction, minimizing blood loss and trauma during the procedure, while also ensuring thorough liposuction and ease of operation.

(I) Preparation of Local Anesthetic Solution (Tumescent Solution): Mix 50ml of 2% lidocaine, 12.5ml of sodium bicarbonate injection, 1ml of 1:1000 adrenaline, and 1000ml of 0.9% physiological saline. Sodium bicarbonate buffers the acidity of lidocaine, reducing stinging sensation during local anesthetic infiltration and increasing the duration of lidocaine's action.

(II) Injection Method: The injection needle is slender, 0.2cm in diameter, and 12cm or 25cm in length, with a blunt, rounded tip and multiple small holes on the side of the anterior segment. Connect the injection needle to a 60ml syringe using a three-way valve. At the selected incision site, administer 1 ml of 1% lidocaine for local anesthesia. Make the incision and slightly separate the subcutaneous fat layer. Through this incision, use a long injection needle to infiltrate the subcutaneous fat within the aspiration area for anesthesia. After injection, the local anesthetic solution will be uniform, firm, and locally whitish, with a cool touch.

(III) Surgical Procedure: Begin fat aspiration at least 15 minutes after local anesthesia injection. Insert the aspiration cannula through the skin incision into the fat layer and perform repeated sawing aspiration. Use a larger cannula initially, followed by a smaller one, gradually moving from deep to superficial layers. On the muscle surface, the suction hole should face upwards; in the superficial layers, the suction hole should face downwards. While the right hand aspirates, the left hand assists by squeezing the fat towards the suction hole. Use a larger inner diameter cannula initially, followed by a smaller one. The specific technique is basically the same as traditional aspiration, but the tumescent method facilitates aspiration. Initially, the aspirated fluid is a light, relatively uniform yellow liquid, with a small amount of pinkish fluid appearing only at the end. During liposuction, localized fat can be removed more accurately and evenly.

(IV) Postoperative Management
Postoperative management is generally the same as for traditional liposuction. The surgical area is tightly bandaged with an elastic bandage over a cotton pad. The lower limbs are kept in a supine position or the upper limbs are immobilized for one week. After suture removal, compression garments are worn for at least three months. Antibiotics and hemostatic agents are administered postoperatively, and fluid replacement is given if necessary. Adhesive tape containing triamcinolone acetonide-A is applied to the incision scar for 2-3 months.

(V) Complications
Complications are similar to those of traditional liposuction, but are milder and recovery is faster.

(VI) Advantages of Tumescent Liposuction

Advantages:
① Less bleeding: only 10-20ml of blood is lost per 100ml of fat removed;
② Faster postoperative recovery;
③ Better anesthesia: not only does it eliminate the need for general anesthesia, reducing its risks, but it also provides longer postoperative anesthesia;
④ Ideal local fat removal results: Tumescent liposuction enlarges fat cells, "expanding" the thickness of local fat, making it easier to remove and allowing for easy local "sculpting," maximizing the removal of local fat with excellent results. It can also achieve ideal results for areas where traditional liposuction is difficult to achieve, such as the back of the calves and inner thighs.

(VII) Precautions

The following points should be noted:
① There should be no negative pressure when the suction tip enters or exits the incision.
② Retain 0.5-1cm of subcutaneous fat thickness to facilitate a smooth recovery.
③ After the procedure, trim a small amount of damaged skin from the incision edge to promote rapid skin healing.
④ The amount of fat removed each time should not exceed 3000ml.