Tumescent Liposuction – how much of fluid infiltration do we really need

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Most people opting for a liposuction understand the meaning of the term tumescence. Basically this means, the infiltration of fluid in the areas to be liposuctioned, so as to make it easier to perform liposuction and also allow the minimum of bleeding. This is made possible by use of various solutions and their constitution. Broadly all these solutions contain local anesthetic in the form of xylocaine, and vasoconstrictor (agents that stop bleeding). A little while back, the fluid infiltration was seen as the most major development in liposuction, but really speaking, how much of fluid do we actually need?. Lets try to answer this question as we proceed

In tumescent anesthesia we like to infiltrate in a 1:1 ration with the expected amount of the fat to be liposuctioned. So if it is estimated that 1000 ml of fat is to be taken out, we would like to infiltrate about a 1000 ml of the solution. About half of this is absorbed by the body, and the rest is out in the aspirated fat. So in actuality when we have aspirated 1500 ml of fat after putting in 1000 ml of fluid, we can assume that the actual fat content is only about 800-900 ml. so now there is a situation where some surgeon like to infiltrate in a 2:1 ratio (called wet technique) or in a 3:1 ratio ( called superwet technique). The advantage of this infiltration is that the liposuction is virtually bloodless, it is fast, smooth. But look at the other aspect. Out of 6 litres that is aspirated in a wet technique, do not expect more than 2.5 litres of actual fat in this. So it is a good idea to ask your plastic surgeon when he tell you that he has aspirated 6 litres of fat, as to how much of fluid did he put in in the first place. 

Now lets look at a reverse situation. Suppose we infiltrate about 1000 ml for about 2 litres of aspirated fat. We would assume that in an aspirate of 2.5 litres, approximately 2.1-2.2 litres is actual fat. Yes there is a little more bleeding, but never alarming enough to require blood replacement. The procedure moves smoothly, and there is prolonged pain relief due to the local anesthetic which was injected. A significant problem that occurs, when large amount of solution in injected, is the difficulty in calculating fluid replacement during surgery, and very rarely the problem of water filling in the lungs has been reported.

In a compromise situation in this scenario, it makes sense to inject in a ration of 0.5-1: 1 amount of infiltration fluid, to get satisfying results, and to give the patient reasonable estimate of the amount of fat that has been aspirated.

Dr Amit Gupta is a Plastic Surgeon from Maulana Azad Medical College, Delhi, who has specialized in the fields of Minimally Invasive Cosmetic Surgery, Microfollicular Hair Transplant, and Lasers. He joined Maulana Azad Medical College in 1994, and completed his MBBS in 1999, with University Honours. He was awarded with Gold Medal during his training for his academic excellence. He was awarded with the Lt. Governor?s Trophy for the Best All Round Medical Graduate in the year 1999, and Dr KB Sharma Shield for Best Contributor to Corporate Life of College.
Dr Amit Gupta joined the superspeciality Course of Plastic Surgery at Maulana Azad Medical College which he cleared in 2007 in his attempt. During his training he underwent training in Burns Trauma Management Cancer and Microvascular Surgery Reconstructive and Congenital Defect Correction Surgery. He then pursued specialized fellowships in Cosmetic Surgery in Belgium (Europe) and Brazil. He has trained with Dr Patrick Tonnard in Belgium where he was trained in MACS Lift Surgery which is the most current development in the field of Facial Rejuvenative Surgery in Europe. He then pursued fellowships in Cosmetic Surgery in Brazil where he trained with the likes of Dr Ruth Graf and Dr Ana Zulmira who are regarded as icons in Cosmetic Surgery

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