TUMESCENT AND SYRINGE LIPOSCULPTURE - A LOGICAL PARTNERSHIP

Liposuction has been traditionally performed under general anesthesia. Standard instrumentation for the procedure has included blunt-tipped suction cannulae connected to an electric vacuum pump by noncollapsibl e tubing. A subcutaneous injection of Lidocaine with Epinephrine is ro utinely employed to minimize blood loss during the procedure. This inf iltration has been described as the ''wet technique,'' but it is not a method to supplant general anesthesia. The tumescent technique, a met hod of infusing very large volumes of dilute lidocaine with epinephrin e solutions, has been advocated as a satisfactory means for providing conscious anesthesia for liposuction procedures, avoiding the need for general anesthesia. The syringe technique employs blunt-tipped suctio n cannulae connected to a syringe. Drawing back the syringe plunger ge nerates the negative pressures needed to remove fat during liposuction and replaces the electric vacuum pump and connecting tubing tradition ally used for this procedure. This study evaluates the combined tumesc ent and syringe techniques for liposuction. One hundred consecutive pa tients were treated with the tumescent technique as the sole means of anesthesia and the syringe technique as the sole means of performing l iposuction. A modified tumescent formula is presented. A comparison of liposuction aspirates using this modified tumescent technique is comp ared and contrasted to liposuction aspirates obtained using the ''dry technique'' and the ''wet technique.'' A historical review of the syri nge technique and its perceived attributes is also presented. Technica l descriptions of the tumescent infusion method, tumescent fluid formu lation, and suggested patient sedation and monitoring is presented. Ph otographic documentation of patients who underwent the combined tumesc ent and syringe liposculpture treating various body areas is shown. A critical analysis of the limitations of this combined technique is als o described noting added time requirements, difficulties with under-co rrection of deformities, and need for reoperation, methods for determi ning the ''end-point'' for the procedure, as well as addressing large- volume liposuction problems. The conclusion reached by this study is t hat combining the tumescent technique and the syringe technique is a l ogical partnership. Each method complements the other, allowing liposu ction to be performed with considerable advantage over traditional met hods. These advantages include eliminating the need for general anesth esia, lessening blood loss and postoperative bruising, greater accurac y, precision, and overall high patient satisfaction.