Safety of Tumescent and Laser-Assisted Liposuction: Review of the Literature
December 2011 | Volume 10 | Issue 12 | Original Article | 1363 | Copyright © 2011
Emily P. Tierney MD,a David J. Kouba MD PhD,b C. William Hanke MD MPHc
aTufts University School of Medicine, Boston, MA bHenry Ford Health System, Detroit, MI cLaser and Skin Surgery Center of Indiana, Carmel, IN
Background: Tumescent liposuction (TL) allows the removal of large volumes of fat with minimal blood loss or postoperative morbidity, excellent cosmesis, and a remarkable safety profile.
Objective: To review the literature on the safety of tumescent liposuction, liposuction under general anesthesia and laser-assisted liposuction.
Results: Aggregate safety data on liposuction under tumescent anesthesia reveals over 100,000 body areas treated with liposuction. There were no serious complications of death, emboli, hypovolemic shock, perforation of thorax or peritoneum, thrombophlebitis, seizures, or toxic reactions to drugs. In contrast, in the plastic surgery literature, liposuction under general anesthesia was associated with complications of deep venous thrombosis or pulmonary embolus, abdominal or other organ perforation, infection, and bleeding. Most recently, survey data in the European literature analyzed data showed 72 cases of severe complications from liposuction, including 23 deaths in a 5-year period from 1998 to 2002. The most frequent complications were bacterial infections such as necrotizing fasciitis, gas gangrene, and different forms of sepsis. Further causes of lethal outcome were hemorrhages, perforation of abdominal viscera, and pulmonary embolism.
Conclusion: Tumescent local anesthesia utilizing lidocaine with epinephrine allows the removal of large volumes of fat with minimal associated blood loss and postoperative morbidity.
J Drugs Dermatol. 2011;10(12):1363-1369.
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The early history of liposuction begins with Fischer's description of hollow cannula liposuction in 1976.1 In 1983, Ilouz, a Frenchman trained in obstetrics and gynecology, and Fournier, a general surgeon, began practicing liposuction using the "wet technique," involving injection of hypotonic saline and hyaluronic acid into the fat prior to suction.2 Fournier pioneered the "criss-cross" technique and syringe liposuction and became a teacher of the technique.3
Subsequently in 1977, an American dermatologist, Lawrence Field, visited Paris and learned about liposuction and published his experience with the technique in 1984. Jeffrey Klein, an American dermatologist, was the first to publish a report of liposuction using exclusively tumescent local anesthesia (TL) in 1987.4 Prior to this point, the pain associated with liposuction had necessitated the procedure be performed under general anesthesia.
In 1988, Hanke and Bernstein published a report on the safety of the tumescent liposuction (TL) technique, reporting the results of 9,478 patients treated by dermatologists.5 Shortly after attending Fournier's liposuction course in Paris, C. William Hanke, the editor-in-chief of the Journal of Dermatologic Surgery and Oncology, commissioned an issue dedicated to liposuction. Further innovations to the field evolved with the publication by Hanke and colleagues documenting the safety of TL in 336 patients in 1995.6 Additionally, while initial reports by Klein established the safety of tumescent liposuction using a lidocaine dose of 35 mg/kg in 1990,4 Ostad et al.7 reported the safety at a total dose of 55 mg/kg. In 2000, Klein published a book entitled Tumescent Technique, highlighting many of his important contributions to the field including: TLA technique, the Klein microcannula, Klein infiltration pumps, multihole Klein Capistrano cannulas, and specific techniques for treating all body areas.8
Since Klein's introduction of the TL technique of in 1987, it has revolutionized the field of cosmetic body fat sculpting among dermatologic surgeons and surgeons of all specialties performing the procedure. Liposuction with TLA facilitates the removal of large volumes of fat with minimal blood loss or postoperative morbidity, a low infection rate, excellent aesthetic results, and a remarkably superior safety profile to general anesthesia.9
Liposuction is designed for individuals at their ideal body weight who seek correction of a single or multiple anatomic sites with focal excess adiposity and laxity.9-13 The ideal liposuction patient is a patient of ideal body weight with focal disproportionate adiposity,