| Klein further demonstrated the safety of the | | | | fatalities from the technique. These cases very |
| tumescent anesthesia by demonstrating that | | | | often were carried out under general anesthesia |
| when lidocaine is used as a dilute solution of | | | | or when large volumes of fluid were used. It is |
| 0.05% lidocaine containing 1:1,000,000 epinephrine, | | | | the opinion of many liposuction surgeons that the |
| does of up to 35 mg of lidocaine per kilogram of | | | | dangers of liposuction are minimal when proper |
| body weightwere safe and effective.This | | | | technique is used using only dilute solutions of local |
| technique allowed increased amounts of fat to be | | | | anesthesia. Complications may occur with heavy |
| safely and comfortably removed using only this | | | | sedation or general anesthesia, large volumes of |
| local anesthetic technique.Studies by other | | | | liposuction, large volumes of fluid, or when |
| liposuction surgeons detail that the maximum | | | | extensive liposuction (megaliposuction) is |
| tumescent safe lidocaine dose is greater than 35 | | | | performed. When intravenous fluids or general |
| mg of lidocaine per kilogram of body weight. | | | | anesthesia is used, patients may experience fluid |
| Ostad proposed that the maximum safe | | | | overload with the possibility of pulmonary edema. |
| tumescent lidocaine dose was 55 mg/kg. Lilles felt | | | | Unconscious patients can experience pulmonary |
| that the maximum allowable dose was above 35 | | | | embolism and thrombophlebitis. Furthermore, |
| mg of lidocaine per kilogram of body weight. | | | | tumescent liposuction performed in the outpatient |
| Butterwick showed that the rate of infusion of | | | | setting appears to be safer than those |
| the tumescent anesthesia was independent of | | | | procedures performed in the hospital environment. |
| plasma lidocaine levels. There have been several | | | | Two variations in instrumentation have been |
| studies that have demonstrated that modern | | | | developed. Ultrasonic liposuction was developed in |
| tumescent liposuction, using only dilute solutions of | | | | Europe in the early 1990s, having been introduced |
| local anesthesia, is an extremely safe procedure. | | | | by Zocchi.The concept was that adipose cells |
| There have been numerous reports documenting | | | | could be treated with ultrasound energy, |
| the safety of this technique. Studies directed by | | | | presumably breaking up their cell walls and |
| Hanke and Bernstein have shown very few | | | | facilitating fat aspiration. The American Society of |
| complications when tumescent liposuction is | | | | Plastic and Reconstructive Surgery quickly |
| performed correctly. A recent study by Housman | | | | adopted ultrasonic liposuction; however, over time, |
| has clearly documented the safety of tumescent | | | | problems were found with this technique. Internal |
| liposuction. In this study, 505 dermatologic | | | | ultrasound (ultrasound tips contained within |
| surgeons were surveyed, asking for their | | | | cannulas) increased the risk of cutaneous burns |
| incidence of serious adverse events (SAEs).A | | | | and seroma formation. Many dermatologic |
| total of 66,570 procedures were reported upon, | | | | surgeons have not found any additional benefit |
| and there was an SAE rate of 0.68/100 cases. No | | | | over standard liposuction. External ultrasound |
| deaths were reported. This study clearly | | | | devices when used before or during a liposuction |
| demonstrates that the procedure is safe and | | | | procedure have not been found to be of any |
| without risk if tumescent liposuction is performed | | | | benefit to the patient or the surgeon. It is the |
| properly. | | | | feeling of the author that unnecessary |
| There have been several reports of the dangers | | | | complications without benefit can result from the |
| of liposuction and several reports reporting on | | | | use of ultrasound in liposuction. |