How much tumescent fluid is used?

Question

Hello If I am getting 360 vaser lipo to my legs from groin to ankle and am told the surgeon is estimating 5 liters for debulking (lipedema), does that mean it will actually be 10 liters since it will include tumescent fluid? I thought they inject as much tumescent as the amount of fat they plan to remove? So if I’m estimated to need 5 liters removed from my legs, I’d need 5 liters of tumescent? I’m less than 110 pounds for reference (if they go by ml/kg for injection of tumescent).

Mats Hagstrom, MD (license on probation) · Answer

Each provider will have their own way of doing this.
Personally, I put a lot of emphasis on Tems and solution.
This is in park because I do all Liposuction with patients awake using local anesthesia with mild sedation.
To do this procedure without causing significant pain The proper injection of tumescent solution becomes mandatory.
Personally, I go to 45 45 mg per kilogram of lidocaine and use a fairly standard solution. 
The percentage of fluid removed with fat depends on the number of variables.
If a lot of fluid is injected first, then the percentage of water in the aspirate will be higher. Personally, I allowed the tumescent solution to sit for at least 20 minutes before I begin Liposuction.
For me, this means it can take me 40 minutes to inject local anesthesia. And then wait 20 minutes before even starting the procedure.
When given enough time the percentage of water that comes out is very small.
There are several major advantages to taking your time and allowing the solution to sit in the body before we begin surgery.
One is that the patient is far more comfortable.
This is not so important under general anesthesia.
The second major advantage is that it takes about 20 to 50 minutes before you get full affect of the drug epinephrine. This drug causes vasoconstriction which dramatically reduces bleeding during surgery.
By waiting, and allowing this drug to be in full effect, we can reduce blood loss to very very little.
This makes the procedure much safer and it also leaves people with minimal bruising afterwards.
Most plastic surgeons are not going to take this much time injecting the fluid or allowing the epinephrine to take full effect.
Operating room time is often well over $1000 per hour.
Typically about 15%.
 It’s a procedure is done immediately after the injection then it can be 40% fluid. 
When we calculate the amount to be removed, we typically referred to total aspirate.
It’s very important to differentiate if surgeons are talking about 5 L of total aspirate or 5 L of pure fat.
On a separate topic, Liposuction of the calaves and ankles it’s pretty complicated.
It’s a technically difficult procedure and the recovery is very difficult.
The amount of foot and leg swelling can be intense.
This is only made worse if liposuction of the thigh is included.
Personally, I would almost always split these into separate procedures.
 my practice has been devoted exclusively to Liposuction for over 20 years.
The first half of my practice was done doing general plastic surgery, including most procedures.
At this point, I’ve done over 8000 Liposuction procedures.
In my practice, there are three surgeons. I’m the only one who is willing to do liposuction below the knee.
I’ve only done six of these procedures.
I’m open to doing them if somebody truly is an excellent candidate and is willing to put up with the recovery.
 You need to really understand what you’re signing up for and you need to really make sure that your surgeon has experience doing this kind of work.
How many before and after pictures did they show you of previous patients who had the same procedure? 
Delivering consistent quality liposuction results is more difficult than most people realize.
The number of plastic surgeons who approach a mastery of liposuction is in reality quite small.
Average plastic surgeons deliver average results.
Only exceptional plastic surgeons will deliver exceptional outcomes.
Specializing in something means they don’t do other procedures.
They’re not a lot of plastic surgeons who truly specialize in Liposuction, but there are a few of us.
I suggest you don’t worry too much about the logistics of surgery.
Leave that up to the provider.
If the amount of fat or fluid is important to you then make sure you ask those questions before your procedure.
I recommend patients focus most of the effort on provider selection because in the end that is far the most important variable and is going to determine if you have a long-term quality outcome or not.
I generally always recommend people have multiple in person consultations before scheduling, permanent irreversible, body contouring procedures.
Best,
Mats Hagstrom MD

How much tumescent fluid is used?

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