Is Tumescent Solution Part of the "Fat" in the Container, or is It Removed Before Aspiration?

Question

If 2000 ml of tumescent solution is injected into the abdomen, is it aspirated out BEFORE the laser lipo begins, or is it present as the laser is used, and pulled out along with the fat? I am trying to distinguish between pure fat aspirated, and fat that is in a suspension with tumescent solution that was initially injected. I am trying to understand the technical aspects of this surgery. thanks

Vivek Bansal, MD · Answer

Thank you for your question. A good question, but no easy answer. Some of the tumescent fluid is absorbed immediately, and as long as it is the fat area. Some is aspirated with the fat. Fat removal also is included with tumescent fluid. Fat cannot just be sucked out, and is removed with less irregularity if hydrated prior. I hope this helps.

George Bitar, MD · Answer

Thank you for your question. Patients often wonder how much fat and how many pounds were removed by liposuction.  While interesting to know, remember liposuction is a body contouring procedure not a weight loss procedure. Fat is removed until the appropriate end point is reached or an aesthetic contour goal is achieved, not an arbitrary weight.  Having said that, the tumescent solution is injected to reduce bleeing and for anesthesia.  With Laser and Ultrasound Assisted Liposuction, the fluid is also a vehicle to facilitate the disruption of the fat cells and to protect the skin.  Once the laser or ultrasound energy is applied, then the fat and any residual tumescent solution is removed via suction.  Some fluid is absorbed during the procedure, some aspirated, and some left behind in the body.  Once the fat and fluid sits in the canister, it naturally separates and then the amount of fat removed can be more accurately estimated. Hope this helps.

Richard H. Tholen, MD, FACS · Answer

Great question! The fact is that 2000cc of tunescent fluid may be injected, but what is removed can be mostly fluid, mostly fat, or anything in between.

	Typically, surgeons will wait for just a bit after injecting the tumescent fluid into your fatty tissues, in order to allow it to diffuse and equalize distribution within and around the fat globules, as well as to compress and vasoconstrict the blood vessels within the fat. This tumescent fluid is particularly important in not only reducing bleeding and bruising, but also post-op swelling and scar fibrosis. For ultrasonic liposuction is also provides a fluid interface between the ultrasonic cannula tip and the actual fat cells, allowing them to be burst by the 26500Hz (or higher) ultrasonic energy. The best analogy for this is the ultrasonic jelly that allows the ultrasound transducer to effectively transmit the sound waves into the abdomen of a pregnant mother, for example!

	Much of the fluid is absorbed before the liposuction is completed, and the time before it is started, as well as the time it takes to complete any given area, all have an impact on the amount of fluid in the actual aspirate. Every surgeon is different, but in my practice, most of the aspirate is fat, but that varies by patient, area of liposuction, redo or primary, and amount of fat to be removed in the first place.

	Tumescent fluid is not needed for laser liposuction, but may actually act in a protective fashion (heat sink for excessive thermal energy that could "burn" the underside of the skin) as the cannula does its work.

	Bottom line here: Fluid is indeed present in the aspirate, but with effective liposuction in appropriate patient candidates and good surgery, the vast majority of the aspirate is fat--often 90% or more. Some surgeons even record the actual fat percentage in the aspirate, since the fat does indeed float and can be accurately measured after it settles out in the canister.

	The real measure of quality surgery, however, is not the volume, or amount, or weight of fat removed (or the presence of fluid), it is the appearance of the patient's contours after healing is complete.

	Any idiot with a hammer and chisel can leave marble chips on the floor, but "what is left behind" is not usually a Michelangelo sculpture, even if "laser hammers and power chisels" are used. The sculptor is the critical factor, not the tools utilized, nor what is left on the floor of the studio! The same is true for liposuction. Best wishes! Dr. Tholen

Steven Wallach, MD · Answer

Tumescent fluid is injected into the soft tissue space and a portion of it is aspirated along with the fat that is suctioned. The fat rises to the top.

Brooke R. Seckel, MD, FACS (retired) · Answer

Thank you for your question.

	The Tumescent Fluid is aspirated along with fat during Laser liposuction. The two fluids appear separated in the container after the procedure but are removed from the body together.

Is Tumescent Solution Part of the "Fat" in the Container, or is It Removed Before Aspiration?

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