09 January 2009

There are several types of liposuction procedures available, all of which use a wand-like instrument called a cannula to remove unwanted fat. Tumescent liposuction involves the injection if a large amount of anesthetic into the area being treated; the wet and super-wet techniques are variations of this type of liposuction. In ultrasonic assisted liposuction (UAL), sound waves are used to liquefy the fat before it is removed. Power assisted liposuction (PAL) employs a motor-powered cannula, which allows the surgeon to use smaller movements and make the experience more comfortable for the patient.

In general, fat is removed via a cannula (a hollow tube) and aspirator (a suction device). The vast majority of these procedures are conducted using "reusable" cannulas. The same reusable cannula is often used over many years and on dozens if not hundreds of different patients. The reusable cannula is cleaned and sterilized before each use by the doctor or his/her staff. One time use disposable cannulas are also available for these procedures. These devices are provided to the doctor in sealed and sterilized packages. They are intended to be used on only one patient and for only one procedure and then discarded. One time use disposable cannulas are disposed of in the same manner that other one time use medical devices are disposed of, such as needles and syringes.

Liposuction techniques can be further categorized by the amount of fluid injection and by the mechanism in which the cannula works.

Amount of Fluid Injection

Dry liposuction
The dry method does not use any fluid injection at all. This method is seldom used today. Dry Technique Dry Technique (no longer used) required general anesthesia. The dry technique derived its name from the fact that it did not use injections of local anesthesia into the fat before liposuction. This technique was abandoned because of the excessive blood loss it caused. Blood composed approximately thirty percent (30%) of the tissue that was removed by liposuction using the dry technique.

Wet liposuction
Wet Technique required general anesthesia. A small amount of fluid, less in volume than the amount of fat to be removed, is injected into the area. It contains :
  • Lidocaine as a local anesthetic (about 100 ml)
  • Epinephrine to contract the blood vessels and thus minimize bleeding
  • A salt solution to make it saline, like our body fluids
This fluid helps to loosen the fat cells and reduce bruising. The fat cells are then suctioned out as in the basic procedure. Although the wet technique caused less blood loss than the dry technique, blood loss with the wet technique was still excessive and dangerous. Blood composed approximately 15% to 20% of the tissue removed by liposuction using the wet technique.

Super-wet liposuction
Super Wet Technique also requires general anesthesia. The infusate volume is in about the same amount as the volume of fat expected to be removed. This is the preferred technique for high-volume liposuction by many plastic surgeons as it better balances hemostasis and potential fluid overload (as with the tumescent technique). It takes one to three hours, depending on the size of the treated area(s). It may require either :
  • IV sedation as well as the local lidocaine, or
  • Complete anesthesia
The super wet technique requires the injection of a volume of dilute local anesthesia that is less than half the volume used for the tumescent technique. Surgical blood loss with the super wet technique is greater than the tumescent technique but significantly less than the wet technique. Approximately eight percent (8%) of the fluid removed by super wet liposuction is blood.

Tumescent liposuction
Tumescent liposuction is the precursor of wet liposuction. Tumescent liposuction refers to a technique that uses large volumes of very dilute local anesthesia and vasoconstrictor that is injected into the fat causing the targeted areas to be come tumescent, or swollen and firm; at a volume of roughly three parts liquid to one part tissue. The technique eliminates the need for general anaesthetic, blood products and intravenous fluids. The high volume of fluid creates a space between the muscle and the fatty tissue allowing more room for the cannula. The procedure requires more time than comparable techniques but can provide smoother results. Despite a large total volume of anaesthetic injected into the tissue, absorption by the body is spread over 24-36 hours because of the vasoconstrictors used. The procedure was developed in 1985.

Modified Tumescent Liposuction
Modified tumescent liposuction refers to a combination of tumescent local anesthesia plus some form of systemic anesthesia (general anesthesia or heavy IV sedation). Because general anesthesia or heavy IV sedation can be dangerous, they must be administered by an anesthesiologist.

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