Tumescent technique chronicles. Local anesthesia, liposuction, and beyond.

The reality of tumescent liposuction is just the opposite of what one might expect based on common sense and experience. The dilution of a local anesthetic solution of lidocaine and epinephrine does not weaken its effect, it actually enhances the degree of anesthesia, and vasoconstriction. Although microcannulas remove less fat per unit of time, they actually permit the removal of greater volumes of fat than traditional liposuction cannulas with diameters of 6-10 mm. Patients find that there is less pain associated with tumescent liposuction than liposuction by general anesthesia. It is disconcerting when clinical expectations are not congruent with clinical reality. However, the concept is better understood, its applications will extend well beyond its present horizon.