CC BY-NC-ND 4.0 · Indian J Plast Surg 2008; 41(S 01): 27-40
DOI: 10.1055/s-0039-1700473
Original Article
Association of Plastic Surgeons of India


Lakshyajit D. Dhami
Laser, Aesthetic and Plastic Surgeon, Vasudhan Arjin Cosmetic and Laser Surgery, Mumbai, India
› Author Affiliations
Further Information

Publication History

Publication Date:
15 January 2020 (online)


Advent of the tumescent technique in 1987 has allowed for safe contouring in ambulatory single session liposuction under regional or general anaesthesia. Safety and aesthetic issues define MegaLiposuction to be in Volume in litres of more than 10% of Body weight in Kgs. 870 cases of liposuction were performed between September 2000 and August 2008. In (65%) cases, the total volume of aspirate was greater then 5 liters. (Range: 5 to 25 liters). In 24% cases, the large volume liposuction was combined with a limited or a total block lipectomy. Regional anaesthesia with conscious sedation was preferred except where liposuction was for above the subcostal region (the Upper Trunk, Lateral Chest, Back, Gynaecomastia, Breast, Arms and Face) or when the patient so desired. Tumescent infiltration with Lactated ringer, adrenalin, triamcinalone and hyalase was made in all cases. This approach has clinically shown less tissue edema in the post operative period than when the conventional physiological saline was being used in place of Ringer Lactate. The amount injected varied from 1,000 ml to 12,500 ml depending on the size, site and area. Local anesthetic was included only to the terminal portion of the tumescent mixture while infiltrating the sub-costal regions, or when above costal region was combined with below costal region being anaesthetized with Spinal Anaesthesia. The aspirate was restricted to the unstained white / yellow fat and the amount of fat aspirated did not have any bearing to the amount of solution infiltrated. There was no major complication. Blood transfusion was given only on one occasion when the patient had been on aspirin and had also received Low Molecular weight Heparin intra-operative. The hospital stay ranged from 8 to 24 hours for liposuction as well as for liposuction with a lipectomy. Serous discharge from access sites, sero-sanguinous fluid accumulation requiring drainage were necessitated in less than 10% cases. Minor re-contouring touch ups were requested in 5% cases. Early ambulation was encouraged for mobilization of third space fluid shifts to expedite recovery and to prevent deep vein thrombosis. More than 10% patients were operated on for Liposuction of other areas, after a gap of 7 days to 6 months. Meticulous perioperative monitoring of systemic functions ensures safety in tumescent megaliposuction for the obese and rewarding results can be achieved in a single sitting.

  • 1 Illouz YG. Body contouring by lipolysis: A 5-year experience with over 3000 cases. Plast Reconstr Surg 1983; 72: 591-7
  • 2 Coleman WP. 3. rd. The history of liposuction and fat transplantation in America. (Dermatol Clin; 17). 1999: 723-7
  • 3 Illouz YG. History and current concepts of lipoplasty. Clin Plast Surg 1996; 23: 721-30
  • 4 Flynn TC, Coleman 3rd WP, Field LM, Klein JA, Hanke CW. History of liposuction. Dermatol Surg 2000; 26: 515-20
  • 5 Grazer FM, de Jong RH. Fatal outcome from liposuction: Census survey of cosmetic surgeons. Plast Reconstr Surg 2000; 105: 447-8
  • 6 Pitanguy I.. Trochanteric lipodystrophy. Plast Reconstr Surg 1964; 34: 280-6
  • 7 Kesselring UK, Meyer R. A suction curette for removal of excessive local deposits of subcutaneous fat. Plast Reconstr Surg 1978; 62: 305-6
  • 8 Fournier PF, Otteni FM. Lipodissection in body sculpturing: The dry procedure. Plast Reconstr Surg 1983; 72: 598-609
  • 9 Illouz YG. Illouz's technique of body contouring by lipolysis. Clin Plast Surg 1984; 11: 409-17
  • 10 Field LM. The dermatologist and liposuction: A history. J Dermatol Surg Oncol 1987; 13: 1040-1
  • 11 Klein JA. The tumescent technique for liposuction surgery. Am J Cosm Surg 1987; 4: 263-7
  • 12 Zocchi M.. Ultrasonic-assisted lipoplasty. Adv Plast Reconstr Surg 1998; 11: 197-221
  • 13 Wagner BM. Adipose tissue and obesity. Hum Pathol 1985; 16: 1183
  • 14 Lillis PJ. Liposuction surgery under LA: Limited blood loss and minimal lidocaine absorption. J Dermatol Surg Oncol 1988; 14: 1145-8
  • 15 Ostad A, Kageyama N, Moy RL. Tumescent anaesthesia with a lidocaine dose of 55 mg/kg is safe for liposuction. Dermatol Surg 1996; 22: 921-7
  • 16 Klein JA. The tumescent technique for regional anaesthesia permits lidocaine doses of 35 mg/kg for liposuction. J Dermatol Surg Oncol 1990; 16: 248-63
  • 17 Gilliland MD, Coates N. Tumescent liposuction complicated by pulmonary edema. Plast Reconstr Surg 1997; 99: 215-9
  • 18 Gilliland MD, Commons GW, Halperin B. Safety issue in ultrasound assisted large volume L ipoplasty. Clin Plast Surg 1999; 26: 317-35
  • 19 Katz BE, Bruck MC, Felsenfeld L, Frew KE. Power liposuction: A report on complications. Dermatol Surg 2003; 29: 925-7
  • 20 Albin R, de Campo T. Large volume liposuction in 181 patients. Aesthet Plast Surg 1999; 23: 5-15
  • 21 Dhami LD, Meenakshi A. Safe total corporal contouring with large volume liposuction for obese patient. Aesthet Plast Surg 2006; 30: 574-88
  • 22 Klein JA. Tumescent technique chronicles: Local anaesthesia, liposuction and beyond. Dermatol Surg Oncol 1995; 21: 449-57
  • 23 Field CM, Skouge J, Anhalt TS, Recht B, Okimoto J. Blunt liposuction cannula dissection with and without suction assisted lipectomy in reconstructive surgery. J Dermatol Surg Oncol 1988; 14: 1116-22
  • 24 Gasperoni C, Salgarello M. Mall Liposuction: The natural evolution of subdermal superficial liposuction. Aesthet Plast Surg 1994; 18: 253-7
  • 25 Mladick RA. The big six: Six important tips for a better result in Lipoplasty. Clin Plast Surg 1989; 16: 249-56
  • 26 Graf R, Auersvald A, Damasio RC, Rippel R, de Araujo LR, Bigarelli LH. Ultrasonic assisted liposuction: An analysis of 348 cases. Aesthet Plast Surg 2003; 27: 146-53
  • 27 Omranifard M.. Ultrasonic liposuction versus surgical lipectomy. Aesthet Plat Surg 2003; 27: 143-5