What is the safe volume for liposuction? When performing liposuction hemostatic solution, termed tumescent solution is infiltrated into the body prior to fat extraction. This solution is meant to constrict the vessels, known as arteries and veins, in an attempt to minimize bleeding and to reduce postoperative pain.
The tumescent solution contains both lidocaine and epinephrine. The lidocaine is a numbing agent that helps reduce pain. The epinephrine is a vasoconstricting agent that contracts the vessels above thus helping reduce blood loss into the surrounding tissues.
When the vessels contact, they become less vulnerable to injury from the liposuction cannulas. Liposuction cannulas are hollow bore rods that literally strip the fat out of the body. Although they are intended to remove the fat, they obviously can theoretically injury other components in the tissues where the fat live. This can include ligaments, nerves, and vessels.
Although the tumescent solution is used to protect the above structures, there are safety considerations that must be considered. The concern for use of tumescent solution involves what doctors term, fluid shift issues. This has to do with the fact that volume both in the vessels and outside in the tissues is in an intimate balance.
Shifts in volume from the vessel out to the tissues or vice versa can have detrimental effects on the balance of body fluids which can adversely affect the function of the heart. As such, standards have been set regarding the safe volume for liposuction. These standards are independently set by each state. In the state of California, safe volume for traditional liposuction is as follows:
- Liposuction volumes of less than 2 L can be performed in an office setting with no IV access or anesthesia precautions.
- For liposuction volumes, greater than 2 L IV is required.
- Liposuction volumes of 3 to 5 L can be performed in an in-office operating room or surgical center.
- Liposuction volumes greater than 5 L pose greater risk to fluid volume shifts and are required to be performed in a hospital setting with an overnight stay.
- The maximum allowed liposuction volume in a single setting is capped at 10L.
The above recommendations are standards set for traditional liposuction. The advent of ultrasound-assisted liposuction provides for safe use of greater volumes than that established for traditional liposuction.
This is because ultrasound liposuction, i.e. VASER, is gentler to the nerves and vessels. VASER stands for vibration amplification of sound energy at resonance and utilizes a phenomenon called acoustic streaming to literally melt the fat off of structures such as nerves and vessels.
As a result, VASER liposuction allows for safer liposuction that is associated with less blood loss and less pain. Although standards have not been set regarding ultrasound-assisted liposuction, higher safe volumes for liposuction are likely feasible.
If you are concerned about safe volumes for liposuction, Dr. Mowlavi can help you understand what volume of tumescent will be required to complete your body contouring. Patients requiring more than the safe liposuction volume guidelines may be recommended to complete their transformation in two settings.
This 39-year-old female who completed her transformation with safe volumes of liposuction measuring 4.2 Liters.