• Ashley DeckerEmail author
  • Naomi Lawrence


Liposuction is a safe and effective method of subcutaneous fat removal involving aspiration of subcutaneous adipose tissue via cannulas introduced through small skin incisions. In tumescent liposuction, the surgeon utilizes subcutaneous infiltration of dilute lidocaine and epinephrine to provide local anesthesia and hemostasis prior to aspiration of the adipose tissue. In addition to its aesthetic indications, tumescent liposuction is also a safe and effective treatment modality for breast reduction, gynecomastia, lipomas, lipoedema, and hyperhidrosis. Despite the development of newer, noninvasive body-contouring modalities, liposuction remains the gold standard.


Liposuction Tumescent liposuction Body contouring Tumescent anesthesia Noninvasive body contouring 


  1. 1.
    Coldiron B, Coleman WP, Cox SE, Jacob C, Lawrence N, Kaminer M, et al. ASDS guidelines of care for tumescent liposuction. Dermatol Surg. 2006;32:709–16.CrossRefGoogle Scholar
  2. 2.
    Mysore V, et al. Tumescent liposuction: standard guidelines of care. Indian J Dermatol Venereol Leprol. 2008;74:S54–60.PubMedGoogle Scholar
  3. 3.
    Marcadenti A, de Abreu-Silva EO. Different adipose tissue depots: metabolic implications and effects of surgical removal. Endocrinol Nutr. 2015;62:458–4.CrossRefGoogle Scholar
  4. 4.
    Rohrich RJ, Smith PD, Marcantonio MD, Kenkel JM. The zones of adherence: role in minimizing and preventing contour deformities in liposuction. Plast Reconstr Surg. 2001;107:1562–9.CrossRefGoogle Scholar
  5. 5.
    Benatti FB, Lira FS, Oyama LM, do Nascimento CM, Lancha AH. Strategies for reducing body fat mass: effects of liposuction and exercise on cardiovascular risk factors and adiposity. Diabetes Metab Syndr Obes. 2011;41:141–54.CrossRefGoogle Scholar
  6. 6.
    Robles-Cervantes JA, Yanez-Diaz S, Cardenas-Camarena L. Modification of insulin, glucose and cholesterol levels in nonobese women undergoing liposuction – is liposuction metabolically safe. Ann Plast Surg. 2004;52:64–7.CrossRefGoogle Scholar
  7. 7.
    Robles-Cervantes JA, Castillo-Salcedo T, Guerrerosantos J, Gonzalez-Ortiz M, Martinez-Abundis E, et al. Behavior of visfatin in nonobese women undergoing liposuction: a pilot study. Aesth Plast Surg. 2010;30:730–2.CrossRefGoogle Scholar
  8. 8.
    Giugliano G, Nicoletti G, Grella E, Giugliano F, Esposito K, Scuderi N, et al. Effect of liposuction on insulin resistance and vascular inflammatory markers in obese women. Br J Plast Surg. 2004;57:190–4.CrossRefGoogle Scholar
  9. 9.
    Klein S, Fontana L, Young VL, Coggan AR, Kilo C, Patterson BW, et al. Absence of an effect of liposuction on insulin action and risk factors for coronary heart disease. N Engl J Med. 2004;350:2549–57.CrossRefGoogle Scholar
  10. 10.
    Flynn TC, Narins RS. Preoperative evaluation of the liposuction patient. Dermatol Clin. 1999;17:729–34.CrossRefGoogle Scholar
  11. 11.
    Cohen SR, Weiss ET, Brightman L, Geronemus RG, Locke KW, Maytom M, et al. Quantitation of the results of the abdominal liposuction. Aesthetic Surg J. 2012;35:593–600.CrossRefGoogle Scholar
  12. 12.
    Broughton GHB, Lipschitz A, Kenkel JM, Brown SA, Rohrich RJ. Lifestyle outcomes, satisfaction, and attitudes of patients after liposuction: a Dallas experience. Plast Reconstr Surg. 2006;117:1738–49.CrossRefGoogle Scholar
  13. 13.
    Choi CW, Kim J, Moon SE, Youn SW, Park KC, Huh CH. Treatment of lipomas assisted with tumescent liposuction. J Eur Acad Dermatol Venereol. 2007;21:243–6.PubMedGoogle Scholar
  14. 14.
    Stebbins WG, Hanke CW, Peterson J. Novel method of minimally invasive removal of large lipoma after laser lipolysis with 980 nm diode laser. Dermatol Ther. 2011;24:125–30.CrossRefGoogle Scholar
  15. 15.
    Tsai RY, Lin JY. Experience of tumescent liposuction in the treatment of osmidrosis. Dermatol Surg. 2001;27:446–8.PubMedGoogle Scholar
  16. 16.
    Lee D, Cho SH, Kim YC, Park JH, Lee SS, Park SW. Tumescent liposuction with dermal curettage for treatment of axillary osmidrosis and hyperhidrosis. Dermatol Surg. 2006;32(4):505–11.PubMedGoogle Scholar
  17. 17.
    Grazer FM. A noninvasive surgical treatment of axillary hyperhidrosis. Clin Dermatol. 1992;10:357–64.CrossRefGoogle Scholar
  18. 18.
    Kim HG. A new osmidrosis procedure, the scrape and suction technique: a review of 4,322 patients. Aesthet Plast Surg. 2014;38:282–7.CrossRefGoogle Scholar
  19. 19.
    Kim WO, Song Y, Kil HK, Yoon KB, DM Y. Suction-curettage with combination of two different cannulae in the treatment of axillary osmidrosis and hyperhidrosis. J Eur Acad Dermatol Venereol. 2008;22:1083–8.CrossRefGoogle Scholar
  20. 20.
    Wang C, Huiling W, Du F, Shujun L, Zheng S. Axillary osmidrosis treatment using an aggressive suction-curettage technique: a clinical study on paired control. Aesth Plast Surg. 2015;39:608–15.CrossRefGoogle Scholar
  21. 21.
    Ibrahim O, Bolotin KR, Nodzenski M, Disphanurat W, Pace N, Becker L, et al. The comparative effectiveness of suction-curettage and onabotulinum toxin-A injections for the treatment of primary focal axillary hyperhidrosis: a randomized control trial. J Am Acad Dermatol. 2013;69:88–95.CrossRefGoogle Scholar
  22. 22.
    Moskovitz MJ, Muskin E, Baxt SA. Outcome study in liposuction breast reduction. Plast Reconstr Surg. 2004;114:55–60.CrossRefGoogle Scholar
  23. 23.
    Moskovitz MJ, Baxt SA, Jain AK, Hausman RE. Liposuction breast reduction: a prospective trial in African American women. Plast Reconstr Surg. 2007;119:718–26.CrossRefGoogle Scholar
  24. 24.
    Habbema L. Breast reduction using liposuction with tumescent local anesthesia and powered cannulas. Dermatol Surg. 2009;35:41–52.PubMedGoogle Scholar
  25. 25.
    Gray LN. Update on experience with liposuction breast reduction. Plast Reconstr Surg. 2001;108:1006–10.CrossRefGoogle Scholar
  26. 26.
    Mellul SD, Dryden RM, Remigio DJ, Wulc AE. Breast reduction performed by liposuction. Dermatol Surg. 2006;32:1124–33.PubMedGoogle Scholar
  27. 27.
    Venkataram J. Tumescent liposuction: a review. J Cutan Aesthet Surg. 2008;1:49–57.CrossRefGoogle Scholar
  28. 28.
    Chia C, Neinstein RM, Theodorou S. Evidence-based medicine: liposuction. Plast Reconstr Surg. 2017;139:267–74.CrossRefGoogle Scholar
  29. 29.
    Courtiss EH, Choucair RJ, Donelan MB. Large-volume suction lipectomy: an analysis of 108 patients. Plast Reconstr Surg. 1992;89:1068–79.CrossRefGoogle Scholar
  30. 30.
    Beaudoin AL, Torso L, Richards K, Said M, et al. Invasive Group A Streptococcus infections associated with liposuction surgery at outpatient facilities not subject to state or federal regulation. JAMA Intern Med. 2014;174:1136–42.CrossRefGoogle Scholar
  31. 31.
    Stephan PJ, Kenkel JM. Updates and advances in liposuction. Aesthet Surg J. 2010;301:83–97.CrossRefGoogle Scholar
  32. 32.
    Klein JA. Tumescent technique: tumescent anesthesia & microcannular liposuction. Detroit, St. Louis: Mosby; 2000.Google Scholar
  33. 33.
    Gasperoni C, Gasperoni P. Subdermal liposuction: long-term experience. Clin Plastic Surg. 2006;33:63–73.CrossRefGoogle Scholar
  34. 34.
    Rebelo A. Power-assisted liposuction. Clin Plastic Surg. 2006;33:91–105.CrossRefGoogle Scholar
  35. 35.
    Regula C, Lawrence N. Update on liposuction: laser-assisted liposuction versus tumescent liposuction. Curr Derm Rep. 2014;3:127–34.CrossRefGoogle Scholar
  36. 36.
    Prado A, Andrades P, Danilla S, Leniz P, Castillo P, Gaete F. A prospective, randomized, double-blind, controlled clinical trial comparing laser-assisted lipoplasty with suction assisted lipoplasty. Plast Reconstr Surg. 2006;118:1032–45.CrossRefGoogle Scholar
  37. 37.
    Nagy MW, Vanek PF. A multicenter, prospective, randomized, single-blind, controlled clinical trial comparing VASER-assisted lipoplasty and suction-assisted lipoplasty. Plast Reconstr Surg. 2012;129:681–9.CrossRefGoogle Scholar
  38. 38.
    Paul M, Mulholland RS. A new approach for adipose tissue treatment and body contouring using radiofrequency-assisted liposuction. Aesth Plast Surg. 2009;33:687–94.CrossRefGoogle Scholar
  39. 39.
    Theodorou S, Chia C. Radiofrequency-assisted liposuction for arm contouring: technique under local anesthesia. Plast Reconstr Surg Glob Open. 2013;1:e37.CrossRefGoogle Scholar
  40. 40.
    Keramidas E, Rodopoulou S. Radiofrequency-assisted liposuction for neck and lower face adipodermal remodeling and contouring. Plast Reconstr Surg Glob Open. 2016;4:850.CrossRefGoogle Scholar
  41. 41.
    Malcolm P. A new approach for adipose tissue treatment and body contouring using radiofrequency-assisted liposuction. Aesth Plast Surg. 2009;33:687–94.CrossRefGoogle Scholar
  42. 42.
    Bernstein G, Hanke CW. Safety of liposuction: a review of 9478 cases performed by dermatologists. J Dermatol Surg Oncol. 1998;14:1112–4.CrossRefGoogle Scholar
  43. 43.
    Houseman TS, Lawrence N, Mellen BG, et al. The safety of liposuction: results of a national survey. Dermatol Surg. 2002;28:971–8.Google Scholar
  44. 44.
    Hanke CW, Bernstein G, Bullock S. Safety of tumescent liposuction in 15,336 patients. Safety of tumescent liposuction in 15,336 patients. Dermatol Surg. 1995;21:459–62.PubMedGoogle Scholar
  45. 45.
    Coldiron BM, Healy C, Bene NI. Office surgery incidents. What seven years of Florida data show us. Dermatol Surg. 2008;34:258–91.CrossRefGoogle Scholar
  46. 46.
    Coldiron B, Fisher A, Yelverton C, Balkrishnan R, Feldman M, Feldman S. Adverse event reporting: lessons learned for 4 years of Florida office data. Dermatol Surg. 2005;31:1079–92.CrossRefGoogle Scholar
  47. 47.
    Alam M, Ricci D, Havey J, Rademaker A, Witherspoon J, West D. Safety of peak serum lidocaine concentration after Mohs micrographic surgery: a prospective cohort study. J Am Acad Dermatol. 2010;63:87–92.CrossRefGoogle Scholar
  48. 48.
    Klein JA. Tumescent technique for regional anesthesia permits lidocaine doses of 35–45 mg/kg for liposuction. Peak plasma are diminished and delayed 12 hours. J Dermatol Surg Oncol. 1990;16:248–63.CrossRefGoogle Scholar
  49. 49.
    Ostad A, Kageyama N, Moy RL. Tumescent anesthesia with a lidocaine dose of 55 mg/kg is safe for liposuction. Dermatol Surg. 1996;22:921–7.PubMedPubMedCentralGoogle Scholar
  50. 50.
    Coleman WP, Glogau RG, Klein JA, Moy RL, Narins RS, Chuang T, et al. Guidelines for care of liposuction. J Am Acad Dermatol. 2001;45:438–47.CrossRefGoogle Scholar
  51. 51.
    Rubin JP, Xie Z, Davidson C, Rosow CD, Chang Y, May JW. Rapid absorption of tumescent lidocaine above the clavicles: a prospective clinical study. Plast Reconstr Surg. 2005;115:1744–52.CrossRefGoogle Scholar
  52. 52.
    Klein JA, Jeske DR. Estimated maximal safe dosages of tumescent lidocaine. Anesth Analg. 2016;122:1350–9.CrossRefGoogle Scholar
  53. 53.
    Lehnhardt M, Homann HH, Daigeler A, Hauser J, Palka P, Steinau H. Major and lethal complications of liposuction: a review of 72 cases in Germany between 1998 and 2002. Plast Reconstr Surg. 2008;121:396–403.CrossRefGoogle Scholar
  54. 54.
    Klein JA. Post-tumescent liposuction care: open drainage and bimodal compression. Dermatol Clin. 1999;17:881–9.CrossRefGoogle Scholar
  55. 55.
    Zelickson B, Egbert BM, Preciado J, Allison J, et al. Cryolipolysis for noninvasive fat cell destruction: initial results from a pig model. Dermatol Surg. 2009;35:1462–70.CrossRefGoogle Scholar
  56. 56.
    Diamantis S, Bastek T, Groben P, Morrell D. Subcutaneous fat necrosis in a newborn following icebag application for treatment of a supraventricular tachycardia. J Perinatol. 2006;26:518–20.CrossRefGoogle Scholar
  57. 57.
    Wiandrowski TP, Marshman G. Subcutaneous fat necrosis of the newborn following hypothermia and complicated by pain and hypercalcemia. Australas J Dermatol. 2001;42:207–10.CrossRefGoogle Scholar
  58. 58.
    Garibyan L, Sipprell WH, Jalian HR, Sakamoto FH, et al. Three dimensional volumetric quantification of fat loss following cryolipolysis. Lasers Surg Med. 2014;46:75–80.CrossRefGoogle Scholar
  59. 59.
    Dierickx CC, Mazer JM, Sand M, Koenig S. Safety, tolerance, and patient satisfaction with noninvasive cryolipolysis. Dermatol Surg. 2013;39:1209–16.CrossRefGoogle Scholar
  60. 60.
    Weiss RA. Noninvasive radiofrequency for skin tightening and body contouring. Semin Cutan Med Surg. 2013;32:9–17.CrossRefGoogle Scholar
  61. 61.
    Brightman L, Weiss E, Chapas A, Karen J, Hale E, Bernstein L, et al. Improvement in arm and post-partum abdominal and flank subcutaneous fat deposits and skin laxity using a bipolar radiofrequency, infrared, vacuum and mechanical massage device. Lasers Surg Med. 2009;41:791–8.CrossRefGoogle Scholar
  62. 62.
    Boisic S, Divaris M, Nelson A, Gharavi NM, Lask G. A clinical and biological evaluation of a novel, noninvasive radiofrequency device for the long term reduction of adipose tissue. Lasers Surg Med. 2014;46:94–103.CrossRefGoogle Scholar
  63. 63.
    Kennedy J, Verne S, Griffith R, Falto-Aizpurua NK. Non-invasive subcutaneous fat reduction: a review. J Eur Acad Dermatol Venereol. 2015;29:1679–88.CrossRefGoogle Scholar
  64. 64.
    Mulholland RS. Non-surgical body contouring: introduction of a new non-invasive device for long-term localized fat reduction and cellulite improvement using controlled, suction coupled, radiofrequency heating and high voltage ultra-short electrical pulses. J Clin Exp Dermatol. 2012;3:157–65.CrossRefGoogle Scholar
  65. 65.
    Chang SL, Huang YL, Lee MC, et al. Combination therapy of focused ultrasound and radio-frequency for noninvasive body contouring in Asians with MRI photographic documentation. Lasers Med Sci. 2014;29:165–72.CrossRefGoogle Scholar
  66. 66.
    Friedmann DP. A review of the aesthetic treatment of abdominal subcutaneous adipose tissue: background, implications, and therapeutic options. Dermatol Surg. 2015;41:18–34.CrossRefGoogle Scholar
  67. 67.
    Jewell ML, Baxter RA, Cox SE, Donofrio L, et al. Randomized sham-controlled trial to evaluate the safety and effectiveness of a high-intensity focused ultrasound device for noninvasive body sculpting. Plast Reconstr Surg. 2011;128:253–62.CrossRefGoogle Scholar
  68. 68.
    Shek SYN, Yeung CK, Chan JCY, Chan HHL. Efficacy of high-intensity focused ultrasonography for noninvasive body sculpting in Chinese patients. Lasers Surg Med. 2010;46:263–9.CrossRefGoogle Scholar
  69. 69.
    Robinson DM, Kaminer MS, Baumann L, Burns AJ, et al. High-intensity focused ultrasound for the reduction of subcutaneous adipose tissue using multiple treatment techniques. Dermatol Surg. 2014;40:641–51.PubMedGoogle Scholar
  70. 70.
    Teitelbaum SA, Burns JL, Kubota J, Hidenori M, et al. Noninvasive body contouring by focused ultrasound: safety and efficacy of the contour I device in a multicenter, controlled, clinical study. Plast Reconstr Surg. 2007;120:779–89.CrossRefGoogle Scholar
  71. 71.
    Anderson RR, Farnelli W, Laubach H, Manstein D, et al. Selective photothermolysis of lipid-rich tissues: a free electron laser study. Lasers Surg Med. 2006;38:913–9.CrossRefGoogle Scholar
  72. 72.
    Wanner M, Avram M, Gagnon D, Mihm MC, et al. Effects of non-invasive, 1,210 nm laser expose on adipose tissue: results of a human pilot study. Lasers Surg Med. 2009;41:401–7.CrossRefGoogle Scholar
  73. 73.
    Caurso-Davis MK, Guillit TS, Podichetty VK, Mashtalir N, et al. Efficacy of low-level laser therapy for body contouring and spot fat reduction. Obes Surg. 2011;21:722–9.CrossRefGoogle Scholar
  74. 74.
    Avci P, Nyame TT, Gupta GK, Sadasivam M, et al. Low-level laser therapy for fat layer reduction: a comprehensive review. Lasers Surg Med. 2013;2013:348–57.Google Scholar
  75. 75.
    Brown SA, Rohrich RJ, Kenkel J, Young L, et al. Effect of low-level laser therapy on abdominal adipocytes before lipoplasty procedures. Plast Reconstr Surg. 2004;113:1796–804.CrossRefGoogle Scholar
  76. 76.
    Kolari PJ, Araksinen O. Poor penetration of infra-red and helium neon low power laser light into dermal tissue. Acupunct Electrother Res. 1993;18:17–21.CrossRefGoogle Scholar
  77. 77.
    Jackson RF, Dedo DD, Roche GC, Turok DI, et al. Low-level laser therapy as a non-invasive approach for body contouring: a randomized, controlled study. Lasers Surg Med. 2009;41:799–809.CrossRefGoogle Scholar
  78. 78.
    McRae E, Boris J. Independent evaluation of low-level laser therapy at 635 nm for non-invasive body contouring of the waist, hips, and thighs. Lasers Surg Med. 2013;45:1–7.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Dermatologic SurgeryCooper University HospitalMarltonUSA
  2. 2.Division of DermatologyCooper Medical School of Rowan UniversityMarltonUSA

Personalised recommendations