Liposuction Removal of Fat with the Tumescence Technique Mangs Solution

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Liposuction is one of the most frequently performed operations in aesthetic/plastic surgery. In men, liposuction is primarily requested for the abdominal/hip area; in women, it is for the lateral and medial thigh, buttocks and hips ("saddle area").

Dry suction under general anesthesia does not merely put a strain on the cardiovascular system with an increased risk of thrombosis and embolism, but also causes blood loss, including a drop in hemoglobin to under 8 g %, as well as destroying the infrastructural supporting tissue (1ST).

This infrastructural supporting tissue is maintained when the tumescence technique is used, so that there is no "chewing gum effect" following liposuction, i.e., the skin does not have depressions in it but instead is tightened.

The tumescence technique was first published at the beginning of the 1990s by Jeff Klein. Lidocaine was used as local anesthesia. In view of the toxicity, we carried out a large study that showed that the aesthetic/ plastic surgical tumescence technique with lower doses of prilocaine solution (Mang's solution) produces the same results with a lower incidence of complications:

• Mang's solution=o.9 % saline solution (NaCl) 3000 ml

• Epinephrine 3 mg

• Triamcinolone acetonide 30 mg

As high doses of prilocaine may cause methemoglobinemia, no more than 6000 ml of this tumescence solution should be injected per session either manually or with a pump. The results are very good if the correct indicationsare given. There is no blood loss, the risk of thrombosis and embolism is significantly reduced, and there is protection from infection. The patient is mobile on the first day after the operation.

The patient should be monitored for 24 h after the operation. He/she may leave the hospital with a special girdle, which must be worn for 3 weeks. The injection sites may be treated with scar ointment for 3 weeks after the operation. Then the region treated by liposuction should be exercised in a gym under supervision.

In the video, the manual tumescence liposuction technique with Mang's solution is presented as a basic technique. Auxiliary devices of whatever type (MicroAire, ultrasound, reciprocator, etc.) may be useful and reduce the liposuction time, although the same results can be achieved perfectly with the manual technique. This technique is simple, can be performed without any large instruments, and there are no significant risks if it is carried out by a specialist.

Similarly, the tumescence injection can be given manually or mechanically with a pump. The manual technique, however, is very time-consuming and it is necessary for the surgeon to have a lot of stamina, so at our clinic we apply the tumescence solution quickly (without too much pressure and over at least 45 min) and homogeneously with a six-cannula pump system. Following local tumescence anesthesia, you should wait 30 min and then begin liposuction.

If performed by an experienced surgeon, manual liposuction may take up to 90 min and up to 45 min with the MicroAire system. The patient must be prepared for the total liposuction procedure with tumescence to last approximately 2.5 h.

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