The history of liposuction is such that it first became popular in France & was performed by Dr. Ilouz. He infiltrated the tissues with fluid & then suctioned out the fat under general anesthesia via incisions hidden in skin creases. This was followed by a period of greater reliance on general anesthesia & less infiltration. Then came a period of greater reliance on infiltration with fluid mixed with local anesthesia. And if some is good more must be better philosophy ensued so a very high volume of fluid was then infiltrated. This made the area to be suctioned swollen & hard hence the term tumescent. The idea behind this was to perform the procedure without general anesthesia or an anesthesiologist to allow the patient to recover more quickly or leave the surgery center earlier & cut costs.
Another reason not usually mentioned is that early proponents of this technique were not surgeons, did not have operating room privileges & could not get anesthesiologists to anesthetize these patients for liability reasons. The infiltration of larger amounts of fluid probably does decrease the amount of postoperative bruising & pain. However, because body contours are severely distorted the practitioner has to be more experienced to gauge where & how much fat to remove in order to obtain a specific result. Also, with the greater reliance on infiltrated fluid for anesthesia shorter & narrower liposuction cannulas had to be used & applied closer to the surface. The reason for this is that despite the local anesthesia there can still be significant pain with longer or wider cannulas passed into the deeper tissue layers. Thus, arose a technique where multiple holes are placed in the area to be suctioned as the short narrow cannulas do not reach very far. Depending on the person & body area these multiple access sites with more superficial suction can cause unsightly scars or uneven skin topography.
In summary be careful about the use of the word tumescent as some people use it to denote slightly different techniques with vastly different results, some of which can be very unsightly. Dr. Stone prefers to use a wet technique rather than true tumescent placing the access sites so they will be hidden in skin folds. Lastly, the end result of any liposuction is dependent more on the condition of the overlying skin immediately after the procedure than the volume of fat removed