Jeffrey A. Klein

Historically, liposuction caused massive, life-threatening blood loss.

The tumescent technique, pioneered by Jeffrey Klein, revolutionized safety by using a fluid infiltration ratio of 3 to 1.

You infiltrate 3 milliliters of highly dilute anesthetic solution for every 1 milliliter of fat you plan to aspirate.

The intense hydrostatic pressure of this fluid mechanically compresses the capillary beds, dropping blood loss to less than 1% of the total aspirate.

Things like MDCalc, the calculators are said that's built for anesthesiologists and don't really take into account the types of lidocaine or anesthetic usage that we as dermatologists use.

And then the actual other counterpoint is from Jeffrey Klein, and it's pretty pointed.

He argues against this calculator, suggesting that it rests on two flawed assumptions.

First, it doesn't address the actual causes of infiltrative local anesthetic toxicity, which he lists as being really variable between patients.