Tumescent anesthesia has become a central aspect of liposuction and lipofilling, revolutionizing the safety and precision of adipose tissue manipulation. Central to its impact is the influence of tumescent anesthesia on adipocyte viability and engraftment, key factors determining the success of liposuction and subsequent autologous fat grafting. This chapter aims to describe the relationship between tumescent anesthesia and adipose tissue, exploring how this anesthetic technique influences adipocyte viability during harvesting and enhances engraftment in lipofilling procedures.