What You Should Know Before Having Liposuction

While the general public may view liposuction simply as a cosmetic procedure, it is real surgery with real risks. So what should you know before having liposuction? As part of its ongoing dedication to patient safety, the American Society of Plastic Surgeons (ASPS) teamed up with a number of professional medical associations to create a practice advisory on liposuction, published in the April issue of Plastic and Reconstructive Surgery®, the official medical journal of ASPS, which outlines recommendations for plastic surgeons and their patients.

“In addition to going to an American Board of Plastic Surgery (ABPS) certified plastic surgeon for liposuction, the most important step toward making sure you have a safe procedure is asking your surgeon the right questions and understanding the decisions that you and your surgeon make together,” said Ronald Iverson, MD, chair of the ASPS Committee on Patient Safety. “There is no substitute for having the knowledge to make intelligent choices to ensure a safe surgery.”

The third practice advisory in a series from the ASPS Committee on Patient Safety explores a variety of issues common to liposuction that patients should talk to their physicians about, including techniques, anesthesia, patient selection, liposuction volume, multiple procedures, postoperative care, facility selection, training and qualifications, and facility accreditation.

“Over the years, advances in liposuction techniques have allowed for ever increasing amounts of fat to be removed. Now more than ever, you need to be smart about choosing a plastic surgeon who addresses your individual needs and condition to ensure a safe and pleasing outcome,” stated Dr. Iverson.

According to the ASPS, liposuction is one of the most popular cosmetic plastic surgery procedures, with more than 320,000 procedures performed in 2003 - second only to nose reshaping.

ASPS offers a number of points patients should discuss with their physicians before choosing to have liposuction:

• Techniques – No one liposuction technique is best suited for all patients in all circumstances. Discuss with your plastic surgeon which technique is appropriate for you, depending on your overall health, body mass index and the amount of fat to be removed.
• Anesthesia – Discuss with your plastic surgeon which anesthesia or anesthetic combination is right for you. Also, a physician should have the primary responsibility for providing and/or supervising your anesthesia.
• Patient Selection – You should receive a thorough preoperative history and physical examination from your surgeon before having liposuction. Even though liposuction is generally an elective procedure, you must be assessed using the same standards as those used for anyone undergoing any type of surgery.
• Liposuction Volume – If your plastic surgeon agrees to perform large-volume liposuction consisting of more than 5,000 cc’s total fat, the procedure should be performed in an acute-care hospital or in a facility that is either accredited or licensed. You should also be monitored overnight in an appropriate facility by qualified and competent staff.
• Multiple Procedures – Having multiple procedures done at the same time increases the potential for complications, particularly with large-volume liposuction. Patients having large-volume liposuction should discuss with their plastic surgeon about having one surgery at a time to limit their risk for serious complications.
• Postoperative Care –Attend every one of your follow-up appointments. During these appointments your plastic surgeon will assess your postoperative recovery and satisfaction, as well as wound healing and scar maturation.
• Facility Selection – While a surgeon can safely perform most liposuction procedures in an accredited office-based surgery facility or ambulatory surgery facility, hospitalization may be required for some patients. Talk to your plastic surgeon to determine which facility is right for you.
• Training and Qualifications – Patients should understand that liposuction is a surgical procedure, and as such, physicians performing liposuction should be trained as surgeons. Physicians who perform liposuction without having surgical training may not be as prepared as trained surgeons to handle an unexpected complication when it occurs.
• Facility Accreditation – Patients should make sure plastic surgery performed under anesthesia, including liposuction, is performed in a surgical facility that is either accredited by a national or state-recognized accrediting organization, certified to participate in the Medicare program under Title XVIII or licensed by the state in which the facility is located.

“Patients need to play an active role in ensuring they have safe surgery,” said Dr. Iverson. “You have a right and responsibility to be proactive in asking your plastic surgeon questions and discussing surgical details.”

Reflecting the society’s dedication to ensuring all plastic surgery is performed safely, ASPS worked with a number of representatives from other professional medical organizations on this advisory, including the Plastic Surgery Educational Foundation, the American Society of Maxillofacial Surgeons, the American Association for Accreditation of Ambulatory Surgery Facilities, the American Society of Anesthesiologists, the American College of Surgeons, and the American Society for Aesthetic Plastic Surgery.

The ASPS has implemented the following initiatives to promote patient safety:

• All ASPS members who perform plastic surgery under anesthesia, other than minor local anesthesia, are required to perform the procedures in accredited facilities and, beginning in 2005, will be required to attend patient safety continuing medical education (CME) courses.

The ASPS is working with accrediting agencies to develop a definition of reportable adverse incidents as well as minimum quality assurance standards for office-based surgical facilities and fully supports the Patient Safety and Quality Improvement Act, H.R. 663, which would enable surgeons and other health care providers to learn why medical errors and adverse events occur.

Reprinted with permission from the American Society of Plastic Surgeons Web site.

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