Liposuction, or liposculpture, is the most common cosmetic surgical procedure in the United States. Traditionally, liposuction was associated with an outpatient surgical setting, where excess fat was removed and patients experienced rapid recovery and gratifying results. In recent years, procedures have become more ambitious with larger amounts of fat being removed. Though this progress frequently allows for more dramatic results, it has unfortunately been associated with serious complications, including death.

Because liposuction remains an attractive cosmetic procedure, patients want to know if liposuction is fundamentally safe and, if so, how they can make sure their particular procedure is done safely.

Liposuction is conceptually simple. A healthy patient with areas of excess fat has these areas reduced by vacuuming the fat through small metal tubes called cannulas. This procedure is frequently done on an outpatient basis under general anesthesia in a hospital or accredited surgical facility. Most liposuction begins with the surgeon infiltrating a special solution into the fatty tissues to be suctioned. This solution is mostly salt water, but also contains adrenaline to reduce blood loss and may contain a local anesthetic to reduce pain. Following the injection of this "tumescent" fluid, fat removal begins. In certain cases, the initial phase of liposuction involves ultrasound cannulas, which loosen the fat to be removed. This is followed by standard liposuction, where a vacuum is employed to remove the excess fat. At the end of the procedure, the patient is placed in a compression garment to reduce postoperative swelling. In most cases, the patient is discharged home the same day and returns to work in a few days. When more significant fat removal is performed (greater than 10 pounds), patients are usually observed overnight.

It sounds so simple, so how could anything go wrong? Easy -- each factor in liposuction can be critical to a safe outcome. For instance, if the patient is not healthy, even liposuction can result in significant problems such as a heart attack or trouble breathing. If the surgeon is overly aggressive in fat removal, excessive blood loss can occur. If the anesthesia is not administered properly, too much fluid can be given with serious consequences. If the surgical facility is poorly maintained, infections can be more frequent and lifesaving equipment might not be available in an emergency.

There are a few general factors that influence the safety of liposuction.

Patient: Liposuction is for healthy patients who are within about 40 percent of their ideal body weight. Liposuction is not intended to be a strategy for weight loss. Obese patients should be considered only rarely. Patients with significant heart or lung disease are not candidates.

Doctors: Ideally, liposuction should be done by surgeons familiar with all facets of liposuction, including the tumescent technique and ultrasound-assisted liposuction. Board certification, preferably by the American Board of Plastic Surgery, is mandatory. This ensures that a national organization feels this surgeon is competent and safe. Additionally, and equally as important, the surgeon should have privileges to perform the procedure in a local hospital. Such privileges mean ' the surgeon has demonstrated to his peers locally that he is capable of performing the procedure safely.

Anesthesiologists: Whether general anesthesia is being used or not, all patients undergoing liposuction should be monitored by someone other than their surgeon. This is preferably done by a Board Certified anesthesiologist but can also be done by an experienced certified registered nurse anesthetist. Experience is essential as it can be difficult to manage liposuction patients, especially during a large volume liposuction.

Facility: Liposuction should always be performed in a hospital or accredited surgery center. The surgery center should be approved by the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF). This certifies that the facility is of the highest quality. Frequently. I hear of patients who have undergone liposuction done under local anesthesia without proper monitoring who have done well. I try to point out that just because the surgery was successful, it does not mean it was performed safely. Since liposuction is a real operation with real risks, the conditions for the procedure should be the same as those for any other surgical procedure such as a hysterectomy. Accepting anything less is simply making liposuction more risky than it needs to be.

Liposuction is like any operation in cosmetic surgery in that it can have unsatisfactory results. Specifically, too much or too little fat can be removed, contour irregularities can develop, and swelling can be prolonged. However, when adequate precautions as outlined above are taken, life~ threatening complications should be exceptionally rare. When done properly by an experienced surgeon in an accredited facility, liposuction remains an extremely safe and effective way to improve one's shape by fat removal.

Paul G. Pin, M.D.
Board Certified,
American Board of Plastic Surgery Dallas, Texas

Liposuction is real surgery and involves risks such as bleeding, infection, and scarring. Results vary. Dr. Pin will be happy to discuss these and other risks of liposuction.