Determining Safe Limits for Untransfused, Outpatient Liposuction: Personal Experience and Review of the Literature

Abstract

Limiting liposuction volumes to avoid transfusion is sound surgical practice. Although the plastic surgery literature reports frequent use of transfusions in liposuction surgery, dermatologists almost never use blood replacement after liposuction. Techniques which favor less bleeding include sufficient use of fresh epinephrine, cryoanesthesia, use of smaller cannulas, fluid preloading, proper preoperative evaluation, serial liposuction, intramuscular steroids, and rapid application of pressure garments. A review of the literature and personal experience are detailed.

Does the Specialty of the Physician Affect Fatality Rates in Liposuction? A Comparison of Specialty Specific Data

“…This problem was addressed by limiting the size of procedures, administration of crystalloid, and blood transfusions. 4 The problem of extensive bleeding with liposuction was solved with the introduction of the tumescent technique in 1987 by dermatologic surgeon Jeffrey Klein. 5 Using experiments designed to expand the use of lidocaine local anesthesia for liposuction, Klein also discovered that infiltration of low concentrations of epinephrine significantly reduced bleeding.…”

Liposuction Under Local Anesthesia

“…In addition, in an effort to prevent unnecessary complications, dermatologists have followed Dr. Fournier's lead in performing “low volume” procedures with less than 1500 cc of fat being removed per session. This minimizes fluid volume shifts 4 . Dermatologists have also been leaders in recommending multiple small‐volume liposuction procedures rather than a single large procedure 4 …”

“…This minimizes fluid volume shifts 4 . Dermatologists have also been leaders in recommending multiple small‐volume liposuction procedures rather than a single large procedure 4 …”