Evidence-Based Patient Safety Advisory: Liposuction

Abstract

Liposuction is considered to be one of the most frequently performed plastic surgery procedures in the United States, yet despite the popularity of liposuction, there is relatively little scientific evidence available on patient safety issues. This practice advisory provides an overview of various techniques, practices, and management strategies that pertain to individuals undergoing liposuction, and recommendations are offered for each issue to ensure and enhance patient safety.

Liposuction: Where are We and Where are We Going?

“…Failure to exclude these patients can lead to clinical and aesthetic disasters and unhappy patients. Offering elective aesthetic surgery to patients with body dysmorphic disorder or eating disorders should be avoided [5]. If the patient has reasonable expectations that agree with technically achievable results, the patient undergoing large volume liposuction tends to be very happy.…”

“…It should be noted, however, that epidural anesthesia and spinal anesthesia can cause vasodilation and hypotension, thereby necessitating the administration of excess fluid and increasing the risk for fluid overload [5]. Although no evidence supports the use of any single technique, the American Society of Plastic Surgeons Practice Advisory recommends avoiding neuraxial anesthesia (i.e., spinal, epidural) in office-based settings because of potential hypotension and volume overload issues; therefore its use must be reserved for the operation room.…”

“…Not all patients are appropriate liposuction candidates. These patients may wish to continue diet and exercise routines, seek medical intervention to treat existing condition(s), or, in the case of patients who have unrealistic expectations about their condition or potential outcomes, be referred for a psychiatric/ psychological evaluation [5]. Preoperative patient evaluation includes a thorough history and physical examination.…”

“…A personal or family history of coagulopathies or bruising tendencies should be elicited. If any concerns exist regarding the health of the patient, refer the patient to the anesthesiologist or the patient's primary care physician for evaluation [4,5].…”

“…In addition, red blood cell loss needs to be assessed and replacement transfusions should be given, if needed. Patients who undergo large-volume liposuction or multiple procedures should be warmed during recovery using appropriate warming methods [5,17].…”