Wants to remove specific areas of fat that are diet- and exercise-resistant (fat pockets in the abdomen, arms, knees, inner thighs, love handles, neck, outer thighs
Weight has been stable for 6 months or more
Has good skin tone and elasticity
Does not have loose or saggy skin
Does not have stretch marks
Has realistic expectations
Is emotionally stable
Understands the risks of surgery
If you do not meet all of these criteria, but meet some of them, you may still be a good candidate for liposuction. The procedure is most suited to those who are close to their ideal body weight, but if you have a lot of fat in a isolated area, you may still be a good candidate. Some patients find liposuction to be a good incentive for weight loss, but it is not a remedy for obesity.
If you have good skin tone, it is more likely that your skin will respond well to the surgery. Patients with saggy skin or stretch marks are more likely not to tighten and may in some cases look worse. A thigh lift or tummy tuck (depending on your problem area) may be more effective.
Patients planning to have large volume liposuction, which involves the removal of more than 5 liters (5,000 cc's; about 11 pounds) of fat and fluid may have an overnight stay at the hospital.
You are also at increased risk for complications from liposuction if you have diabetes, poor circulation, heart, lung or liver disease, smoke, have a family history of blood clots, take certain medications, etc. You'll want to discuss your medical history thoroughly with your physician before you choose to undergo surgery.
Lidocaine Lidocaine use poses particular hazards, especially since experts do not agree on safe injectable levels. "If you get too much lidocaine for too long," says Bruner, "the heart muscles become lazy. On the other hand, the brain becomes very agitated at first, which may cause a seizure, before coma sets in." At least one study links possible lidocaine toxicity to liposuction deaths. People with less than normal liver function or those who have been drinking alcohol may not be able to metabolize lidocaine well.
According to the FDA, a survey conducted by the American Society of Plastic Surgeons (ASPS) of more than 1,500 plastic and reconstructive surgeons in January 1999, there was an unexpected high death rate of one in every 5,000 (or 20 out of 100,000) liposuction patients between 1994 and 1998. These high numbers may be due to an increase in unqualified surgeons performing liposuction during that period. Since 1995, the number of deaths related to liposuction have decreased dramatically, to around 1 in 100,000 (approximately 25 deaths out of 250,000 liposuction procedures per year).
A study published in the scientific journal, Dermatologic Surgery, shows that office-based liposuction may be significantly safer than hospital-based liposuction. No deaths were reported by dermatologists performing approximately 300,000 procedures from 1995 - 2000.
A review of malpractice claims from the Physicians Insurance Association of America (PIAA) showed that of the 257 claims filed from January 1, 1995 through December 31,1997, less than 1 percent were against dermatologists even though dermatologic surgeons perform more than one-third of the liposuction procedures in the United States. In addition, 89% of claims were against plastic surgeons, with patients undergoing liposuction in a hospital setting accounting for 71% of malpractice claims.
According to statistics from their respective professional organizations, dermatologic surgeons currently perform about 100,000 liposuctions annually, with plastic surgeons accounting for more than 170,000 fat removal procedures per year. "Our study found that liposuction is safest when it is performed as a solo procedure under local (tumescent) anesthesia in an outpatient setting by a board-certified dermatologic surgeon. In fact, our data shows that there have been no deaths from liposuction by dermatologic surgeons." William P. Coleman, III, MD, president of the American Society for Dermatologic Surgery.
According to Dr. Coleman, more risks are associated with:
Extracting large amounts of fat
Using general anesthesia in a hospital setting
Performing multiple procedures during the same surgery
The PIAA study confirmed that patients who had liposuction performed under local anesthesia using the tumescent technique had no fatalities and fewer complications.
According to a study by the ASPS Liposuction Task Force, released in October 1998, the rate of significant complications from liposuction is low. The Task Force reviewed 24,295 liposuction surgeries performed by board-certified plastic surgeons for the study and found that only .03 percent reported significant complications.
Factors that increase the risk of complications include: large volume liposuction, because of the use of greater amounts of fluid and anesthesia, as well as removal of more fat; extended length of surgery; multiple procedures; or a patient whose preoperative health is compromised.
In 1997 board certified plastic surgeons formed a task force to investigate liposuction safety. Their research led to increased efforts by ASAPS and other plastic surgery organizations to re-educate plastic surgeons about risk reduction in lipoplasty procedures. Several measures were identified as ways to increase patient safety, including: 1) using stricter patient selection criteria, 2) limiting the length of surgery, 3) avoiding pre-injection of excessive amounts of fluid and local anesthetic, 4) removing a smaller volume of fat, 5) avoiding the combination of liposuction and certain other procedures, and 6) careful postoperative monitoring.
Beginning in mid-1998, the safety record of lipoplasty performed by board-certified plastic surgeons appears to have improved dramatically. In May 2001, a major survey on lipoplasty safety was published in Aesthetic Surgery Journal, the peer-reviewed journal of the American Society for Aesthetic Plastic Surgery. The survey, covering many thousands of lipoplasty procedures performed by ASAPS members from September 1998 through August 2000, showed that the risk of death from lipoplasty performed as an isolated procedure (not in combination with any other surgeries) was 1 per 47,415 procedures, a nearly 10-fold decrease from rates suggested by earlier published surveys.
The following tables record the data from that survey.
Nonfatal complications from lipoplasty and lipoplasty combination procedures for 94,159 lipoplasty procedures performed by ASAPS members: Sept 1, 1998, through Aug 31, 2000
Complication
Percent Rate
(1 complication in every __ procedures)
Skin slough
.0903%
1 per 1107
Ultrasound-assisted lipoplasty skin burns
0.0712%
1 per 1404
Deep vein thrombophlebitis
0.329%
1 per 3040
Pulmonary embolus
0.0266%
1 per 3759
Excessive blood loss
0.0149%
1 per 6711
Fluid overload
0.0138%
1 per 7246
Fat emboli
0.0053%
1 per 18.868
Cannula penetration of abdominal cavity
0.0021%
1 per 47,619
Lidocaine toxicity
0.0021%
1 per 47,619
Surgical shock
0.0011%
1 per 90,909
In the same study, the mortality rate was 0.0021%, or 1 death per 47,415 procedures. "Stated positively, the estimated non-mortality probability is 99.98%." Source: CE Hughes, Reduction of lipoplasty risks and mortality: An ASAPS survey. Aesth Plast Surg 2001;21:120-127
Information provided is for general education about liposuction, breast augmentation, breast reduction, eyelid surgery, face lifts, lip implants, rhinoplasty and other cosmetic plastic surgery procedures. This information is subject to change. Smart Plastic Surgery.com does not guarantee that it is accurate or complete, and is not responsible for any actions resulting from the use of this information. General information provided in this fashion should not be construed as specific medical advice or recommendation, and is not a substitute for a consultation and physical examination by a physician. Only discussion of your individual needs with a qualified physician will determine the best method of treatment for you. All board certified plastic surgeons listed are board certified by the American Board of Plastic Surgery. Board certified plastic surgeons are verified by the American Board of Medical Specialties.
Before and After Photos