Practice Advisory on Liposuction

Abstract

COMMITTEE STATEMENT: At the 69th annual meeting of the American Society of Plastic Surgeons (ASPS) in October of 2000, the ASPS Board of Directors convened the Task Force on Patient Safety in Office-Based Surgery Facilities. The task force was assembled in the wake of several highly publicized patient deaths involving plastic surgery and increasing state legislative and regulatory activity of office-based surgery facilities. In response to the increased scrutiny of the office-based surgery setting, the task force produced two practice advisories: "Procedures in the Office-Based Surgery Setting" and "Patient Selection in the Office-Based Surgery Setting." Since the task force's inception, professional and public awareness of patient safety issues has continued to grow. This heightened interest resulted in an increased need for plastic surgeons to communicate their views on the topic. To meet this challenge, the task force evolved into the Committee on Patient Safety, allowing the committee to address topics affecting the safety and welfare of plastic surgery patients, regardless of the facility setting. The "Practice Advisory on Liposuction" is the first advisory developed since the committee was formed. It was a lengthy and painstaking process for the committee, which included representatives from related plastic surgery organizations as well as the American Society of Anesthesiologists (ASA). Committee members included Ronald E. Iverson, M.D., chair; Jeffery L. Apfelbaum, M.D., ASA representative; Bruce L. Cunningham, M.D., ASPS/Plastic Surgery Educational Foundation (PSEF) Joint Outcomes Task Force representative; Richard A. D'Amico, M.D., ASPS representative; Victor L. Lewis, Jr., M.D., ASPS Health Policy Analysis Committee representative; Dennis J. Lynch, M.D., ASPS representative; Noel B. McDevitt, M.D., ASPS Deep Vein Thrombosis Task Force representative; Michael F. McGuire, M.D., The American Society for Aesthetic Plastic Surgery (ASAPS) representative; Louis Morales, Jr., M.D., American Society of Maxillofacial Surgeons representative; Calvin R. Peters, M.D., Florida Ad Hoc Commission on Patient Safety representative; Robert Singer, M.D., American Association for Accreditation of Ambulatory Surgery Facilities representative; Thomas Ray Stevenson, M.D., American College of Surgeons representative; Rebecca S. Twersky, M.D., ASA representative; Ronald H. Wender, M.D., ASA representative; and James A. Yates, ASAPS representative. The authors thank members of the committee for the insights they brought to this process. The final document represents their significant contributions to these efforts. They would also like to recognize DeLaine Schmitz and Pat Farrell of the ASPS staff for their work on and support of this project.

Teenagers and Cosmetic Surgery: Focus on Breast Augmentation and Liposuction

“…However, several studies attempted to measure the specific body image issues related to adolescents seeking cosmetic surgery. The previously cited study of Dutch adolescents (ages [12][13][14][15][16][17][18][19][20][21][22] presenting for plastic surgery found that these patients did not differ from other adolescents on most selfconfidence or mental health measures. However, they were slightly less confident of their physical appearance and romantic appeal, and significantly more dissatisfied with the body part for which they were considering surgery compared to adolescents in the general population [21].…”

“…The different techniques (tumescent, superwet, and ultrasound-assisted liposuction) are associated with additional complications such as skin or deep tissue damage. The American Society of Plastic Surgeons' advisory states that the likelihood of serious medical complications, such as lidocaine toxicity and fluid accumulation in the lungs, increase with "the number of sites treated and the volume of fat aspirated" [16].…”

Acute Respiratory Distress following Liposuction

“…Major com- plications include bleeding, infection, skin necrosis, vital organ injury, adverse anesthesia reaction, pulmonary embolism, and fat embolism. 1 A census survey of North American cosmetic surgeons in the mid-1990s revealed a perioperative mortality rate of 20 per 100,000 cases; death was attributed to pulmonary embolism in 23% of the fatal cases and fat embolism was identified as the cause of death in 8.5% of cases. 2 Fat embolism occurs when adipocytes and small blood vessels are damaged during the procedure, introducing lipid microthrombi into the circulation.…”

Discussion

“…Liposuction remains one of the procedures most commonly performed by plastic surgeons and is predominantly performed for aesthetic reasons, 5 gaining attention in the public eye only if a tragic death occurs 6,7 or presented on television purely for entertainment and noneducational purposes. Recent data highlighted in this review show that there may be physiologic improvements following liposuction that could not only help the self-esteem of individuals who have supersized themselves but also result in unanticipated improvements to their long-term health.…”