Safety Studies in the Field of Liposuction: A Systematic Review

Abstract

BACKGROUND There is an increasing demand for safety standards for cosmetic treatments. With regard to liposuction, interdisciplinary consensus is lacking, especially regarding treatment setting and physician specialty. OBJECTIVE A solid, independent interpretation of scientific data on safety requires a systematic approach, which is the aim of this study. METHODS A systematic literature search was conducted for safety studies about liposuction through April 2017. Fatalities and/or reported serious adverse events served as outcome measures for safety. RESULTS Twenty-four studies were included. Factors that contributed to increased serious complication and mortality risk were: use of the (super)wet technique; use of systemic anesthetics, especially general anesthesia and intravenous sedation; execution by a plastic surgeon; execution in an operating room; and combination with other procedures. CONCLUSION Liposuction using tumescent local anesthesia has been shown to be the safest method of fat removal, especially if no or only minimal systemic anesthesia is used. Performance of this technique in an office-based setting has been proven to be safe beyond doubt. When systemic anesthesia is used, an outpatient or ambulatory surgery facility seems also safe. Regardless of the physician specialty, knowledge and training on the execution of the tumescent procedure are vital to ensure optimal safety.

Principles and Applications of Fat Grafting in Plastic Surgery

“…Direct excision, manual aspiration, and liposuction are among the techniques described in the literature. 41 For liposuction or manual aspiration to be performed, negative pressures are required. Despite the heterogeneity between the negative pressure values suggested by different authors, it is well Fig.…”

“…The resultant ratio of infiltrate volume to total aspirate volume is typically 2 to 3:1 L. This technique is considered to be the safest method of fat removal as associated blood loss is around 1% of the aspirated volume and general anesthesia is not required. 41 Proper graft delivery is an extremely important factor that is often underappreciated in the literature. An even distribution of the fat graft at the recipient site is the key for a successful injection.…”

A Combined Prilocaine-Lidocaine Tumescent Solution Has Lower Clinical Side Effects Compared With Lidocaine Only

“…[1][2][3] Tumescent liposuction in awake local anesthesia was shown to be a safe method, providing it is performed by an experienced surgeon and the guidelines of care for liposuction are strictly followed. [4][5][6][7] In the United States, the anesthetic that is most often used is lidocaine, while in Germany and several other European countries, prilocaine has been used for several decades now. [8][9][10] Estimated maximum safe dosages of tumescent lidocaine are 45 to 55 mg/kg body weight, 11,12 and the estimated maximum safe dosages of tumescent prilocaine are 35 mg/kg body weight.…”

High-Definition Liposculpture in Males Using Power-Assisted Liposuction and Local Anesthesia

“…1 Independent predictors of major complications are combined procedures, procedures performed in a hospital, and the use of systemic anesthesia. [2][3][4] Tumescent infiltration is a type of local anesthesia for cutaneous and subcutaneous surgery, where large amounts of dilute local anesthetic are subcutaneously administered, with either a blunt cannula or needles. It enlarges the target area, reduces pain and bleeding during and after surgery, and also has antibacterial properties.…”

“…[5][6][7] Tumescent liposuction under wide-awake local anesthesia was shown to be a safe method, provided it is performed by an experienced surgeon and the guidelines of care for liposuction are strictly followed. [1][2][3] Estimated maximum safe dosages of tumescent lidocaine are 45 mg/kg. 8 Depending on the lidocaine concentration, this limits the total injection volume and hence the size of body area that can be treated in a single session.…”