title: 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.
authors.affiliation: Arlington Heights, Ill. From the American Society of Plastic Surgeons' Patient Safety Committee.
authors.forename: Phillip C
authors.initials: PC
authors.lastname: Haeck
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Swanson
authors.forename: Karol A
authors.initials: KA
authors.lastname: Gutowski
authors.forename: C Bob
authors.initials: CB
authors.lastname: Basu
authors.forename: Amy G
authors.initials: AG
authors.lastname: Wandel
authors.forename: Lynn A
authors.initials: LA
authors.lastname: Damitz
authors.forename: Neal R
authors.initials: NR
authors.lastname: Reisman
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Baker
mesh_terms: D000556:Ambulatory Surgical Procedures / Q000592:standards*; D019317:Evidence-Based Medicine; D006801:Humans; D015187:Lipectomy; D018579:Patient Selection; D012449:Safety
references.citation: Iverson RE, Lynch DJ. Practice advisory on liposuction. Plast Reconstr Surg. 2004;113:1478–1490.
references.citation: Greenhalgh T. How to Read a Paper: The Basics of Evidence-Based Medicine. 3rd ed. Oxford: Blackwell Publishing; 2006.
references.citation: Lang TA, Secic M. How to Report Statistics in Medicine. 2nd ed. Philadelphia: American College of Physicians; 2006.
references.citation: Straus SE, Richardson WS, Glasziou P, Haynes RB. Evidence-Based Medicine: How to Practice and Teach EBM. 3rd ed. Philadelphia: Elsevier Churchill Livingstone; 2005.
references.citation: Evidence-Based Medicine Working Group. Users’ Guides to the Medical Literature: Essentials of Evidence-Based Clinical Practice. Chicago: American Medical Association; 2002.
references.citation: Rohrich RJ, Leedy JE, Swamy R, Brown SA, Coleman J. Fluid resuscitation in liposuction: A retrospective review of 89 consecutive patients. Plast Reconstr Surg. 2006;117:431–435.
references.citation: Samdal F, Amland PF, Bugge JF. Blood loss during suction-assisted lipectomy with large volumes of dilute adrenaline. Scand J Plast Reconstr Surg Hand Surg. 1995;29:161–165.
references.citation: Fodor PB, Watson JP. Wetting solutions in ultrasound-assisted lipoplasty. Clin Plast Surg. 1999;26:289–283.
references.citation: Matarasso A. Ultrasound-assisted lipoplasty: Is this new technology for you? Clin Plast Surg. 1999;26:369–375.
references.citation: Tebbetts JB. Minimizing complications of ultrasound-assisted lipoplasty: An initial experience with no related complications. Plast Reconstr Surg. 1998;102:1690–1697.
references.citation: Jewell ML, Fodor PB, de Souza Pinto EB, Al Shammari MA. Clinical application of VASER–assisted lipoplasty: A pilot clinical study. Aesthetic Surg J. 2002;22:131–146.
references.citation: Mendes FH. External ultrasound-assisted lipoplasty from our own experience. Aesthetic Plast Surg. 2000;24:270–274.
references.citation: Gasperoni C, Salgarello M, Gasperoni P. External ultrasound used in conjunction with superficial subdermal liposuction: A safe and effective technique. Aesthetic Plast Surg. 2000;24:253–258.
references.citation: Cardenas-Camarena L, Cardenas A, Fajardo-Barajas D. Clinical and histopathological analysis of tissue retraction in tumescent liposuction assisted by external ultrasound. Ann Plast Surg. 2001;46:287–292.
references.citation: Lawrence N, Cox SE. The efficacy of external ultrasound-assisted liposuction: A randomized controlled trial. Dermatol Surg. 2000;26:329–332.
references.citation: Badin AZ, Gondek LB, Garcia M, Valle LC, Flizikowski FB, de Noronha L. Analysis of laser lipolysis effects on human tissue samples obtained from liposuction. Aesthetic Plast Surg. 2005;29:281–286.
references.citation: Prado A, Andrades P, Danilla S, Leniz P, Castillo P, Gaete F. A prospective, randomized, double-blind, controlled clinical trial comparing laser-assisted lipoplasty with suction-assisted lipoplasty. Plast Reconstr Surg. 2006;118:1032–1045.
references.citation: Araco A, Gravante G, Araco F, Delogu D, Cervelli V. Comparison of power water–assisted and traditional liposuction: A prospective randomized trial of postoperative pain. Aesthetic Plast Surg. 2007;31:259–265.
references.citation: Thornton LK, Nahai F. Equipment and instrumentation for ultrasound-assisted lipoplasty. Clin Plast Surg. 1999;26:299–304.
references.citation: Young VL. Power-assisted lipoplasty. Plast Reconstr Surg. 2001;108:1429–1432.
references.citation: Chang CC, Commons GW. A comparison of various ultrasound technologies. Clin Plast Surg. 1999;26:261–268.
references.citation: Grotting JC, Beckenstein MS. The solid-probe technique in ultrasound-assisted lipoplasty. Clin Plast Surg. 1999;26:245–254.
references.citation: Gingrass MK. Lipoplasty complications and their prevention. Clin Plast Surg. 1999 26:341–354.
references.citation: Rao RB, Ely SF, Hoffman RS. Deaths related to liposuction. N Engl J Med. 1999;340:1471–1475.
references.citation: Rubinstein EH. An anesthesiologist’s perspective of lipoplasty. Clin Plast Surg. 1999;26:423–429.
references.citation: Miller RD. Anesthesia. 5th ed. Philadelphia: Churchill Livingstone; 2000:503–517.
references.citation: Physicians’ Desk Reference. Montvale NJ: Medical Economics; 2002.
references.citation: Hagerty T, Klein P. Fat partitioning of lidocaine in tumescent liposuction. Ann Plast Surg. 1999;42:372–375.
references.citation: Klein JA. Tumescent technique for regional anesthesia permits lidocaine doses of 35 mg/kg for liposuction. J Dermatol Surg Oncol. 1990;16:248–263.
references.citation: Samdal F, Amland PF, Bugge JF. Plasma lidocaine levels during suction-assisted lipectomy using large doses of dilute lidocaine with epinephrine. Plast Reconstr Surg. 1994;93:1217–1223.
references.citation: Burk RW III, Guzman-Stein G, Vasconez LO. Lidocaine and epinephrine levels in tumescent technique liposuction. Plast Reconstr Surg. 1996;97:1379–1384.
references.citation: Butterwick KJ, Goldman MP, Sriprachya-Anunt S. Lidocaine levels during the first two hours of infiltration of dilute anesthetic solution for tumescent liposuction: Rapid versus slow delivery. Dermatol Surg. 1999;25:681–685.
references.citation: Nordstrom H, Stange K. Plasma lidocaine levels and risks after liposuction with tumescent anaesthesia. Acta Anaesthesiol Scand. 2005;49:1487–1490.
references.citation: Meister F. Possible association between tumescent technique and life-threatening pulmonary complications. Clin Plast Surg. 1996;23:642–645.
references.citation: Rubin JP, Xie Z, Davidson C, Rosow CE, Chang Y, May JW Jr. Rapid absorption of tumescent lidocaine above the clavicles: A prospective clinical study. Plast Reconstr Surg. 2005;115:1744–1751.
references.citation: Naguib M, Magboul MM, Samarkandi A, Attia M. Adverse effects and drug interactions associated with local and regional anaesthesia. Drug Saf. 1998;18:221–225.
references.citation: Lindenblatt N, Belusa L, Tiefenbach B, Schareck W, Olbrisch RR. Prilocaine plasma levels and methemoglobinemia in patients undergoing tumescent liposuction involving less than 2,000 ml. Aesthetic Plast Surg. 2004;28:435–440.
references.citation: Matarasso A. Lidocaine in ultrasound-assisted lipoplasty. Clin Plast Surg. 1999;26:431–439.
references.citation: Ersek RA. Dissociative anesthesia for safety’s sake: Ketamine and diazepam. A 35-year personal experience. Plast Reconstr Surg. 2004;113:1955–1959.
references.citation: Knize DM, Fishell R. Use of preoperative subcutaneous “wetting solution” and epidural block anesthesia for liposuction in the office-based surgical suite. Plast Reconstr Surg. 1997;100:1867–1874.
references.citation: Burns SM, Meland NB. Spinal anesthesia for abdominoplasty with liposuction: A case report. AANA J. 2007;75:126–128.
references.citation: Marcus JR, Tyrone JW, Few J, Fine NA, Mustoe TA. Optimization of conscious sedation in plastic surgery. Plast Reconstr Surg. 1999;104:1338–1345.
references.citation: Fleisher LA, Pasternak LR, Lyles A. A novel index of elevated risk of inpatient hospital admission immediately following outpatient surgery. Arch Surg. 2007;142:263–268.
references.citation: Mandal A, Imran D, McKinnell T, Rao GS. Unplanned admissions following ambulatory plastic surgery: A retrospective study. Ann R Coll Surg Engl. 2005;87:466–468.
references.citation: Mattila K, Toivonen J, Janhunen L, Rosenberg PH, Hynynen M. Postdischarge symptoms after ambulatory surgery: First-week incidence, intensity, and risk factors. Anesth Analg. 2005;101:1643–1650.
references.citation: Shirakami G, Teratani Y, Namba T, Hirakata H, Tasuke-Nishimura M, Fukuda K. Delayed discharge and acceptability of ambulatory surgery in adult outpatients receiving general anesthesia. J Anesth. 2005;19:93–101.
references.citation: Fortier J, Chung F, Su J. Unanticipated admission after ambulatory surgery: A prospective study. Can J Anaesth. 1998;45:612–619.
references.citation: Price MF, Massey B, Rumbolo P, Paletta CE. Liposuction as an adjunct procedure in reduction mammaplasty. Ann Plast Surg. 2001;47:115–118.
references.citation: Nahai F. Update on experience with liposuction breast reduction (Discussion). Plast Reconstr Surg. 2001;108:1011–1013.
references.citation: Handschin AE, Bietry D, Husler R, Banic A, Constantinescu M. Surgical management of gynecomastia: A 10-year analysis. World J Surg. 2008;32:38–44.
references.citation: Giese SY, Neborsky R, Bulan E, Spear SL, Yanovski JA. Improvements in cardiovascular risk profile after large-volume lipoplasty: A 1-year follow-up study. Aesthetic Surg J. 2001;21:527–531.
references.citation: Giugliano G, Nicoletti G, Grella E, et al. Effect of liposuction on insulin resistance and vascular inflammatory markers in obese women. Br J Plast Surg. 2004;57:190–194.
references.citation: Ovrebo KK, Grong K, Vindenes H. Small intestinal perforation and peritonitis after abdominal suction lipoplasty. Ann Plast Surg. 1997;38:642–644.
references.citation: McGrath MH, Schooler WG. Elective plastic surgical procedures in adolescence. Adolesc Med Clin. 2004;15:487–502.
references.citation: McGrath MH, Mukerji S. Plastic surgery and the teenage patient. J Pediatr Adolesc Gynecol. 2000;13:105–118.
references.citation: Trott SA, Beran SJ, Rohrich R, Kenkel JM, Adams WP Jr, Klein KW. Safety considerations and fluid resuscitation in liposuction: An analysis of 53 consecutive patients. Plast Reconstr Surg. 1998;102:2220–2229.
references.citation: Hunstad JP. Body contouring in the obese patient. Clin Plast Surg. 1996;23:647–670.
references.citation: Gilliland MD, Coates N. Tumescent liposuction complicated by pulmonary edema. Plast Reconstr Surg. 1997;99:215–219.
references.citation: Platt MS, Kohler LJ, Ruiz R, Cohle SD, Ravichandran P. Deaths associated with liposuction: Case reports and review of the literature. J Forensic Sci. 2002;47:205–207.
references.citation: Rohrich RJ, Beran SJ. Is liposuction safe? Plast Reconstr Surg. 1999;104:819–822.
references.citation: Hughes CE III. Reduction of lipoplasty risks and mortality: An ASAPS survey. Aesthetic Surg J. 2001;21:120–127.
references.citation: Buescher TM. Paraspinous muscle hemorrhage as a potential source of liposuction mortality. Plast Reconstr Surg. 2000;106:740–741.
references.citation: Cardenas-Camarena L, Paillet JC. Combined gluteoplasty: Liposuction and gluteal implants. Plast Reconstr Surg. 2007;119:1067–1074.
references.citation: Stevens WG, Cohen R, Vath S, Stoker DA, Hirsch EM. Does lipoplasty really add morbidity to abdominoplasty? Revisiting the controversy with a series of 406 cases. Aesthetic Surg J. 2005;25:353–358.
references.citation: Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology 2002;96:1004–1017.
references.citation: Amaragiri SV, Lees TA. Elastic compression stockings for prevention of deep vein thrombosis. Cochrane Database Syst Rev. 2000;3:CD001484.
references.citation: Urbankova J, Quiroz R, Kucher N, Goldhaber SZ. Intermittent pneumatic compression and deep vein thrombosis prevention: A meta-analysis in postoperative patients. Thromb Haemost. 2005;94:1181–1185.
references.citation: Behroozan DS, Christian MM, Moy RL. Mycobacterium fortuitum infection following neck liposuction: A case report. Dermatol Surg. 2000;26:588–590.
references.citation: Sharma D, Dalencourt G, Bitterly T, Benotti PN. Small intestinal perforation and necrotizing fasciitis after abdominal liposuction. Aesthetic Plast Surg. 2006;30:712–716.
references.citation: Chang KN. Long-term results of surgical correction of postliposuction contour irregularities. Plast Reconstr Surg. 2002;109:2141–2145.
references.citation: Glashofer M, Coleman WP III, Lewis A, Mason S, Plaisance J. Seroma formation following abdominal liposuction. Dermatol Surg. 2005;31:770–771.
references.citation: Minagar A, Schatz NJ, Glaser JS. Liposuction and ischemic optic neuropathy: Case report and review of literature. J Neurol Sci. 2000;181:132–136.
references.citation: Cedidi CC, Berger A. Severe abdominal wall necrosis after ultrasound-assisted liposuction. Aesthetic Plast Surg. 2002;26:20–22.
references.citation: Cohen A, Kishore K, Wolansky L, Frohman L. Pituitary apoplexy occurring during large volume liposuction surgery. J Neuroophthalmol. 2004;24:31–33.
references.citation: Moura FC, Cunha LP, Monteiro ML. Bilateral visual loss after liposuction: Case report and review of the literature. Clinics (Sao Paulo) 2006;61:489–491.
references.citation: Ribeiro Monteiro ML, Moura FC, Cunha LP. Bilateral visual loss complicating liposuction in a patient with idiopathic intracranial hypertension. J Neuroophthalmol. 2006;26:34–37.
references.citation: Uemura K, Kikuchi Y, Shintani-Ishida K, Nakajima Y, Yoshida K. A fatal case of post-operative pulmonary thromboembolism with cosmetic liposuction. J Clin Forensic Med. 2006;13:41–43.
references.citation: Mallappa M, Rangaswamy M, Badiuddin MF. Small intestinal perforation and peritonitis after liposuction. Aesthetic Plast Surg. 2007;31:589–592.
references.citation: Ross RM, Johnson GW. Fat embolism after liposuction. Chest 1988;93:1294–1295.
references.citation: Barillo DJ, Cancio LC, Kim S, et al. Fatal and near-fatal complications of liposuction. South Med J. 1998;91:487–492.
references.citation: Heitmann C, Czermak C, Germann G. Rapidly fatal necrotizing fasciitis after aesthetic liposuction. Aesthetic Plast Surg. 2000;24:344–347.
references.citation: Anwar UM, Ahmad M, Sharpe DT. Necrotizing fasciitis after liposculpture. Aesthetic Plast Surg. 2004;28:426–427.
references.citation: Murillo J, Torres J, Bofill L, et al. Skin and wound infection by rapidly growing mycobacteria: An unexpected complication of liposuction and liposculpture. The Venezuelan Collaborative Infectious and Tropical Diseases Study Group. Arch Dermatol. 2000;136:1347–1352.
references.citation: Dessy LA, Mazzocchi M, Fioramonti P, Scuderi N. Conservative management of local Mycobacterium chelonae infection after combined liposuction and lipofilling. Aesthetic Plast Surg. 2006;30:717–722.
references.citation: Samama MM. An epidemiologic study of risk factors for deep vein thrombosis in medical outpatients: The Sirius study. Arch Intern Med. 2000;160:3415–3420.
references.citation: Spring MA, Gutowski KA. Venous thromboembolism in plastic surgery patients: Survey results of plastic surgeons. Aesthetic Surg J. 2006;26:522–529.
references.citation: Wu O, Robertson L, Twaddle S, et al. Screening for thrombophilia in high-risk situations: Systematic review and cost-effectiveness analysis. The Thrombosis: Risk and Economic Assessment of Thrombophilia Screening (TREATS) study. Health Technol Assess. 2006;10:1–110.
references.citation: Wu O, Robertson L, Langhorne P, et al. Oral contraceptives, hormone replacement therapy, thrombophilias and risk of venous thromboembolism: A systematic review. The Thrombosis: Risk and Economic Assessment of Thrombophilia Screening (TREATS) Study. Thromb Haemost. 2005;94:17–25.
references.citation: Wille-Jorgensen P, Rasmussen MS, Andersen BR, Borly L. Heparins and mechanical methods for thromboprophylaxis in colorectal surgery. Cochrane Database Syst Rev. 2003;4:CD001217.
references.citation: Handoll HH, Farrar MJ, McBirnie J, et al. Heparin, low molecular weight heparin and physical methods for preventing deep vein thrombosis and pulmonary embolism following surgery for hip fractures. Cochrane Database Syst Rev. 2002;4:CD000305.
references.citation: Michot M, Conen D, Holtz D, et al. Prevention of deep-vein thrombosis in ambulatory arthroscopic knee surgery: A randomized trial of prophylaxis with low–molecular weight heparin. Arthroscopy 2002;18:257–263.
references.citation: Turpie AG, Bauer KA, Eriksson B, Lassen MR. Fondaparinux vs enoxaparin for the prevention of venous thromboembolism in major orthopedic surgery: A meta-analysis of 4 randomized double-blind studies. Arch Intern Med. 2002;162:1833–1840.
references.citation: Young VL, Watson ME. The need for venous thromboembolism (VTE) prophylaxis in plastic surgery. Aesthetic Surg J. 2006;26:157–175.
references.citation: El-Ali KM, Gourlay T. Assessment of the risk of systemic fat mobilization and fat embolism as a consequence of liposuction: Ex vivo study. Plast Reconstr Surg. 2006;117:2269–2276.
references.citation: Wang HD, Zheng JH, Deng C, Liu QY, Yang SL. Fat embolism syndromes following liposuction. Aesthetic Plast Surg. 2008;32:731–736.
references.citation: Greene AK, Slavin SA, Borud L. Treatment of lower extremity lymphedema with suction-assisted lipectomy. Plast Reconstr Surg. 2006;118:118e–121e.
references.citation: Emsen IM. Treatment with ultrasound-assisted liposuction of accessory axillary breast tissues. Aesthetic Plast Surg. 2006;30:251–252.