The American Society of Plastic Surgeons (ASPS) recommends that anyone considering liposuction be fully informed about the procedure before surgery. "Liposuction is generally a safe procedure," said C. Lin Puckett, MD, President of ASPS, "provided that patients are carefully selected, the operating facility is properly equipped, and the physician has proper surgical education with special training in body contouring. It is important to remember that liposuction is surgery and with any surgery there are both benefits and risks."

Liposuction is a surgical technique that removes unwanted fat from the body while improving body contours. Since its introduction in the United States in 1982, liposuction has become the most frequently performed cosmetic surgery procedure. The procedure is also used as an aid in some reconstructive surgical procedures. According to the latest ASPS statistics, board-certified plastic surgeons performed 172,079 liposuction procedures in 1998, compared with 109,353 in 1996, an increase of 57 percent.

Patients considering liposuction should know that there are no state or federal laws that govern the scope or quality of specialty education a physician must attain to designate him/herself a specialist in liposuction. A thorough understanding of the procedure, however, and careful selection of the physician can greatly enhance the possibility of a successful surgical outcome. Patients should consult a surgeon certified by the American Board of Plastic Surgery (ABPS), the only board recognized by the American Board of Medical Specialties to certify a surgeon in plastic surgery of the face and entire body. ABPS-certified surgeons who are ASPS members can be located by calling 1-888-4-PLASTIC(1-888-475-2784) or via the ASPS web site at www.plasticsurgery.org.

Before choosing a surgeon for liposuction, or any other plastic surgery procedure, ASPS recommends that patients clearly understand what to expect from the procedure as well as its limitations. Questions potential liposuction patients may want to ask the surgeon include:

• How often does the surgeon perform liposuction?
• What are realistic expectations?
• If the surgery is to be performed in an office surgical facility, does the surgeon have hospital privileges to perform liposuction?
• Is the surgical facility accredited, or in the process of being accredited, by a recognized external agency for safety?

Such accrediting organizations include the Accreditation Association for Ambulatory Health Care or AAAHC (847-676-9610), the Joint Commission on Accreditation of Healthcare Organizations or JCAHO (630-792-5000), or the American Association for Accreditation of Ambulatory Surgery Facilities or AAAASF(847)-949-6058.

Surgical facilities not accredited may not be adequately equipped and staffed to appropriately monitor patients and deal with any potential complications.

In addition, viewing pre- and post-operative photos can also be helpful in trying to understand what the surgery can accomplish.

Serious medical complications from liposuction surgery are rare, but they can occur. 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. " While any complication is one too many, ASPS continues to research ways to make liposuction as safe as possible," said Dr. Puckett. "Patient safety is our primary concern."

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.

Patients planning to have large volume liposuction, which involves the removal of more than 5,000 cc of aspirate (approximately 11 lbs.), should be aware that extra precautions should be taken and admission to a hospital may be appropriate.

In addition to the traditional suction-assisted liposuction, there are three other techniques: tumescent, "super-wet", and "UAL". The tumescent technique, which involves injecting of a large amount of a solution containing saline and local anesthetic into the area to be suctioned, can reduce blood loss and alleviate pain. The local anesthesia may be supplemented with intravenous sedation or general anesthesia. With the "super-wet" technique, lesser amounts of fluid and local anesthetic are injected and blood loss is similarly reduced. The procedure is usually done under general or spinal anesthetic. Another technical development is ultrasound-assisted liposuction or "UAL" which uses high-frequency ultrasonic energy to liquefy fat, which is then removed with a suction-assisted device.

"While liposuction can be an effective method of improving body contour, it should not be used as a weight-loss method," said Dr. Puckett. "Liposuction is not a substitute for exercise and a healthy diet."

A briefing paper on the history and physiology of liposuction was developed by ASPS. ASPS commissioned a task force to examine the liposuction procedure and prepare safety and informational guidelines. The task force includes representatives from ASPS, the American Society for Aesthetic Plastic Surgery and the Lipoplasty Society. The entire text of the briefing paper is available on the ASPS website at www.plasticsurgery.org.

ASPS, founded in 1931, is the largest plastic surgery organization in the world. It represents physicians certified by the American Board of Plastic Surgery (ABPS) or the Royal College of Physicians and Surgeons of Canada. To find an ABPS-certified plastic surgeon in your area or to learn more about cosmetic and reconstructive surgery, call the Plastic Surgery Information Service at 1-888-4-PLASTIC (1-888-475-2784).