Introduction

The American Society for Aesthetic Plastic Surgery (ASAPS) is an organization representing surgeons certified by the American Board of Plastic Surgery (ABPS) who concentrate their practices in cosmetic surgery. ASAPS has nearly 3000 members and candidates. ASAPS is a participant in the Lipoplasty Task Force that developed Clinical Practice Guidelines for plastic surgeons. These guidelines represent input not only from ASAPS, but also from the American Society of Plastic Surgeons (ASPS), as well as several other significant groups within organized plastic surgery, including the Aesthetic Surgery Education and Research Foundation, the Lipoplasty Society and the Plastic Surgery Educational Foundation.

Guidelines/practice parameters are strategies for patient management, developed to assist physicians in clinical decision-making. The following guidelines/practice parameters reflect the state of knowledge current at the time of publication. Periodic review, updating and revision will be done. This document does not intend to establish a standard of care, but to spell out recommendations that can serve as guidelines to ensure the highest level of patient care.

Background

Nearly two decades of clinical experience in the United States and Canada have demonstrated that lipoplasty (liposuction) is safe and produces effective therapeutic outcomes when performed by a trained surgeon in accordance with accepted standards of surgical practice. Lipoplasty is generally recommended for patients of normal weight who have localized fat deposits that are resistant to diet or exercise. Lipoplasty to remove a greater volume of fat is sometimes performed on patients who exceed their ideal body weight but who otherwise are appropriate candidates for fat suctioning. Lipoplasty is not a surgical treatment for obesity.

Lipoplasty is the single most requested aesthetic (cosmetic) surgical procedure in the United States, with 376,633 procedures performed in 2000 (statistics from the American Society for Aesthetic Plastic Surgery). From its introduction in the U.S. in 1982 until the early 1990s, lipoplasty had among the lowest complication rates of all aesthetic surgical procedures. However, as new techniques were introduced, and physicians found they could remove larger amounts of fat, the incidence of major complications, including fatal outcomes, rose.

Data on Lipoplasty Safety

While data prior to 1994 showed a very low rate of lipoplasty complications, surveys examining procedures performed between mid-1994 and mid-1998 suggested mortality rates as high as 1 in 5,000. Educational efforts conducted to alert plastic surgeons to lipoplasty risk factors have produced a dramatic effect on the procedure's safety record since 1998, according to results of a major survey published in Aesthetic Surgery Journal (ASJ), ASAPS' peer-reviewed journal. Survey respondents reported a total of 94,159 lipoplasty procedures performed from September 1998 through August 2000. Based on the results, the estimated risk of death from lipoplasty performed as an isolated procedure (not in combination with any other surgeries) was found to be 1 per 47,415 procedures.

The educational efforts that led to these significant improvements in lipoplasty safety focused on data from earlier studies showing that the following factors contribute to increased risk: 1) excessive amounts of fluid and local anesthesia, 2) excessive fat removal, 3) performance of multiple unrelated procedures in the same surgical session and 4) poor patient selection/patient health. All these factors can be avoided. Results of the data analysis were used by the Lipoplasty Task Force to establish recommended clinical guidelines.

Training

It is ASAPS' position that since lipoplasty is a surgical procedure, physicians performing lipoplasty should be trained as surgeons. Such training is absolutely necessary to ensure the highest standard of care, to ensure patient safety, and to minimize potential complications. Physicians who perform liposuction without having had the customary surgical training, including fluid management, may not be prepared to prevent or handle unexpected complications. Yet no current state laws prohibit any physician, including those without appropriate specialty training, from performing lipoplasty and other cosmetic surgery. Physicians may use titles such as "plastic surgeon," "cosmetic surgeon," or similar names without actually being certified in the specialty of plastic surgery or even being formally trained in surgery.