Medical education is comprised of three components: undergraduate medical education ("medical school"), graduate medical education ("residency training"), which prepares a physician to practice a specialty, and continuing medical education (CME), which continues throughout a physician's professional life. Following medical school, doctors performing lipoplasty should either have completed a general surgery residency program approved by the Accreditation Council on Graduate Medical Education (ACGME); a plastic surgery integrated residency program approved by the ACGME; or a surgical specialty residency program approved by the ACGME in a specialty recognized by the American Board of Medical Specialties (ABMS). The physician should also have specific training in lipoplasty. The American College of Surgeons has stated that qualification of a surgeon as a specialist implies that practice will be conducted within specialty limits.

The American Board of Plastic Surgery (ABPS) is recognized by the ABMS to certify doctors in the specialty of plastic surgery. Plastic surgeons certified by the ABPS have successfully completed a minimum of 3 years of clinical training in general surgery or other surgical specialty and a minimum of 2 years of approved residency training specifically in plastic surgery. All ASAPS members are ABPS certified. (more)

Hospital Privileges and Outpatient Surgical Facilities

Credentials to perform specific surgical procedures within an acute care hospital setting are a form of physician accreditation. Hospital surgical privileges to perform specific procedures are granted only after a hospital review committee evaluates a surgeon's training and competency. This involves peer review and monitoring of results and complications. Permission to perform new surgical techniques may be granted upon documentation of additional training.

ASAPS maintains that cosmetic surgical procedures and treatments may be safely performed in facilities outside of a hospital. Published data regarding complications associated with a variety of plastic surgery procedures performed in accredited office-based facilities showed a complication rate of less that ½ of 1 percent (0.47%) in over 400,000 operations. This number compares favorably with the rate of complications for similar procedures performed in hospitals.

It is recommended that out-of-hospital facilities, including office-based surgical facilities, meet strict quality standards, peer review, and external quality assurance assessment, such as accreditation by the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) or equivalent agency. All facilities should be adequately staffed and equipped to monitor patients and deal with potential complications. All facilities should have appropriate resuscitation equipment, and be required to report morbidity and mortality data.

Beginning in July 2002, ASAPS will require its membership of ABPS-certified plastic surgeons to perform operations required anesthesia (other than local anesthesia and/or minimal oral or intramuscular tranquilization) only in accredited surgical facilities.

It is ASAPS' position that the performance of cosmetic surgical procedures and treatments in any venue requires ABMS board certification in a surgical specialty and hospital privileges, based on documented training and peer review. The hospital privileges should be for the aesthetic procedure to be performed whether the procedure is performed in the hospital or an approved outpatient setting. Issues of patient safety must be addressed when planning procedures, wherever they may be performed. The common denominator is prudent surgical judgment with respect to patient evaluation, risk disclosure, amount/length of surgery planned, and postoperative care.

Patient Selection

Lipoplasty is well suited for women and men who are within 30 percent of their ideal body weight and have adequate skin elasticity to ensure good cosmetic results, but who have localized fat deposits that are resistant to diet or exercise. It is not an indicated treatment for obesity. Appropriate patient selection should include candid discussion of any pre-existing medical conditions, and any current medications, including dietary or herbal supplements. An appropriate physical examination, including laboratory work based on the patient's general health and age, is necessary; the American Society of Anesthesiologists (ASA) has set general standards for preoperative testing. Special attention should be given to possible drug interactions.

Lipoplasty should be considered a major surgical (not a "lunch time") procedure, with the need for accurate disclosure of risk and potential complications to patients electing to undergo this procedure using any of the currently performed techniques.