Lipoplasty is based on the principle of the aspiration of subcutaneous fat through an inserted can-nula that is attached to a vacuum pump or syringe. A "superwet" technique has become the one most surgeon's choose, wherein a small volume dilute solution of local anesthetic and a vasocon-strictor is infiltrated into the surgical areas prior to beginning the procedure. Significant medical complications are rare, although the risk of significant complications and fatalities has been shown to increase with larger volume infusion and removal.

Preinjection of fluids containing local anesthetics and vasoconstrictors in a volume equal to the expected volume of fat to be removed has enabled lower morbidity and has decreased blood loss, swelling, bruising, and discomfort. Prior to the use of preinjection techniques, most fat removals of greater than 1500-2000 cc required blood transfusions to replace intraoperative blood loss.

Fluid Management

It is recommended that patients undergoing moderate (greater than 2000 cc) and large volume lipoplasty (greater than 5000 cc) have extended postoperative monitoring of vital signs and urine output. Only experienced surgeons should consider volumes of aspirate above 5000 cc, and they should monitor all intake and output fluids. Patients undergoing removal of significant amounts of fat may require additional intravenous fluid replacement and monitoring by an overnight stay in a hospital or an accredited extended outpatient care facility.

Fluid management is a fundamental part of surgery. A physician possessing core knowledge in surgery is best equipped to manage fluid and electrolyte balance in patients undergoing lipoplasty. Physicians who perform lipoplasty without having received thorough surgical training may be unable to prevent, identify, or treat potential complications should they occur.

Anesthesia

Some patients and their doctors prefer local anesthesia, or epidural anesthesia (with or without conscious sedation), while others prefer general anesthesia. A board-certified/board-eligible anesthesiologist or a certified registered nurse anesthetist should administer general anesthesia.

Techniques

Over time, several techniques have evolved as modifications of standard lipoplasty (Suction-Assisted Lipoplasty [SAL]), including Power-Assisted Lipoplasty (PAL), and Ultrasound-Assisted Lipoplasty (UAL) and using terms such as superwet or tumescent to refer to the ratios of injected fluid to aspirate (including fat) removed during lipoplasty. It is ASAPS' position that the technique used is subject to the determination of the operating surgeon and is of less consequence than the training of the surgeon and the accreditation of the facilities.

General Recommendations

Lipoplasty is a serious surgical procedure that has been demonstrated to be safe and effective when safety guidelines are in place. Among the risks are those associated with all surgery, such as pulmo-nary embolism.

General recommendations include:

Physicians performing lipoplasty in any facility should be required to have surgical privileges/ accreditation to perform this procedure in an acute care hospital.

Physicians should be qualified for examination or certified by an ABMS-recognized surgical board.

Facilities outside of acute care hospitals should possess a peer-review system, should report morbidity and mortality data, and should be accredited by AAAASF or equivalent agency.

Appropriate patient monitoring and resuscitation equipment and medication are essential, regardless of who is performing the procedure and how much fat is being removed.

Precise records of fluid intake and output should be maintained during the perioperative period. In addition to the standard discharge criteria, patients and their caregivers should be provided with written information on the symptoms of drug reactions and fluid overload and with instructions on how to respond if these symptoms occur.

Duration of care should include close monitoring 2-4 hours post operative and physician follow-up in 24 to 48 hours, with outcome reviews scheduled at intervals from a week to a year.

************************************************************ The American Society for Aesthetic Plastic Surgery (ASAPS) is the leading organization of plastic surgeons certified by the American Board of Plastic Surgery (ABPS) who specialize in cosmetic surgery of the face and the entire body.

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