THE AMERICAN ACADEMY OF COSMETIC SURGERY
1. Training and Education

Physicians practicing liposuction surgery should have adequate training and experience in the field:
residency training
cosmetic surgery fellowship training
observational training programs
CME accredited post?graduate didactic
surgical programs

2. Preoperative Evaluation
A documented medical history
physical examination
appropriate laboratory work based upon the patient’s general health and age
bleeding disorders-
potential drug interactions
history of thrombophlebitis

Documented informed consent

clinical examination
detailed evaluation of the regions
notation of hernias
scars
asymmetries
cellulite
stretch marks
The quality of the skin(elasticity, presence of stria and dimpling)
photodocumentation

Indications
removal of localized deposits of adipose tissues that do not respond to diet and exercise , include:
1) Body contouring, including the face, neck, trunk, and extremities
2) Treatment of diseases, such as lipomas,gynecomastia,pseudogynecomastia, lipodystrophy, and axillary hyperhydrosis.
3) Reconstruction of the skin and subtissues in flap elevations, subcutaneous debulking, and help in mobilization of flaps or other conditions
4) To harvest fat cells for transfer (grafting) to provide tissue augmentation, correction of scar defects, etc.

Weight loss is not considered an indication for liposuction surgery

4. Techniques of Liposuction
Tumescent :lidocaine [0.5 – 1.0 gm/L] with epinephrine [1.0 mg/L]) as placement of a 1:1 or higher ratio of subcutaneous infiltration
lidocaine with epinephrine, studies recommend a maximum range of 45?55 mg/kg

General Anesthesia may be used for liposuction surgery but some studies have shown general anesthesia to be associated with higher rates of morbidity and mortality

Ultrasonic: Ultrasonic?assisted liposuction (UAL) is a recognized technique that appears to be safe, based on current reported clinical experiences. in conjunction with conventional liposuction techniques
recommended for use by surgeons who have extensive previous experience with use of conventional techniques

Laser Light Technologies/Power Assisted: Newer technologies continue to emerge and potentially facilitate the process of liposculpting. The onus is on the physician to obtain adequate education and training before incorporating these newer technologies into his or her practice.

5. Megaliposuction
single stage removal of more than 6,000 mL supranatant fat
The American Academy of Cosmetic Surgery recommends serial liposuction for the removal of large volumes of fat, rather than utilizing megaliposuction. Until sufficient data is collected on megaliposuction, its use should be restricted to experienced surgeons performing clinical research in a hospital setting and under the supervision of an IRB (Institutional Review Board). Megaliposuction can be associated with higher rates of morbidity and mortality.

6. Recommended Volumes for Removal

safe for the routine removal of volumes up to 5,000 mL
Liposuctions within the recommended volume range typically do not require use of autologous blood transfusion

7.  Surgical Setting
outpatient basis in clinic?based surgical facilities
free?standing surgical facilities
hospital settings
sterile technique
routine monitoring of vital signs
oxygen saturation
EKG monitoring
end?tidal CO2 monitoring (if under general anesthesia).
IV access is recommended for removal of volumes greater than 100 mL of fat.

At least one health care provider in the operating room should have adequate training in cardiopulmonary resuscitation techniques(ACLS).

8.Expected Sequelae and Outcomes
based on realistic preoperative evaluation of:
the patient’s age
skin elasticity
volume of fat to be removed
area of liposuction

Best results are expected in:
younger patients
minor deformities
normal weight
elastic skin
small volume removal
 

Contour irregularities and skin texture changes are commonly seen especially in patients over forty and increase with aging.

a.) Common side effects: Edema, ecchymosis, dysesthesia, fatigue, soreness, scarring, asymmetry, and contour imperfections are expected sequelae
b.) Occasional Side Effects: Persistent edema, long?term dysesthesia, hyperpigmentation, pruritis, hematoma, seroma, and drug or tape adhesive reactions

c.) Uncommon Complications: Skin necrosis, severe hematomas, recurrent seromas, nerve damage, systemic infection, hypovolemic shock, intraperitoneal or intrathoracic perforation, deep vein thrombosis, pulmonary edema, pulmonary embolism (ARDS) and loss of life have been reported

9. Postoperative Care and Medications
compression garments most helpful in the first seven days following surgery
Prophylactic antibiotic
Reasonable early ambulation

10. Documentation of Care
pre?operative and post?operative photographs
Patient’s weight should be recorded prior to the procedure
operative record should include:
1) Quantity of tumescent fluid infused
2) Total dosages and drugs utilized;
3) Total volume of fat and fluid extracted;
4) Volume of supranatant fat;
5) Technique utilized;
6) Type of anesthesia;
7) Anatomical sites treated;
8) Use of ultra?assisted technique (internal of external);
9) Drains (if placed);
10) Complications should be noted;
11) Post?operative garments utilized

11. Privileging for Liposuction Surgeons
Surgeons seeking privileges in liposuction should be prepared to submit evidence of completed accredited CME didactic coursework,live surgical conferences, and clinical case experience.

12. Recording Adverse Events
It is the surgeon’s duty and responsibility to report any adverse event, including, without limitation, significant morbidity and mortality as required by local or state requirements
Report should also be provided to the surgeon’s respective professional organizations, such as the American Academy of Cosmetic Surgery and/or American Society of Liposuction Surgery in order to provide statistical tracking of such events
 

Thank You