Megaliposuction: A Staged Event

Elliott Schmerler, MD

Introduction: Concerns about the safety of patients undergoing liposuction have led to recent guidelines from the American Academy of Cosmetic Surgery to not remove more than 5 L of total supranatant fat during the one procedure.

Case Report: Patients A and B had 10.3 and 6.2 L of fat removed, respectively, without postoperative complications.

Conclusions: The staging method described here is for large patients presenting for liposuction in whom more than 5L of total supranatant fat is expected. Staging is one way to perform megaliposuction while possibly reducing the risk of patient and to the surgeon.

As practicing cosmetic surgeons, we face numerous liabilities that currently exist in our medical environment, including patient safety and malpractice liabilities. Because of safety concerns, the American Academy of Cosmetic Surgery has set a limit of 5L of total supranatant fat aspirate during one procedure.

I suggest a method of liposuction for large patients whom total supranatant fat removal of more than 5L is expected during one procedure. Staging tumescent liposuction procedures allows the removal of large quantities of supranatant fat over time while addressing the current safety concerns in our community.

CASE REPORT AND PROCEDURE

Using standard tumescent liposuction technique with Klein solution (1000mg lidocaine with 1 mg epinephrine[1:1000] and 15 mEq sodium bicarbonate per liter of 0.9% saline), 2 obese female patients were treated, at the same anatomical site with the same instrumentation, repeatedly over time while not removing more than 5L total supranatant fat aspirate during one procedure. Repeated liposuction was performed on previously treated areas to touch up irregularities and on new areas during the same procedure while keep the end point of each procedure as the 5-L total supranatant fat aspirate limit. Time periods between procedures were selected arbitrarily and not based scientifically. Fat extraction was judged complete by standard criteria of symmetry, size, irregularities, firmness, ECT. The volumes removed from both patients are noted in Figures 1 and 2.

RESULTS

Both patients presented here underwent staged liposuction procedures safely and effectively. Healing was essentially the same after each procedure with no more apparent bruising with repeated procedures. Repeated infusions of tumescent did not present particular problems except there was slightly more pain, which was probably associated with less penetration of anesthesia because of healing fibrous tissue. Patient A’s total fat aspirate was 10.3 L, and Patient B’s total fat aspirate was 6.2L. They were very pleased with their results, which are shown in Figures 1 and 2. There were no complications.

DISCUSSION

Staging liposuction allows the removal of large quantities of fat (megaliposuction) over time while not removing more than 5L total supranatant fat aspirate during one procedure. The fibrosis and hardening associated with healing after liposuction did present some difficulty in conducting repeated procedures at the same site. The advantages of staging are that smaller volumes of supranatant fat aspirate (less than 5 L) may possibly be associated with reduced risk, improved patient safety, and reduced malpractice liability. In addition, staging allows the surgeon the opportunity to touch up any irregularities of previously treated areas. The disadvantages of staging are that the patient must return for additional procedures and there is increased risk and cost associated with doing multiple procedures. Whether liposuction safety revolves around aspirate volumes is still unknown, and indeed may not be. 4 But what is known is that conservative tumescent liposuction is safe and effective in out current practice environment.

CONCULSION

Staging liposuction on large patients allows the opportunity to treat these patients safely and to touch up previously treated areas during repeated procedures.  Two large patients who presented for liposuction had excellent outcomes following staging of their procedures. It is probably best to stage the procedures as far apart as possible to allow more softening of the healing tissues because more mature healing has less fibrous tissue. Staging is one way to perform megaliposuction while possibly reducing the risk both to the patient and to the surgeon.

REFERENCES

1. Rao RB, Ely SF Hoffman RS.  Deaths related to liposuction. N Engl J Med. 1999;340:1471-1475
2. Kirchner JT. Causes of death related to tumescent liposuction. Am Fam Physician. Oct 15, 1999.
3. American Academy of Cosmetic Surgery. Liposuction Guidelines. 2001. Available at http://www.cosmeticsurgery.org/guidelines/2000_liposuction_guidelines.asp?mn=sc. Accessed January 2001.
4. Ali Eed MD. Mega-liposuction: analysis of 1520 patients. Aesthetic Plast Surg. 1999;23(1):16-22.
5. Algeria Peren P, Barba Gomez J, Guerrero-Santos J. Total corporal contouring with megaliposuction (120 consecutive cases). Aesthetic Plast Surg. 1999; 23(2):93-100.
6. Albin R. de Campo T. Large volume liposuction in 181 patients. Aesthetic Plast Surg. 1999:23(1):5-15.

Printed The American Journal of Cosmetic Surgery VOL. 19, No. 4, 2002