Subscribe to RSS

DOI: 10.4103/0970-0358.173122
Current trends of liposuction in India: Survey and Analysis
Address for correspondence:
Publication History
Publication Date:
26 August 2019 (online)
ABSTRACT
Background: Liposuction is the commonest aesthetic procedure performed by Indian plastic surgeons. However, there exists substantial disparity amongst Indian surgeons about guidelines concerning liposuction.To address this disparity, a nationwide email survey (Association of Plastic Surgeons of India [APSI] database) was started in December 2013 and continued for 5 months. Material and Methods: The survey was developed with software from www.fluidsurveys.com. The study was designed to cover most aspects of patient selection, perioperative management, technical considerations, postoperative management and complications. This is the first survey to be conducted in India for an extremely popular procedure. It is also one of the most exhaustive surveys that have been conducted in terms of the topics covered. Results and Conclusions: One hundred and eighteen surgeons (including a majority of the cosmetic surgery stalwarts in the country) completed the survey. As expected, the results show a disparity in most parameters but also consolidation on some issues. Liposuction is considered extremely safe (86.1%). The majority of surgeons (70.3%) aspirated >5 L at onetime.The majority (80.2%) felt that the limits for liposuction should be relative and not absolute. The survey highlights lack of standardization with respect to infiltration solutions. The commonest complications observed were contour irregularities, followed by seroma and inadequate skin redrape. The amount of aspirate is the only factor, which achieves statistical significance with respect to major complications. A review of the current evidence and recommendations has been incorporated, along with an in depth analysis of the survey.
#
#
Conflicts of interest
There are no conflicts of interest.
-
REFERENCES
- 1 Ahmad J, Eaves 3rd FF, Rohrich RJ, Kenkel JM. The American Society for Aesthetic Plastic Surgery (ASAPS) survey: Current trends in liposuction. Aesthet Surg J 2011; 31: 214-24
- 2 Wells JH, Hurvitz KA. An evidence-based approach to liposuction. Plast Reconstr Surg 2011; 127: 949-54
- 3 Haeck PC, Swanson JA, Gutowski KA, Basu CB, Wandel AG, Damitz LA. et al Evidence based patient safety advisory: Liposuction. Plast Reconstr Surg 2009; 124 (Suppl) 28S-44S
- 4 ASAPS. Practice Advisory on Liposuction: Executive Summary. 2003. Available from http://www.plasticsurgery.org/Documents/medical-professionals/health-policy/key-issues/Executive-Summary-on-Liposuction.pdf
- 5 Iverson RE, Lynch DJ. American Society of Plastic Surgeons Committee on Patient Safety. Practice advisory on liposuction. Plast Reconstr Surg 2004; 113: 1478-95
- 6 Stephan PJ, Kenkel JM. Updates and advances in liposuction. Aesthet Surg J 2010; 30: 83-100
- 7 Matarasso A, Levine SM. Evidence-based medicine: Liposuction. Plast Reconstr Surg 2013; 132: 1697-705
- 8 de Jong RH. Body mass index: Risk predictor for cosmetic day surgery. Plast Reconstr Surg 2001; 108: 556-63
- 9 Scuderi N, Paolini G, Grippaudo FR, Tenna S. Comparative evaluation of traditional, ultrasonic, and pneumatic assisted lipoplasty: Analysis of local and systemic effects, efficacy, and costs of these methods. Aesthetic Plast Surg 2000; 24: 395-400
- 10 Scuderi N, Tenna S, Spalvieri C, De Gado F. Power-assisted lipoplasty versus traditional suction-assisted lipoplasty: Comparative evaluation and analysis of output. Aesthetic Plast Surg 2005; 29: 49-52
- 11 Triana L, Triana C, Barbato C, Zambrano M. Liposuction: 25 years of experience in 26,259 patients using different devices. Aesthetic Surg J 2009; 29: 509-12
- 12 Knize DM, Fishell R. Use of preoperative “wetting solution” and epidural block anesthesia for liposuction in the office-based surgical suite. Plast Reconstr Surg 1997; 100: 1867-74
- 13 Hughes 3 rd CE. Reduction of liposuction risks and mortality: An ASAPS survey. Aesthetic Surg J 2001; 21: 120-7
- 14 Florida Department of Health, Rule 64B8-9.009: Standard of Care for Office Surgery. Available from https://www.flrules.org/gateway/ruleNo.asp?id=64B8-9.009 Last accessed on 2015 Nov 20
- 15 Tennesse Board of Medical Examiners, Chapter 0880-2: General Rules and Regulations Governing Practice of Medicine. Available from https://tn.gov/assets/entities/health/attachments/0880-02.pdf
- 16 Klein JA. Tumescent technique for local anesthesia improves safety in large-volume liposuction. Plast Reconstr Surg 1993; 92: 1085-100
- 17 Hatef DA, Brown SA, Lipschitz AH, Kenkel JM. Efficacy of lidocaine for pain control in subcutaneous infiltration during liposuction. Aesthet Surg J 2009; 29: 122-8
- 18 Perry AW, Petti C, Rankin M. Lidocaine is not necessary in liposuction. Plast Reconstr Surg 1999; 104: 1900-6
- 19 Kenkel JM, Lipschitz AH, Shepherd G, Armstrong VW, Streit F, Oellerich M. et al Pharmacokinetics and safety of lidocaine and monoethylglycinexylidide in liposuction: A microdialysis study. Plast Reconstr Surg 2004; 114: 516-26
- 20 Brown SA, Lipschitz AH, Kenkel JM, Sorokin E, Shepherd G, Grebe S. et al Pharmacokinetics and safety of epinephrine use in liposuction. Plast Reconstr Surg 2004; 114: 756-65
- 21 Trott SA, Beran SJ, Rohrich RJ, Kenkel JM, Adams Jr WP, Klein KW. et al Safety considerations and fluid resuscitation in liposuction: An analysis of 53 consecutive patients. Plast Reconstr Surg 1998; 102: 2220-9
- 22 Rohrich RJ, Leedy JE, Swamy R, Brown SA, Coleman J. Fluid resucitation in liposuction: A retrospective review of 89 consecutive patients. Plast Reconstr Surg 2006; 117: 431-5
- 23 Commons GW, Halperin B, Chang CC. Large-volume liposuction: A review of 631 consecutive cases over 12 years. Plast Reconstr Surg 2001; 108: 1753-67
- 24 ASPRS Urges Members to Exercise Caution in Liposuction Procedures. Task Force Call for Scrutiny of Training. Large Volume Removals. http://www.surgery.org/media/news-releases/lipoplasty-safety
- 25 Kenkel JM, Lipschitz AH, Luby M, Kallmeyer I, Sorokin E, Appelt E. et al Hemodynamic physiology and thermoregulation in liposuction. Plast Reconstr Surg 2004; 114: 503-15
- 26 Swanson E. Assessment of reduction in subcutaneous fat thickness following liposuction using magnetic resonance imaging. J Plast Reconstr Aesthet Surg 2012; 65: 128-30
- 27 Chang KN. Long-term results of surgical correction of postliposuction contour irregularities. Plast Reconstr Surg 2002; 109: 2141-5
- 28 Chang KN. Surgical correction of postliposuction contour irregularities. Plast Reconstr Surg 1994; 94: 126-38
- 29 Trott SA, Rohrich RJ, Beran SJ, Kenkel JM, Adams Jr WP, Robinson Jr JB. Sensory changes after traditional and ultrasound-assisted liposuction using computer-assisted analysis. Plast Reconstr Surg 1999; 103: 2016-28
- 30 Grazer FM, de Jong RH. Fatal outcomes from liposuction: Census survey of cosmetic surgeons. Plast Reconstr Surg 2000; 105: 436-48
- 31 Young VL, Watson ME. Prevention of perioperative hypothermia in plastic surgery. Aesthet Surg J 2006; 26: 551-71
- 32 Cavallini M, Baruffaldi Preis FW, Casati A. Effects of mild hypothermia on blood coagulation in patients undergoing elective plastic surgery. Plast Reconstr Surg 2005; 116: 316-23
- 33 Robles-Cervantes JA, Martinez-Molina R, Cárdenas-Camarena L. Heating infiltration solutions used in tumescent liposuction: Minimizing surgical risk. Plast Reconstr Surg 2005; 116: 1077-81
- 34 El-Ali KM, Gourlay T. Assessment of the risk of systemic fat mobilization and fat embolism as a consequence of liposuction: Ex vivo study. Plast Reconstr Surg 2006; 117: 2269-76
- 35 Senen D, Atakul D, Erten G, Erdoğan B, Lortlar N. Evaluation of the risk of systemic fat mobilization and fat embolus following liposuction with dry and tumescent technique: An experimental study on rats. Aesthetic Plast Surg 2009; 33: 730-7
- 36 Franco FF, Tincani AJ, Meirelles LR, Kharmandayan P, Guidi MC. Occurrence of fat embolism after liposuction surgery with or without lipografting: An experimental study. Ann Plast Surg 2011; 67: 101-5
- 37 Wang HD, Zheng JH, Deng CL, Liu QY, Yang SL. Fat embolism syndromes following liposuction. Aesthetic Plast Surg 2008; 32: 731-6
- 38 Gurd AR, Wilson RI. The fat embolism syndrome. J Bone Joint Surg Br 1974; 56B: 408-16
- 39 Richards RR. Fat embolism syndrome. Can J Surg 1997; 40: 334-9
- 40 Shiffman MA. Fat embolism following liposuction. Am J Cosmet Surg 2011; 28: 212-8
- 41 Rohrich RJ, Muzaffar AR. Fatal outcomes from liposuction: Census survey of cosmetic surgeons: Discussion. Plast Reconstr Surg 2000; 105: 447-8
Address for correspondence:
-
REFERENCES
- 1 Ahmad J, Eaves 3rd FF, Rohrich RJ, Kenkel JM. The American Society for Aesthetic Plastic Surgery (ASAPS) survey: Current trends in liposuction. Aesthet Surg J 2011; 31: 214-24
- 2 Wells JH, Hurvitz KA. An evidence-based approach to liposuction. Plast Reconstr Surg 2011; 127: 949-54
- 3 Haeck PC, Swanson JA, Gutowski KA, Basu CB, Wandel AG, Damitz LA. et al Evidence based patient safety advisory: Liposuction. Plast Reconstr Surg 2009; 124 (Suppl) 28S-44S
- 4 ASAPS. Practice Advisory on Liposuction: Executive Summary. 2003. Available from http://www.plasticsurgery.org/Documents/medical-professionals/health-policy/key-issues/Executive-Summary-on-Liposuction.pdf
- 5 Iverson RE, Lynch DJ. American Society of Plastic Surgeons Committee on Patient Safety. Practice advisory on liposuction. Plast Reconstr Surg 2004; 113: 1478-95
- 6 Stephan PJ, Kenkel JM. Updates and advances in liposuction. Aesthet Surg J 2010; 30: 83-100
- 7 Matarasso A, Levine SM. Evidence-based medicine: Liposuction. Plast Reconstr Surg 2013; 132: 1697-705
- 8 de Jong RH. Body mass index: Risk predictor for cosmetic day surgery. Plast Reconstr Surg 2001; 108: 556-63
- 9 Scuderi N, Paolini G, Grippaudo FR, Tenna S. Comparative evaluation of traditional, ultrasonic, and pneumatic assisted lipoplasty: Analysis of local and systemic effects, efficacy, and costs of these methods. Aesthetic Plast Surg 2000; 24: 395-400
- 10 Scuderi N, Tenna S, Spalvieri C, De Gado F. Power-assisted lipoplasty versus traditional suction-assisted lipoplasty: Comparative evaluation and analysis of output. Aesthetic Plast Surg 2005; 29: 49-52
- 11 Triana L, Triana C, Barbato C, Zambrano M. Liposuction: 25 years of experience in 26,259 patients using different devices. Aesthetic Surg J 2009; 29: 509-12
- 12 Knize DM, Fishell R. Use of preoperative “wetting solution” and epidural block anesthesia for liposuction in the office-based surgical suite. Plast Reconstr Surg 1997; 100: 1867-74
- 13 Hughes 3 rd CE. Reduction of liposuction risks and mortality: An ASAPS survey. Aesthetic Surg J 2001; 21: 120-7
- 14 Florida Department of Health, Rule 64B8-9.009: Standard of Care for Office Surgery. Available from https://www.flrules.org/gateway/ruleNo.asp?id=64B8-9.009 Last accessed on 2015 Nov 20
- 15 Tennesse Board of Medical Examiners, Chapter 0880-2: General Rules and Regulations Governing Practice of Medicine. Available from https://tn.gov/assets/entities/health/attachments/0880-02.pdf
- 16 Klein JA. Tumescent technique for local anesthesia improves safety in large-volume liposuction. Plast Reconstr Surg 1993; 92: 1085-100
- 17 Hatef DA, Brown SA, Lipschitz AH, Kenkel JM. Efficacy of lidocaine for pain control in subcutaneous infiltration during liposuction. Aesthet Surg J 2009; 29: 122-8
- 18 Perry AW, Petti C, Rankin M. Lidocaine is not necessary in liposuction. Plast Reconstr Surg 1999; 104: 1900-6
- 19 Kenkel JM, Lipschitz AH, Shepherd G, Armstrong VW, Streit F, Oellerich M. et al Pharmacokinetics and safety of lidocaine and monoethylglycinexylidide in liposuction: A microdialysis study. Plast Reconstr Surg 2004; 114: 516-26
- 20 Brown SA, Lipschitz AH, Kenkel JM, Sorokin E, Shepherd G, Grebe S. et al Pharmacokinetics and safety of epinephrine use in liposuction. Plast Reconstr Surg 2004; 114: 756-65
- 21 Trott SA, Beran SJ, Rohrich RJ, Kenkel JM, Adams Jr WP, Klein KW. et al Safety considerations and fluid resuscitation in liposuction: An analysis of 53 consecutive patients. Plast Reconstr Surg 1998; 102: 2220-9
- 22 Rohrich RJ, Leedy JE, Swamy R, Brown SA, Coleman J. Fluid resucitation in liposuction: A retrospective review of 89 consecutive patients. Plast Reconstr Surg 2006; 117: 431-5
- 23 Commons GW, Halperin B, Chang CC. Large-volume liposuction: A review of 631 consecutive cases over 12 years. Plast Reconstr Surg 2001; 108: 1753-67
- 24 ASPRS Urges Members to Exercise Caution in Liposuction Procedures. Task Force Call for Scrutiny of Training. Large Volume Removals. http://www.surgery.org/media/news-releases/lipoplasty-safety
- 25 Kenkel JM, Lipschitz AH, Luby M, Kallmeyer I, Sorokin E, Appelt E. et al Hemodynamic physiology and thermoregulation in liposuction. Plast Reconstr Surg 2004; 114: 503-15
- 26 Swanson E. Assessment of reduction in subcutaneous fat thickness following liposuction using magnetic resonance imaging. J Plast Reconstr Aesthet Surg 2012; 65: 128-30
- 27 Chang KN. Long-term results of surgical correction of postliposuction contour irregularities. Plast Reconstr Surg 2002; 109: 2141-5
- 28 Chang KN. Surgical correction of postliposuction contour irregularities. Plast Reconstr Surg 1994; 94: 126-38
- 29 Trott SA, Rohrich RJ, Beran SJ, Kenkel JM, Adams Jr WP, Robinson Jr JB. Sensory changes after traditional and ultrasound-assisted liposuction using computer-assisted analysis. Plast Reconstr Surg 1999; 103: 2016-28
- 30 Grazer FM, de Jong RH. Fatal outcomes from liposuction: Census survey of cosmetic surgeons. Plast Reconstr Surg 2000; 105: 436-48
- 31 Young VL, Watson ME. Prevention of perioperative hypothermia in plastic surgery. Aesthet Surg J 2006; 26: 551-71
- 32 Cavallini M, Baruffaldi Preis FW, Casati A. Effects of mild hypothermia on blood coagulation in patients undergoing elective plastic surgery. Plast Reconstr Surg 2005; 116: 316-23
- 33 Robles-Cervantes JA, Martinez-Molina R, Cárdenas-Camarena L. Heating infiltration solutions used in tumescent liposuction: Minimizing surgical risk. Plast Reconstr Surg 2005; 116: 1077-81
- 34 El-Ali KM, Gourlay T. Assessment of the risk of systemic fat mobilization and fat embolism as a consequence of liposuction: Ex vivo study. Plast Reconstr Surg 2006; 117: 2269-76
- 35 Senen D, Atakul D, Erten G, Erdoğan B, Lortlar N. Evaluation of the risk of systemic fat mobilization and fat embolus following liposuction with dry and tumescent technique: An experimental study on rats. Aesthetic Plast Surg 2009; 33: 730-7
- 36 Franco FF, Tincani AJ, Meirelles LR, Kharmandayan P, Guidi MC. Occurrence of fat embolism after liposuction surgery with or without lipografting: An experimental study. Ann Plast Surg 2011; 67: 101-5
- 37 Wang HD, Zheng JH, Deng CL, Liu QY, Yang SL. Fat embolism syndromes following liposuction. Aesthetic Plast Surg 2008; 32: 731-6
- 38 Gurd AR, Wilson RI. The fat embolism syndrome. J Bone Joint Surg Br 1974; 56B: 408-16
- 39 Richards RR. Fat embolism syndrome. Can J Surg 1997; 40: 334-9
- 40 Shiffman MA. Fat embolism following liposuction. Am J Cosmet Surg 2011; 28: 212-8
- 41 Rohrich RJ, Muzaffar AR. Fatal outcomes from liposuction: Census survey of cosmetic surgeons: Discussion. Plast Reconstr Surg 2000; 105: 447-8