It’s safe to say, the amount of fat you may want to remove through liposuction will differ from the person standing next to you. You might be keen to undergo liposuction just to neaten up your waist line, while someone else may be wanting to transform their body shape entirely. Under current guidelines however, there is a maximum extraction limit regardless of your weight, percentage of body fat or desired outcome. A new study is suggesting this regulation should be updated and a BMI based sliding scale should be put into place.
A number just picked out of a hat says plastic surgeon Dr. Gutowksi
The current guidelines state that 5 Litres is the maximum amount of fat that can be safely removed during any one liposuction procedure. This guideline is now under question as there is no scientific data to support the absolute threshold which is in place. And it is not the first time; for years there has been a debate over the way in which the volume limit has been calculated.
“The problem is that this guideline seems like it was picked out of a hat”, says Dr. Karol Gutowski, a clinical associate professor at the University of Illinois at Chicago and a board-certified plastic surgeon. “…There’s no data behind it. No science.”
Dr. Gutowski together with his colleagues established a database to record the outcomes of liposuction procedures performed by board-certified plastic surgeons over the past fifteen years. The author’s aim was to evaluate the relationship between liposuction volume and any complication risk, including interactions with the patient’s BMI.
The findings, published in the September issue of Plastic and Reconstructive Surgery, revealed that those with a higher BMI could have more fat safely removed by liposuction.
During the study, the investigators tracked over 4,500 liposuction patients. Most of those patients were women, however a rise in men undergoing the cosmetic surgery was seen. A large majority of the patients were treated as outpatients and were able to go home the same day following the procedure.
Complication risk rose as the amount of fat removed increased
After analysing the information gathered, Dr. Scot Glasberg, president of the American Society of Plastic Surgeons, said “the reality is liposuction is incredibly safe”. In fact, the total complication rate was less than 1.5 percent with most of the complications not deemed serious and no deaths occurring. The most common complication was a build-up of fluid, also known as seroma which can require drainage.
The body’s normal response to the trauma of the surgery is to swell and excess fluid can build-up in the cavities where the fat has been removed. Most of the fluid will clear within six to eight weeks, however sometimes seroma will form. Generally this is not considered a serious complication and most often than not, it will resolve slowly on its own. However, depending on the severity, the surgeon may wish to remove it by draining the site of excess fluid to speed up recovery.
The researchers of the study did find the complication risk increased as the amount of fat removed rose. Patients who experienced complications had large liposuction volumes, on average 3.4 Litres and higher BMIs. Those who underwent higher volume liposuction extracting more than 5 Litres, increased their complication rate to 3.7 percent. The complications that occurred were almost all due to an increase in seromas. “…obviously if you set out to take [more than 10 pounds] of fat from a person who weighs 130 pounds, versus someone who is 230, you’re looking at a very different situation”, says Dr. Glasberg.
For a patient weighing 50 kg, removing 1 litre of fat may be excessive, whereas removing 4 litres of fat during one liposuction procedure in a patient of 100 kg might not be excessive. As you can see the amount of volume that can be safely removed is often difficult to define.
Dr. Gutowski said that through their research they identified the key factor in the liposuction complication risk to be the patient’s BMI. Those with the higher BMI were better able to tolerate large-scale fat removal during the procedure than those with a lower BMI. To put it simply, obese patients may be able to tolerate larger volumes of fat extracted during any one liposuction procedure without an increased risk of complications. Those who have less fat to remove, would experience a “more exponential increase in risk” the more fat they extract.
Patient’s BMI can help determine what liposuction treatment to undergo
The patient’s weight prior to undergoing liposuction surgery can not only be used to indicate the safe level of fat that can be removed, but also the type of liposuction procedure. For example, those who are overweight and require large amounts of fat removal perhaps over the course of several liposuction treatments would be better suited to the Mega Liposuction procedure.
Patients who require less fat to be removed on the other hand, but are having trouble shifting the weight in problem areas such as the love handles or abdomen would be better candidates for Vaser Liposuction. And those who are seeking a more defined, athletic physic can achieve great results from Vaser Hi Definition Liposuction, which can accurately sculpt the body.
The patient’s own individual risks could be considered
From a risk perspective, the results from the recent study promoted the authors to introduce the concept of a “relative liposuction volume threshold” which is based on BMI. This tool enables surgeons to have a sliding scale to assess complication risk and see where this would increase, but co-author Dr. John Y.S. Kim of Northwestern University, Feinberg School of Medicine, Chicago emphasises this does not provide an absolute limit on the volume of fat removed during a liposuction procedure.
While the researchers suggest that a BMI sliding scale approach may be more suitable for determining the safe levels of fat removal, each patient’s own individual risk factors must be considered. No cosmetic surgery procedure is risk-free including liposuction. Considerations such as the length of the surgery, adjunct cosmetic procedures and the patients overall health prior to surgery should all be taken into account when evaluating the liposuction risk.
Some of the risk associated with excessive amount of fat removal include:
- Unattractive lumpiness or hallow dimpling of the skin where areas have been “over-suctioned”
- Increase health risks such as anaesthesia-related reactions, infections and oedema
- Longer surgical procedures which could increase the likelihood of blood clots forming, seromas, drop in blood pressure and toxicity
Patient may just not benefit from having more fat removed
While the current guidelines state that the fat removed from liposuction patients should not exceed the recommended 5 litres in any one procedure, it is not just because of the risks. Often we don’t remove more than this amount, as most patients simply don’t benefit from having more fat removed. Liposuction is a procedure we use to enhance the body shape and remove isolated fat deposits, rather than to serve as a quick weight-loss tool and get rid of large amounts of fat.
Patients with larger deposits of fat and requiring greater amounts removed may be better candidates for procedures such as tummy tuck or thigh lift. Those who are overweight and want to undergo liposuction may see better results losing some of the additional weight through exercise and diet prior to the treatment.
Over the years, the advancement in liposuction techniques and technology have meant that a larger number of fat cells can be removed with less risk, less blood loss and discomfort as well as reduced recovery periods. The BMI sliding scale developed as a result of the recent study could be used to assist in evaluating the safe amount of fat to remove depending on the individual patient.
“Our risk assessment tool can further aid shared decision-making between the surgeon and patient by linking BMI and liposuction volumes,” adds Dr. Kim.