As liposuction techniques have improved, recontouring of large or even multiple areas of the body is now possible, taking it from the realm of minor surgical procedures to that of major surgery. During a traditional liposuction procedure, around 200 to 500 mL of fat are typically removed from a single area, which can be performed under local anesthesia. However, with Lipo 360, multiple treatment sites can be targeted, allowing a total removal of up to 5000 mL (5 L) of aspirate, including the Tumescence.
QUAD A standards require that no more than 5,000 ccs of aspirate be removed while performing liposuction unless the patient is monitored overnight within the facility. This 5,000 ccs includes the total amount of aspirate removed including fat and any fluid removed during the procedure.
As the number of procedures performed in office-based and ambulatory surgical facilities continues to expand, clinical, policy, and regulatory decisions must be based on a solid understanding of these procedures for patient safety. This is particularly important in the case of liposuction, the most frequently performed plastic surgery procedure. In addition, it is commonly performed in office-based surgery settings. Many states either have or are considering specific liposuction regulations, and facilities must be knowledgeable of their state regulations.
Scientific data does not support a specific maximum volume of removal when liposuction is no longer safe. However, the risk of complications is unavoidably higher as the volume of aspirate and the number of anatomic sites treated increases. It is essential to note the distinction between total fat removed and total aspirate removed. Total aspirate is the combination of total fat and fluid removed during liposuction and should be used when tracking the volume of liposuction removed. Regardless of the anesthetic route, large-volume liposuction (greater than 5,000 cc total aspirate) should be performed in an acute-care hospital or a facility accredited or licensed by staff who are knowledgeable in the care of large-volume liposuction. Postoperative vital signs and urinary output should be monitored overnight in an appropriate facility by qualified and competent staff.
Limited liposuction aspiration volumes are routinely and safely performed with additional plastic surgery procedures. Large-volume liposuction combined with other specific procedures has resulted in serious complications, and such combinations can be avoided.
Serious medical complications are rare following liposuction, though their frequency increases with the number of sites treated and the volume of fat aspirated. Minor complications that are resolved on their own or with little additional treatment include small hematomas, seromas, and minor contour irregularities. More severe complications include lidocaine toxicity, fluid overload, infection, skin perforations, major contour defects, skin necrosis, thermal injury, adverse anesthesia reaction, pulmonary embolus, and fat embolus. Some severe complications may require additional surgery or hospitalization and, in rare cases, result in death. Facility staff caring for these patients must be well-trained to identify potential complications early to minimize more serious complications.
Since 1980, QUAD A (a non-profit, physician-founded and led global accreditation organization) has worked with thousands of healthcare facilities to standardize and improve the quality of healthcare they provide – believing that patient safety should always come first.
