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Guideline Summary
Guideline Title
Evidence-based patient safety advisory: liposuction.
Bibliographic Source(s)
Haeck PC, Swanson JA, Gutowski KA, Basu CB, Wandel AG, Damitz LA, Reisman NR, Baker SB, ASPS Patient Safety Committee. Evidence-based patient safety advisory: liposuction. Plast Reconstr Surg. 2009 Oct;124(4 Suppl):28S-44S. [138 references]
Guideline Status

This is the current release of the guideline.

This guideline updates a previous version: Iverson RE, Lynch DJ. Practice advisory on liposuction. Plast Reconstr Surg 2004 Apr 15;113(5):1478-90. [59 references]

Scope

Disease/Condition(s)
  • Body contour irregularities due to localized fat deposits (localized adiposity)
  • Obesity, gynecomastia, and breast hypertrophy
Guideline Category
Management
Clinical Specialty
Anesthesiology
Plastic Surgery
Surgery
Intended Users
Advanced Practice Nurses
Health Care Providers
Physician Assistants
Physicians
Guideline Objective(s)

To provide an overview of various techniques, practices, and management strategies that pertain to individuals undergoing liposuction, and to offer recommendations for each issue to ensure and enhance patient safety

Target Population

Patients undergoing liposuction surgery

Interventions and Practices Considered

Liposuction Techniques

  1. Suction-assisted lipoplasty
  2. Dry technique (not recommended except in limited applications)
  3. Wet technique
  4. Superwet technique
  5. Tumescent technique
  6. Ultrasound-assisted liposuction
  7. Laser-assisted liposuction
  8. Power water-assisted liposuction
  9. Cannula selection

Patient Management

  1. Patient selection
  2. Determination of appropriate liposuction volume
  3. Fluid management (monitoring of fluid intake and output, communication with anesthesia care provider, hemoglobin measurements, calculation of residual fluid volumes after liposuction)
  4. Multiple procedure management
  5. Recognition of complications
  6. Facility selection and accreditation
  7. Physical training and qualifications

Anesthesia

  1. Anesthetic infiltrate solutions
    • Marcaine (bupivacaine) (caution urged due to severity of side effects)
    • Lidocaine
    • Epinephrine
  2. Epidural anesthesia (not recommended)
  3. General anesthesia
  4. Moderate sedation/analgesia
  5. Use of American Society of Anesthesiologists' Guidelines for Sedation and Analgesia
Major Outcomes Considered

Morbidity and mortality associated with liposuction and anesthesia

Methodology

Methods Used to Collect/Select the Evidence
Searches of Electronic Databases
Description of Methods Used to Collect/Select the Evidence

PubMed and the Cochrane Library were searched. The search terms used were: liposuction, suction lipectomy, liposuction technique, liposuction cannulas, anesthesia, analgesia, lidocaine, prilocaine, bupivacaine, epinephrine, patient selection, preoperative assessment, physical examination, medical history, localized adiposity, obesity, duration of operation/procedure/surgery, liposuction volume, fluid management, multiple procedures, intraoperative care, postoperative care, compression garments, complications. No limits were set on publication dates in the searches. The searches included all types of published articles. However, articles that were critically appraised and rated for level of evidence were limited to systematic reviews, meta-analyses, randomized controlled trials (RCTs), clinical trials, comparative studies, case series and case reports.

Number of Source Documents

Not stated

Methods Used to Assess the Quality and Strength of the Evidence
Weighting According to a Rating Scheme (Scheme Given)
Rating Scheme for the Strength of the Evidence
Level of Evidence Qualifying Studies
I High-quality, multi-centered or single-centered, randomized controlled trial with adequate power; or a systematic review of these studies
II Lesser-quality, randomized controlled trial; prospective cohort study; or a systematic review of these studies
III Retrospective comparative study; case-control study; or a systematic review of these studies
IV Case series
V Expert opinion; case report or clinical example; or evidence based on physiology, bench research, or "first principles"
Methods Used to Analyze the Evidence
Systematic Review
Description of the Methods Used to Analyze the Evidence

The supporting literature was critically appraised for study quality according to criteria referenced in key publications on evidence-based medicine. Depending on study design and quality, each reference was assigned a corresponding level of evidence (I through V) with the American Society of Plastic Surgeons (ASPS) Evidence Rating Scales, and the evidence was synthesized into practice recommendations (see "Rating Scheme for the Strength of the Evidence").

Methods Used to Formulate the Recommendations
Expert Consensus
Description of Methods Used to Formulate the Recommendations

Not stated

Rating Scheme for the Strength of the Recommendations
Grade Descriptor Qualifying Evidence Implications for Practice
A Strong Recommendation Level I evidence or consistent findings from multiple studies of levels II, III, or IV Clinicians should follow a strong recommendation unless a clear and compelling rationale for an alternative approach is present.
B Recommendation Levels II, III, or IV evidence and findings are generally consistent Generally, clinicians should follow a recommendation but should remain alert to new information and sensitive to patient preference.
C Option Levels II, III, or IV evidence, but findings are inconsistent Clinicians should be flexible in their decision-making regarding appropriate practice, although they may set bounds on alternatives; patient preference should have a substantial influencing role.
D Option Level V; little or no systematic empirical evidence Clinicians should consider all options in their decision-making and be alert to new published evidence that clarifies the balance of benefit versus harm; patient preference should have a substantial influencing role.
Cost Analysis

A formal cost analysis was not performed and published cost analyses were not reviewed.

Method of Guideline Validation
Internal Peer Review
Description of Method of Guideline Validation

The guideline was approved by the American Society of Plastic Surgeons Executive Committee on January 10, 2009.

Recommendations

Major Recommendations

Definitions for the levels of evidence (I–V) and the grades of the recommendations (A–D) are provided at the end of the "Major Recommendations" field.

Recommendations Supporting Evidence Grade
Liposuction Technique

No one single liposuction technique is best suited for all patients in all circumstances. Factors such as the patient's overall health, the patient's body mass index (BMI), the estimated volume of aspirate to be removed, the number of sites to be addressed, and any other concomitant procedures to be performed should be considered by the surgeon to determine the best technique for the individual patient.

Rohrich, Beran, & Fodor, 1997; Rohrich et al., 2006; Samdal, Amland, & Bugge, 1995; Fodor & Watson, 1999; Klein, 1993; Pitman, Aker, & Tripp, 1996; Matarasso, "Ultrasound-assisted lipoplasty," 1999; Rohrich et al., 2000; Tebbetts, 1998; Giese et al., 2001; Karmo, Milan, & Silbergleit, 2001; Jewell et al., 2002; Mendes, 2000; Gasperoni, Salgarello, & Gasperoni, 2000; Cardenas-Camarena, Cardenas, & Fajardo-Barajas, 2001; Lawrence & Cox, 2000; Badin et al., 2005; Prado et al., 2006; Araco et al., 2007; Price et al., 2001; Gryskiewicz, 2003; Greene, Slavin, & Borud, 2006; Emsen, 2006

B

Due to the amount of blood loss associated with the dry technique, its use is not recommended except in limited applications with a total aspirate volume ≤100 cc.

Rohrich, Beran, & Fodor, 1997

D

The dry technique should never be used in conjunction with ultrasound assisted liposuction.

Fodor & Watson, 1999

D

The benefits of performing liposuction while the patient is awake and standing are not currently supported by clinical studies, and this procedure may compromise patient safety.

Shuter & Drourr, 1999

D
Liposuction Cannulas

No one cannula is best suited for all patients in all circumstances. Factors such as the patient's overall health, the estimated volume of the aspirate to be removed, the areas of the body to be treated, the number of sites to be addressed, the technique chosen (i.e., suction assisted, power assisted, or ultrasound assisted), and physician preference determine the cannula best suited for the individual patient.

Expert opinion

D
Anesthetic Infiltrate Solutions

In small volume liposuction, infiltrate solutions containing local anesthetic agents may be sufficient to provide adequate pain relief without the need for additional anesthesia measures. The patient or the surgeon may prefer the use of sedation or general anesthesia even with small volumes of liposuction.

Klein, 1993; Pitman, Aker, & Tripp, 1996; Samdal, Amland, & Bugge, 1994; Burk, Guzman-Stein, & Vasconez, 1996; Hanke et al., 2004; Knize & Fishell, 1997

B

Insufficient data are available to support the use of bupivacaine or prilocaine in addition to or as a substitute for lidocaine. These agents should be used cautiously if included in infiltrate solutions because of their potential for severe side effects.

Miller, 2000; Naguib et al., 1998; Lindenblatt et al., 2004

D

Lidocaine wetting solutions have the potential to cause systemic toxicity when administered to large or multiple regions of the body. Preventive measures include the following:

   
  • Limit the lidocaine dose to 35 mg/kg. This level may not be safe in patients with low protein levels and other medical conditions where the metabolic byproducts of lidocaine breakdown may reach problematic levels.

Klein, 1993; Pitman, Aker, & Tripp, 1996; Samdal, Amland, & Bugge, 1994; Burk, Guzman-Stein, & Vasconez, 1996; Hanke et al., 2004; Nordstrom & Stange, 2005; Rubin et al., 2005

B
  • Calculate the dose for total body weight.

Pitman, Aker, & Tripp, 1996

D
  • Reduce the concentration of lidocaine when necessary (e.g., depending on the site of infiltration).

Rubin et al., 2005

D
  • Use the super wet rather than the tumescent technique.

Rohric et al., 2006

D
  • Consider avoiding the use of lidocaine when general or regional anesthesia is used.

Expert opinion

D

Epinephrine use should be avoided in patients who present with pheochromocytoma, hyperthyroidism, severe hypertension, cardiac disease, or peripheral vascular disease. In addition, cardiac arrhythmias can occur in predisposed individuals or when epinephrine is used with halothane anesthesia. The surgeon must carefully evaluate these types of patients before performing liposuction.

Matarasso, "Lidocaine," 1999; Kenkel et al., 2004; Brown et al., 2004

D

Consider staging the infiltration of multiple anatomical sites to reduce the possibility of an excess epinephrine effect.

Expert opinion

D
Type of Anesthesia

A physician should have the primary responsibility for providing and/or supervising anesthesia. All anesthesia should be ordered by a physician. Anesthetics may be administered by either a qualified physician, a certified registered nurse anesthetist under physician supervision, or another qualified health care provider under the supervision of a qualified physician as required by law. The responsible physician must be physically present in the operating room throughout the conduct of the anesthetic. (See the American Society of Anesthesiologists [ASA] "Guidelines for Sedation and Analgesia" and state law for more specific information.)

Expert opinion

D

General anesthesia can be used safely in the ambulatory setting for liposuction procedures.

Hoefflin, Bornstein, & Gordon, 2001; Bitar et al., 2003; Ersek, 2004

C

General anesthesia has advantages for more complex liposuction procedures that include precise dosing, controlled patient movement, and airway management.

Expert opinion

D

Epidural and spinal anesthesia is discouraged in the ambulatory setting because of the possibility of vasodilation, hypotension, and fluid overload.

Knize & Fishell, 1997; Burns & Meland, 2007

D

Moderate sedation/analgesia augments the patient's comfort level and is an effective adjunct to anesthetic infiltrate solutions.

Bitar et al., 2003; Marcus et al., 1999

B
Patient Selection

Even though liposuction is generally an elective procedure, the liposuction patient must be assessed using the same standards as those used for anyone who is undergoing any type of surgery, including a complete preoperative history and physical examination. (See the National Guideline Clearinghouse [NGC] summary of the ASPS guideline, Evidence-Based Patient Safety Advisory: Patient Selection and Procedures in Ambulatory Surgery, for a more detailed discussion of patient selection criteria for the ambulatory surgery setting.)

Expert opinion

D

In some cases, liposuction may be used in the treatment of gynecomastia and breast hypertrophy.

Samdal, Amland, & Bugge, 1994; Price et al., 2001; Gray, 2001; Nahai, 2001; Handschin et al., 2008; Lista & Ahmad, 2006; Rohrich et al., 2004

D

BMI is a good method with which to assess a patient’s relative risks and benefits for liposuction.

Giese et al., 2001

D

In obese patients receiving large-volume liposuction, it may be necessary to modify the anesthetic infiltrate solution to prevent lidocaine toxicity.

Rohrich et al., 2006

D

Not all patients are appropriate liposuction candidates, in particular, patients with minimal localized adiposity, patients with existing medical conditions that preclude surgical intervention (e.g., certain blood dyscrasias, risk for hernia), patients with unrealistic expectations, and youths and adolescents.

Ovrebo, Grong, & Vindenes, 1997; McGrath & Schooler, 2004; McGrath & Mukerji, 2000

D

Patients who are not liposuction candidates may wish to continue diet and exercise routines, seek medical intervention to treat an existing condition(s), consider bariatric evaluation, or, in the case of patients who have unrealistic expectations about their condition or potential outcomes, be referred for a psychiatric or psychological evaluation.

Expert opinion

D
Liposuction Volume

Large volume liposuction (>5000 cc of total aspirate) should be performed in an acute care hospital or in a facility that is either accredited or licensed, regardless of the anesthetic method.

Expert opinion

D

For patients undergoing large volume liposuction, postoperative vital signs and urinary output should be monitored overnight in an appropriate facility by qualified and competent staff members who are familiar with liposuction perioperative care.

Rohrich et al., 2006

D

Under certain circumstances, it may be in the best interest of the patient to perform large volume procedures as separate serial procedures and to avoid combining them with additional procedures.

Hunstad, 1996

D
Fluid Management

A data sheet should be used to facilitate communication.

Expert opinion

D

The intake and output of all fluids used in the operative and postoperative periods should be monitored accurately.

Commons, Halperin, & Chang, 2001; Basile et al., 2006

D

Communication with the anesthesia care provider about fluid management is critical.

Expert opinion

D

Fluid management and liposuction surgery must account for preexisting deficits (i.e., created by a fasting state), maintenance requirements (based on vital signs and urine output), and intraoperative losses of aspirated tissue and third space deficit.

Rohrich et al., 2006; Commons, Halperin, & Chang, 2001; Trott et al., 1998

D

Blood loss estimates should be made and confirmed with preoperative and postoperative hemoglobin measurements. However, because of fluid shifts, hemoglobin levels may not be reliable during the first 24 hr postoperatively.

Expert opinion

D

Calculation of residual fluid volumes after liposuction is helpful in planning postoperative care.

Commons, Halperin, & Chang, 2001

D

Suggested fluid resuscitation guidelines:

  • For aspirate <5000 cc: maintenance fluid plus subcutaneous infiltrate
  • For aspirate ≥5000 cc: maintenance fluid plus subcutaneous infiltrate plus 0.25 ml intravenous crystalloid for each milliliter of aspirate

Rohrich et al., 2006; Trott et al., 1998

D
Multiple Procedures

Large volume liposuction combined with certain other procedures (e.g., abdominoplasty) has resulted in serious complications, and such combinations should be avoided.

Hughes, 2001; Buescher, 2000; Cardenas-Camarena, 2005

D

Individual patient circumstances may warrant performing liposuction as a separate procedure

Expert opinion

D
Possible Complications

Physicians should be aware of the signs and symptoms of the following complications that may arise during or after liposuction (all complications listed below were described in at least one case report).

 

N/A

Minor complications:

  • Small hematomas
  • Seromas
  • Minor contour irregularities

Glashofer et al., 2005

 

More severe complications:

  • Skin perforation
  • Major contour defects
  • Skin necrosis
  • Thermal injury
  • Vital organ injury
  • Adverse anesthesia reaction
  • Major hemorrhage
  • Ischemic optic neuropathy
  • Deep vein thrombosis
  • Pulmonary embolism
  • Fat embolism

Gingrass, 1999; Rao, Ely, & Hoffman, 1999; Talmor et al., 2000; Buescher, 2000; Sharma et al., 2006; Minagar, Schatz, & Glaser, 2000; Cedidi & Berger, 2002; Cohen et al., 2004; Moura, Cunha, & Monteiro, 2006; Ribeiro et al., 2006; Uemura et al., 2006; Mallappa, Rangaswamy, & Badiuddin, 2007; Bruner & de Jong, 2001

 

Most severe complications:

  • Infection
  • Toxic shock
  • Necrotizing fasciitis

Behroozan, Christian, & Moy, 2000; Sharma et al., 2006; Cedidi & Berger, 2002; Ross & Johnson, 1988; Barillo, 1998; Heitmann, Czermak, & Germann, 2000; Umeda et al., 2000; Anwar, Ahmad, & Sharpe, 2004; Murillo et al., 2000; Dessy et al., 2006

 
Facility Selection and Accreditation
  • The physician should determine the appropriate surgical technique and surgical facility in which to perform liposuction after considering the patient's overall health and body areas to be liposuctioned, and state regulations. Hospitalization may be required in select cases to ensure patient safety. (See the National Guideline Clearinghouse [NGC] summary of the ASPS guideline, Evidence-Based Patient Safety Advisory: Patient Selection and Procedures in Ambulatory Surgery, for a more detailed discussion of patient selection criteria for the ambulatory surgery setting.)
  • Plastic surgery, including liposuction, performed under anesthesia, other than minor local anesthesia and/or minimal oral tranquilization, should be performed in a surgical facility that meets at least one of the following criteria:
    • Accredited by a national- or state-recognized accrediting agency/organization such as the American Association for Accreditation of Ambulatory Surgery Facilities, the Accreditation Association for Ambulatory Health Care, the American Osteopathic Association, or the Joint Commission on Accreditation of Healthcare Organizations.
    • Certified to participate in the Medicare program under Title XVIII.
    • Licensed by the state in which the facility is located.

Expert opinion

D
Physician Training and Qualifications
  • Physicians performing liposuction must be trained as surgeons.
  • Surgeons performing procedures outside of his or her area of training, defined by the surgeon's specialty, must obtain additional education, certification, and experience. The American Board of Medical Specialties (ABMS) surgeon must have liposuction and body-contouring training and must operate in his or her area of anatomical expertise. The physician who performs liposuction in any surgical setting must meet all of the following minimal formal training requirements:
    • The physician must have a basic education: M.D. or D.O.
    • The physician must be qualified for examination or be certified by a surgical board recognized by the ABMS, and the physician must:
      • Complete training in liposuction/body contouring during an accredited residency or fellowship, or
      • Complete an 8-hr liposuction/body-contouring training course approved for category I Continuing Medical Education credit with at least 3 hr of hands-on bio-skills cadaver training and a comprehensive instructional program on fluid replacement. Observation by a proctor with liposuction privileges for the first three clinical procedures is recommended.
    • The physician must operate within his or her area of training and area of anatomical expertise, which is defined by his or her ABMS surgical specialty board.

American Association for Accreditation of Ambulatory Surgical Facilities, 2009

D

Definitions:

Evidence Rating Scale for Studies Reviewed

Level of Evidence Qualifying Studies
I High-quality, multi-centered or single-centered, randomized controlled trial with adequate power; or a systematic review of these studies
II Lesser-quality, randomized controlled trial; prospective cohort study; or a systematic review of these studies
III Retrospective comparative study; case-control study; or a systematic review of these studies
IV Case series
V Expert opinion; case report or clinical example; or evidence based on physiology, bench research, or "first principles"

Scale for Grading Recommendations

Grade Descriptor Qualifying Evidence Implications for Practice
A Strong Recommendation Level I evidence or consistent findings from multiple studies of levels II, III, or IV Clinicians should follow a strong recommendation unless a clear and compelling rationale for an alternative approach is present.
B Recommendation Levels II, III, or IV evidence and findings are generally consistent Generally, clinicians should follow a recommendation but should remain alert to new information and sensitive to patient preference.
C Option Levels II, III, or IV evidence, but findings are inconsistent Clinicians should be flexible in their decision-making regarding appropriate practice, although they may set bounds on alternatives; patient preference should have a substantial influencing role.
D Option Level V; little or no systematic empirical evidence Clinicians should consider all options in their decision-making and be alert to new published evidence that clarifies the balance of benefit versus harm; patient preference should have a substantial influencing role.
Clinical Algorithm(s)

None provided

Evidence Supporting the Recommendations

References Supporting the Recommendations
Type of Evidence Supporting the Recommendations

The type of supporting evidence is identified and graded for each recommendation (see "Major Recommendations").

Benefits/Harms of Implementing the Guideline Recommendations

Potential Benefits
  • The performance of liposuction with minimal risks of morbidity and no mortality
  • When performed by a surgeon with knowledge of the physiologic implications of this surgery, liposuction can be a safe procedure that results in significant patient satisfaction.
Potential Harms

Physicians should be aware of the signs and symptoms of the following complications that may arise during or after liposuction (all complications listed below were described in at least one case report):

  • Minor complications
    • Small hematomas
    • Seromas
    • Minor contour irregularities
  • More severe complications
    • Skin perforation
    • Major contour defects
    • Skin necrosis
    • Thermal injury
    • Vital organ injury
    • Adverse anesthesia reaction
    • Major hemorrhage
    • Ischemic optic neuropathy
    • Deep vein thrombosis
    • Pulmonary embolism
    • Fat embolism
  • Most severe complications
    • Infection
    • Toxic shock
    • Necrotizing fasciitis

Contraindications

Contraindications

Epinephrine use should be avoided in patients who present with pheochromocytoma, hyperthyroidism, severe hypertension, cardiac disease, or peripheral vascular disease. In addition, cardiac arrhythmias can occur in predisposed individuals or when epinephrine is used with halothane anesthesia. The surgeon must carefully evaluate these types of patients before performing liposuction.

Qualifying Statements

Qualifying Statements
  • Practice advisories are strategies for patient management, developed to assist physicians in clinical decision-making. This practice advisory, based on a thorough evaluation of the present scientific literature and relevant clinical experience, describes a range of generally acceptable approaches to diagnosis, management, or prevention of specific diseases or conditions. This practice advisory attempts to define principles of practice that should generally meet the needs of most patients in most circumstances. However, this practice advisory should not be construed as a rule, nor should it be deemed inclusive of all proper methods of care or exclusive of other methods of care reasonably directed at obtaining the appropriate results. It is anticipated that it will be necessary to approach some patients' needs in different ways. The ultimate judgment regarding the care of a particular patient must be made by the physician in light of all the circumstances presented by the patient, the diagnostic and treatment options available, and available resources.
  • This practice advisory is not intended to define or serve as the standard of medical care. Standards of medical care are determined on the basis of all the facts or circumstances involved in an individual case and are subject to change as scientific knowledge and technology advance, and as practice patterns evolve. This practice advisory reflects the state of knowledge current at the time of publication. Given the inevitable changes in the state of scientific information and technology, periodic review and revision will be necessary.

Implementation of the Guideline

Description of Implementation Strategy

An implementation strategy was not provided.

Institute of Medicine (IOM) National Healthcare Quality Report Categories

IOM Care Need
Getting Better
Staying Healthy
IOM Domain
Effectiveness
Safety

Identifying Information and Availability

Bibliographic Source(s)
Haeck PC, Swanson JA, Gutowski KA, Basu CB, Wandel AG, Damitz LA, Reisman NR, Baker SB, ASPS Patient Safety Committee. Evidence-based patient safety advisory: liposuction. Plast Reconstr Surg. 2009 Oct;124(4 Suppl):28S-44S. [138 references]
Adaptation

Not applicable: The guideline was not adapted from another source.

Date Released
2004 Apr (revised 2009 Oct)
Guideline Developer(s)
American Society of Plastic Surgeons - Medical Specialty Society
Source(s) of Funding

American Society of Plastic Surgeons

Guideline Committee

American Society of Plastic Surgeons Patient Safety Committee

Composition of Group That Authored the Guideline

Committee Members: Phillip C. Haeck, M.D. (Chairman); Stephen B. Baker, M.D., D.D.S., Georgetown University Hospital, Washington, D.C.; Charles W. Bailey, Jr., M.D., J.D., Austin, Texas; C. Bob Basu, M.D., M.P.H., Center for Advanced Breast Restoration and Basu Plastic Surgery, Houston, Texas; Lynn A. Damitz, M.D., University of North Carolina, Chapel Hill, North Carolina; Felmont F. Eaves, III, M.D., Charlotte Plastic Surgery, Charlotte, North Carolina; Paul D. Faringer, M.D., Kaiser Permanente, Honolulu, Hawaii; Scot Bradley Glasberg, M.D., Lenox Hill Hospital and Manhattan Eye Ear and Throat Hospital, New York, New York; Lawrence S. Glassman, M.D., Nyack Hospital, Nyack, New York; Karol A. Gutowski, M.D., North Shore University Health System and University of Chicago, Evanston, Illinois; Elizabeth J. Hall-Findlay, M.D., private practice, Banff, Alberta, Canada; Ronald E. Iverson, M.D., Stanford University Medical School, Palo Alto, California; Linda J. Leffel, M.D., Bend, Oregon; Dennis J. Lynch, M.D., retired, Scott and White Healthcare, Texas A&M University, Temple, Texas; Noel B. McDevitt, M.D., Pinehurst Surgical, Pinehurst, North Carolina; Michael F. McGuire, M.D., David Geffen UCLA School of Medicine, Los Angeles, California; Patrick J. O'Neill, M.D., Medical University of South Carolina, Charleston, South Carolina; Neal R. Reisman, M.D., J.D., St. Luke's Episcopal Hospital and Baylor College of Medicine, Houston, Texas; Gary F. Rogers, M.D., Children's Hospital Boston, Boston, Massachusetts; Loren S. Schechter, M.D., Morton Grove, Illinois; Maria Siemionow, M.D., Ph.D., D.Sc., Cleveland Clinic, Cleveland, Ohio; Robert Singer, M.D., University of California, San Diego, La Jolla, California; Gary A. Smotrich, M.D., Lawrenceville Plastic Surgery, Lawrenceville, New Jersey; Rebecca S. Twersky, M.D., M.P.H., SUNY Downstate Medical Center, Brooklyn, New York; Amy G. Wandel, M.D., Mercy Medical Group, Sacramento, California; Ronald H. Wender, M.D., Cedars-Sinai Medical Center, Los Angeles, California; and James A. Yates, M.D., Grandview Surgery Center, Vista Surgery Center, Plastic Surgery Center, and Holy Spirit Hospital, Camp Hill, Pennsylvania

Financial Disclosures/Conflicts of Interest

The authors have no financial interests related to this article.

Guideline Status

This is the current release of the guideline.

This guideline updates a previous version: Iverson RE, Lynch DJ. Practice advisory on liposuction. Plast Reconstr Surg 2004 Apr 15;113(5):1478-90. [59 references]

Guideline Availability

Electronic copies: Available in Portable Document Format (PDF) from the American Society of Plastic Surgeons Web site External Web Site Policy.

Print copies: Available from the American Society of Plastic Surgeons, 444 East Algonquin Road, Arlington Heights, IL 60005-4664

Availability of Companion Documents

None available

Patient Resources

None available

NGC Status

This NGC summary was completed by ECRI on July 7, 2005. This NGC summary was updated by ECRI Institute on June 16, 2010. The information was verified by the guideline developer on August 31, 2010.

Copyright Statement

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.

Copyright ©2009 by the American Society of Plastic Surgeons

Disclaimer

NGC Disclaimer

The National Guideline Clearinghouseâ„¢ (NGC) does not develop, produce, approve, or endorse the guidelines represented on this site.

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