Large Volume Liposuction, Safety and Indications

Large volume liposuction can be performed safely if certain guidelines are followed. Properly selected patients who have a good understanding of the expectations and limitations of the procedure tend to be very satisfied with the results. Importantly, physicians who are considering performing large volume liposuction must understand the physiology and differences from smaller volume liposuction. Applying the same standards and treatment parameters as with small volume liposuction may result in death and disaster.

The 5 pillars of safety must be followed at all times. The surgeon first must be well trained in smaller volume liposuction and have a thorough understanding of the physiologic implications of infusing and suctioning large amounts of fluids from the body. Cases should be scheduled and performed such that incrementally larger volumes of fat are removed as the physician gains experience. The anesthesiologist, present on every case, likewise must have a complete understanding of the procedure and be well trained to handle preoperative, perioperative, or postoperative problems. The facility where the procedure is performed should be accredited, properly equipped, and have experience with large volume liposuction procedures. Overnight care facilities must be available with registered nursing care and the appropriate monitoring equipment. Support staff at every level of the procedure, from the preoperative phase through recovery, must be competent and experienced.

Finally, the patient must be healthy and appropriately selected. Motivation, goals, and expectations must agree with what is clinically possible. Patients should be psychologically stable with good diet and exercise habits or evidence of motivation toward these habits.

In addition to these basic pillars, several other issues are worth repeating to ensure a safe outcome. Frequent communication between all members of the surgical team is critical. The tumescent technique of injecting very large volumes of wetting solution must be avoided in large volume liposuction, as this invariably leads to fluid overload and its associated problems. Instead, the superwet technique of fluid infiltration, in which volume infused is roughly equal to total volume removed (1:1 ratio), should be practiced. With this in mind, remember that enough wetting solution with epinephrine should be infused to maintain an essentially bloodless aspirate. If the aspirate becomes excessively bloody, reevaluate the procedure. In such cases, either the procedure should be terminated or more wetting solution should be infused for added hemostatic effect from the epinephrine.

Compressive postoperative garments always are worn to minimize postoperative bleeding, swelling, and third spacing of fluid. Finally, attention must be paid to maintaining the patient's core body temperature using heating blankets on the table, minimizing body exposure, using Bair Hugger-type warming blankets, and using warmed wetting solution.

Ultimately, the long-term results following large volume liposuction depend on the preoperative condition of the patient's skin, the patient's overall health and expectations, and the ability of the patient to maintain a healthy weight and lifestyle postoperatively. Whenever in doubt, consider staging procedures in terms of multiple liposuction procedures or combining the liposuction with other procedures.

further more see http://emedicine.medscape.com/article/1272958-overview