This is a meta analysis and systematic review of studies from 1946 to 2020.
This appeared in the September 2021 issue of Aesthetic Surgery Journal. “Safety of Large Volume Liposuction in Aesthetic Surgery: A Systematic Review and Meta Analysis.” They wanted to evaluate the safety of large volume liposuction. My national society, the American Society of Plastic Surgery, defines large volume liposuction as removing over 5 liters of aspirate. The authors point out this definition was made 15 years ago, and most studies in the literature define large volume as the removal of 3500cc or more of aspirate during a single procedure.
They looked at 23 articles involving 3583 patients. The average aspirate volume was 7.7 liters. (FYI one liter of fat removed is about 2.2 pounds). The average age was 36. The average BMI was 32. Many patients (863) had liposuction combined with another surgical procedure. the most common being tummy tuck, followed by breast lift +/- breast implant, and BBL (adding fat to the bottom, the brazilian butt lift).
What did they find?
- Major complication pooled rate was 3.35%. What were these? Blood transfusion needed 2.9%, pulmonary embolism 0.2%, hematoma 0.16%, necrotizing fascitis 0.13%, DVT 0.12%,
- No fat emboli or deaths were reported.
- Minor complication rate was 11%, with the most often cited one being seroma 5.5%, then contour irregularities, pigmentation, persistent redness, surgery site infection, et al.
- Metabolic changes: Reduction in total cholesterol, triglyceride level, fasting glucose, insulin level, weight, and hematocrit.
Discussion:
They realize there are many limitations to this study. This is a huge retrospective study. Clearly different techniques (how much fluid did you give for tumnescent?, did you use UAL or laser?), was this a combined surgery (ie if you do a tummy tuck at the same time, clearly the risk of blood loss and other issues like DVT are higher due to the longer surgical times and the risk of the other procedure), postop management (drains? garments? pt compliance with follow ups?), length of time of surgery, what type of center was the surgery done in, etc. When reading the range of volumes, it went from 3500 to 25,000. (!) Clearly these are not equivalencies.
There are also issues with the study because it went back so far. Prior to using tumnescence 30+ years ago, plastic surgeons would do “dry” liposuction. Liposuction was not done commonly because dry liposuction caused significant bleeding. I heard something in my early training about those days, something to the effect of for every one liter of fat you removed you would lose a unit of blood. Including those early studies in this retrospective would clearly be distorting.
My thoughts?
Retrospective studies are tough. They are not equivalent- different techniques, protocols, etc are used. But to evaluate things we need large numbers. I love liposuction. It is an important tool in my plastic surgery toolbox. I use some liposuction on every tummy tuck and breast reduction to help sculpt and contour. For healthy patients, we do combine liposuction with other larger procedures like tummy tuck and breast surgery.
This study shows an overall rate of safety, particularly when you consider its inclusion of old studies from back when “dry” liposuction was being done. I love that liposuction has added medical benefits like improvement in cholesterol, TG, and glucose in addition to lower weights.