How Much Fat Can Safely Be Removed with Liposuction?
The issue of how much fat can be extracted during one session of liposuction is debatable and the debate is a dangerous one. There is a limit to how much fat can be removed with no consequences to health and life, but no one agrees on what that limit is. Some surgeons remove more than what other surgeons feel is a safe amount. Some surgeons decide what is a safe amount on a patient-by-patient basis and on whether the surgery will be performed in a hospital, where there is greater access to emergency assistance.
Some states have rules on how much fat can be extracted: Florida limits the amount of fat removed in ambulatory setting, such as a freestanding surgical unit or a surgeon's office.
But the fact is that very aggressive fat removalthe removal of more than a few pounds of fatis dangerous. Deaths have occurred during or shortly after high-volume liposuction. These deaths are rarer now, but they still occur occasionally. The average amount of fat removed today is under 10 lb.
Generally, the more fat that is removed, the greater the risk to the patient. Removing only 2 or 3 lb of fat is safer than removing 5 or 6 lb. Remember, liposuction is not a weight-loss surgery. It is a surgery to remove a few recalcitrant pockets of fat that resist diet and exercise.
The upper limit of what is thought to be safe is no more than 6,000 ml (6 liters or about 12 lb of fat/fluid aspirate), for any single liposuction procedure. This upper limit was once 5,000 ml, and before that it was 3,000 ml. Now, this does not mean you lose 12 lb. It means that your fat, your blood, and the tumescent fluid infused and removed will equal about this amount.
As liposuction techniques have improved, surgeons have reduced the risks and the incidence of adverse outcomes. Complications are less frequent. However, many surgeons still do not recommend more than 6,000cc of fat/fluid aspirate removal during one procedure so that the risks of complications are as low as possible.
This is not to say that procedures with removal volumes over 6,000 ml are not performed, or that they are not done with reasonably safety if the patient is kept in the hospital for a day or two. Both experienced and inexperienced surgeons may offer this to their patients. A lot depends on your overall health. But you as a patient must understand that the risks for these large-volume procedures are greater. The surgery lasts longer and the body endures a greater amount of trauma.
Procedures removing more than 6,000 ml increase other risks such as anesthesia-related problems, infection, dehydration-induced shock (caused when the body loses too much fluid), or conversely a build-up of too much fluid that can seriously affect breathing and may pool in the lungs and other tissues. The risks of a fat embolism (a bit of emulsified fat that enters the blood stream) or blood clots, seroma and hematoma formation, a drop in blood pressure, and lidocaine toxicity are increased in longer procedures.
Excessive blood loss can still be a concern, but the use of epinephrine, which constricts the blood vessels, has reduced the amount of blood loss during liposuction. This vasoconstriction also decreases the amount of lidocaine absorbed by the body.
The bottom line is that most liposuction patients don't need to have more than 6,000 ml removed. Removal of more than 6,000 ml of fat and infusion liquid should be avoided in any one procedure.
Lastly, the trend is to combine several cosmetic surgical procedures into one longer surgery. Many people have liposuction, a tummy tuck, and breast implants done in one day, or a face lift and liposuction. The risks of doing this on an out-patient basis are usually still low for someone who is in good health, but they are greater than with any one procedure by itself. I am not saying don't do it, but just understand that the risks increase along with the number of procedures performed simultaneously.
Erwin J. Bulan, MD
Bulan Plastic Surgery
75 Main Street
Millburn, NJ 07041
Joshua A. Greenwald, MD, FACS
Cosmetic Surgery Associates of New York
166 5th Avenue
New York, NY 10010
Nikesh K. Patel, MD
New Reflections Plastic Surgery
1001 West Main Street
Freehold, NJ 07728