In NY Times article in 2002 called Liposuction Grows Safer As Less Fat Is Removed articulated the premise that the liposuction was safer with less fat removed. I think this is largely self-evident to plastic surgeons and the public at large. Certainly, less fat can be removed at a given time. Certainly, this would be safer when examined in only that context and without the benefit of much less myopic view of surgery and surgical goals.

I would say that the goal should be to not have revision surgery, which is the cause for many complications due to scar tissue and false tissue planes from previous surgery. Liposuction procedures average about 400,000 procedures per year. The article quoted a risk of death, which in 1998 was 1 in 5,000, according to results of more than 94,000 procedures reviewed in the March/April 2001 issue of Aesthetic Surgery Journal. Some groups promoted larger fat volume removals as a method to produce significant decreases in systolic blood pressure, fasting insulin levels and total body weight that could possibly improve overall health. Though those results have not really been borne out or sought, liposuction remains a very popular procedure due to its effectiveness.

However, the revision rate may be 25% or higher in some practices. What are the reasons for such a high number of revisions?
The first reason is that many doctors view the procedure as easy or mundane and think that anyone can make an incision and remove fat. Though this is true, even a few poorly performed strokes can result in damage to internal structures and creation of contour deformities that can be very difficult if not impossible to correct. Many of these surgeries are done very conservatively to make the surgery easier for the surgeon not for the benefit of the patient. In fact, the less fat that is removed the less the probability that contour deformities are created.

However, the goal should be to remove a significant amount of fat without complications or deformities. This uniform and smooth liposuction paradigm is difficult to teach and many surgeons can never really achieve this level. The technical concerns are manifold but suffice it to say that visual inspection and tactile palpation and proprioception are absolutely vital to both performing the procedure and evaluating the process and endpoint.

In the end, it is this proficiency that results in a few plastic surgeons being much more sought after than others.

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