How to Pick a Liposuction Surgeon

Choosing a Liposuction Surgeon
Choosing a liposuction surgeon who is well trained, skilled and ethical requires careful attention. A surgeon’s reputation for good liposuction results, happy patients, and ethical standards are most important. Not every cosmetic surgeon is well trained and experienced in doing liposuction. The best facelift surgeon or the best breast surgeon might have limited skills as a liposuction surgeon. Ask others about the surgeon’s reputation. Ask doctors, former patients, and friends who might known about the surgeon’s reputation.

Consider “Safety First”
Most surgeons now recognize that there is a limit on the maximum amount of liposuction that a patient can safely tolerate on a single day, yet there is controversy about what constitutes “an excessive amount of liposuction.” The Medical Board of California prohibits outpatient liposuction of more than 5 liters of aspirate (fat and fluid) in an office on a single day. Many surgeons believe that the maximum safe volume of aspirate is less than 4 liters. Most surgeons who put safety above all other considerations agree that removing more than 4 or 5 liters fat and fluid by liposuction is too dangerous. When choosing a liposuction surgeon it is recommended that you consider the surgeon’s philosophy about safety.

Is the Surgeon Board Certified in a Surgical Specialty?
A surgeon who could never pass his or her board examination might not be your first choice. Similarly, board certification in a non-surgical specialty might not provide evidence of adequate training in using sterile surgical technique nor in managing an acute surgical emergency.

Is the Surgeon Well Trained?
Is the surgeon well trained in preventing and taking care of surgical emergencies? Training in preventing liposuction complications might be more important than experience in taking care of liposuction complications. If you had to choose between two equally qualified liposuction surgeons, would you prefer a surgeon who never had to take care of a liposuction emergency, or would you prefer the surgeon who has had to take care of many liposuction emergencies?

What to Avoid
Avoid exposing your self to the risks associated with excessive volumes of liposuction or excessive number of body areas treated by liposuction on the same day. Avoid having liposuction on the same day that other unrelated surgical procedures, such as facelift or breast surgery are done. It is especially dangerous to have a liposuction at the same time as a gynecological surgical procedure such as hysterectomy, tubal ligation, or bladder suspension. Virtually all deaths associated with liposuction have occurred when there was an excessive amount of liposuction, or when other unrelated surgical procedures were performed on the same day.

The Safest Choice
The safest choice is to select a surgeon who is willing to 1) limit the amount of liposuction performed on a single day to less than 4 liters of aspirate (fat and fluid), 2) avoid doing liposuction of an excessive number of body areas on a single day, 3) schedule the surgical days at least one month apart if more than one day of liposuction is required, 4) avoid doing any unrelated surgical procedures on the same day as liposuction.

Surgical Specialty is not Critical
Qualifications of a liposuction surgeon are not rigidly defined. Liposuction was developed by multiple specialities. No specialty can honestly claim superior training in the world of liposuction. There are many excellent liposuction surgeons who obtained their basic surgical education during residency training in dermatology, general surgery, gynecology, ophthalmology, otolaryngology (ENT), or plastic surgery. For example, both dermatologists and plastic surgeons receive instruction in doing liposuction during their residency training. When selecting a liposuction surgeon, the surgeon’s specialty is not as important as the surgeon’s liposuction technique, the surgeon’s record for safety, and the individual surgeon’s honesty and integrity.

Avoid Marketing Hype
There is no surgical specialty that can honestly claim that its training in liposuction is superior to that of any other surgical specialty. There is absolutely no published data on liposuction safety upon which any specialty can objectively base a claim of superiority. In fact, it is quite likely that the one surgical specialty that claims to be superior to all others, is in fact the specialty that has had the highest rate of severe liposuction complications and surgical deaths. Do not be deceived by an advertising agency’s hyperbole. Do not confuse marketing hyperbole with surgical skill and integrity.

Liposuction Safety Has Improved
Surgeons of all specialties have learned from the mistakes of the past. Modern liposuction is now regarded as much improved. Nevertheless, patients must be aware that different surgeons within the same specialty may use different techniques. In fact, some surgeons have not kept up to date, and continue to use outmoded techniques. It is important for a prospective patient to know which are the safest surgical techniques, and which are outmoded. For example, you should know that most liposuction surgeons have rejected the technique of ultrasonic liposuction, and the FDA does not permit the sale of ultrasonic liposuction machines in the United States.

Arrogant Surgeons Are Dangerous
Every specialty has its unique advantages and limitations in the liposuction training its members have received. It is natural for a specialist to believe that his own specialty is the best. However, a surgeon becomes dangerous when he begins to believe in the infallibility of his own specialty. Arrogant surgeons are more likely to attempt more aggressive and more dangerous liposuction procedures. Consequently their patients are exposed to greater risks and serious surgical complications. Beware of any specialty that advertises itself as having the best training to do liposuction. The patient’s most important concern should be to choose a liposuction surgeon whose primary concern is safety. Avoid overconfident surgeons who believe their training permits them to attempt excessively large liposuction procedures.

Essential Prerequisites
What are the necessary and sufficient prerequisites to becoming a competent liposuction surgeon?. Each of the following criteria are necessary: board certification in a surgical specialty, expertise in managing cardiac emergencies, accredited liposuction training in the classroom (didactic) and hands-on training in the operating room. These attributes are considered in greater detail in the following paragraphs.
Surgical training and board certification in an accredited residency training program, such as dermatology, general surgery, gynecology, ophthalmology, otolaryngology, and plastic surgery insures training in sterile surgical techniques.

Expertise
Expertise in emergency management of surgical and medical complications is important. It is reasonable to demand that all liposuction surgeons be trained in the diagnosis and emergency management of potential liposuction complications. It is unrealistic to require that a surgeon be able to provide definitive management of such complications. Serious cardiac complications can occur in liposuction surgery, yet it is unrealistic to expect a surgeons to provide definitive long term care after a heart attack. It would be best to have such a complication managed by a cardiologist. However, training in the emergency management of a cardiac arrest is important.

Certification
Certification in Advanced Cardiac Life Support (ACLS) with re-certification every two years should be part of every liposuction surgeon’s qualifications. Preferably all operating room staff members have similar training. It is wise to inquire if a surgeon has training equivalent to certification by the American Heart Association in ACLS.

Classroom Instruction in Liposuction is Essential
The best liposuction courses often include testing to assure that the trainee has attained in-depth knowledge of factors associated with severe liposuction complications, possible undesirable results of liposuction, surgical techniques for liposuction, clinical pharmacology, potential drug interactions, and optimal post-liposuction care.

Hands-on Training in Liposuction
Clinical experience with in-the-operating-room, hands-on liposuction training provided by a certified course for Continuing Medical Education (CME) is essential. Introductory hands-on training provided during a two or three day course with 8 to 25 students is necessary, but perhaps not sufficient. Additional individualized hands-on training is also desirable.

Other Essential Attributes
Other essential attributes of a liposuction surgeon that are difficult to teach, include: integrity, high ethical standards, artistic and aesthetic sensibility, and an ability to discriminate between fad and fact as new liposuction techniques are introduced. Humility, and the ability to recognize and avoid unnecessarily dangerous situations are good qualities in any surgeon.

Surgicenter Accreditation
Surgicenter Accreditation is required only if the anesthetic technique involves the use of systemic anesthesia (general anesthesia or heavy IV sedation) that might compromise a patient’s protective airway reflexes. If a patient is to have liposuction that involves either intramuscular anesthesia, intravenous anesthesia or general anesthesia, then it is important that the patient be certain that the surgical facility is accredited. When liposuction is done totally by local anesthesia then an accredited surgical facility is not essential. Nevertheless, surgeons who regularly do many liposuction surgeries totally by local anesthesia will often seek accreditation of their office facility as a testament to professional excellence and attention to detail.

Hospital Privileges are not Essential
Hospital privileges for liposuction are not essential. Hospital privileges are often more dependent upon political considerations than on a surgeon’s skill and experience. Economic considerations and turf battles between competing specialties may prevent a well qualified liposuction surgeon from obtaining liposuction privileges in his local hospital despite having treated over 6,000 liposuction patients without any serious complications. On the other hand, this same hospital might grant liposuction privileges to a plastic surgeon who has only recently finished residency training and has never done a liposuction surgery entirely without assistance.

Additional Considerations

In the process of choosing a liposuction surgeon, the patient should be prepared to ask very specific questions of each candidate surgeon. A discussion of some important questions is considered in the following paragraphs. A list of specific questions is provided in the next chapter (see Check List for Choosing Surgeon).

Hospitalization
Has the surgeon had any liposuction patients who have been hospitalized after liposuction surgery? A hospitalization is not necessarily a bad indicator. It might be very desirable to choose a liposuction surgeon who is attentive to potential problems and does not hesitate to hospitalize a patient for observation in order to avoid overlooking a potentially serious complication. A surgeon who is reluctant to hospitalize a patient because he fears it might affect his reputation, might not regard patient safety as the highest concern.

Good Reputation?
Does the surgeon have a good reputation among other physicians in the community? Ask another physician or another health care professional what they know about the liposuction surgeon you are considering.

How Many Liposuction Patients?
How many liposuction patients has the surgeon treated? You might not want to be the first liposuction patient. Be aware of confusing terminology. Some surgeons might use confusing or deceptive terminology when describing their own experience with liposuction. If a surgeon has only treated 25 patients with each patient having 4 areas treated by liposuction, then it might be misleading for the surgeon to claim to have done 100 liposuction “procedures”. How many liposuction patients does the surgeon treat each week? A surgeon who does only a few liposuction patients per year might not be as competent as a surgeon who does liposuction on 3 or 4 patients every week.

Is the Surgeon Board Certified in a Surgical Specialty?
A surgeon who could never pass his or her board examination might not be your first choice. Similarly, board certification in psychiatry might not document adequate training in basic sterile surgical technique.

Is the Surgeon Well Trained?
Is the surgeon well trained in preventing and taking care of surgical emergencies? Training in preventing complications is more important than experience in taking care of complications. If you had to choose between two equally qualified liposuction surgeons, would you prefer a surgeon who never had to take care of a liposuction emergency, or would you prefer the surgeon who has had to take care of many liposuction emergencies?

Is the Surgeon a Member of the Volunteer Faculty?
Is the surgeon a member of the volunteer faculty of the local medical school? It is likely that any surgeon who teaches medical students and surgical residents will be up-to-date with current developments within his or her specialty.
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