Factors that increase the dangers of liposuction include 1) lack of good judgment in patient selection, 2) excessive duration and intensity of exposure to anesthesia, 3) excessive amounts of surgical trauma per month, and 4) ineffective post-liposuction care.
What is Too Much Liposuction?
Excessive amounts of surgical trauma can be regarded as toxic to patients. Increasing doses of liposuction-induced surgical trauma produce increasing risks of toxicity in the form of surgical complications. It is not possible to precisely identify the threshold for dangerous amounts of liposuction. However, one can be certain that removing 6 to 9 liters of fat on one day is many times more dangerous than removing 2 to 3 liters of fat on each of three separate surgeries spaced at least one month apart. Liposuction of 5% of the body's subcutaneous surface area is obviously safer than liposuction of 40% of the body surface area. Cosmetic surgery is not emergency surgery, liposuction patients should not be exposed unnecessary risks of excessive liposuction on a single day.
Excessive liposuction is not safe. This patient had too much liposuction on a single day resulting in gross irregularities of the skin. The goal of liposuction should not be to remove the maximum amount of fat, but rather to achieve the best cosmetic results. Mega liposuction is never necessary and often it is dangerous.
Excessive Liposuction is Difficult to Define
Excessive liposuction might be defined as a volume of liposuction that is excessively dangerous. The designation of excessive liposuction often depends on the size and health of the patient. Removing 1 liter (2.2 pounds) of fat by liposuction might be excessive in a patient weighing 50 kg (110 pounds). On the other hand, removing 4 liters (9 pounds) of fat in one procedure might not be excessive in a 100 kg (220 pound) patient. There is no clear cut dividing line between to the amount of liposuction that can be considered safe and an amount of liposuction that is too dangerous. Patients and surgeons must use common sense.
Toxic Dose of Liposuction
Increasing doses of a toxin can be expected to produce increasing risks of a toxic response. Drinking a very small amount of alcohol usually has no detectable effect. Increasing doses of alcohol first produce a mild subjective effect, then mild intoxication (inebriation), followed by moderate intoxication (drunkenness), and dangerous intoxication (unconsciousness, coma, death). The severity of a skin burn can be measured as a percentage of the body-surface area that is burnt. The probability of death increases with increasing percentage of body-surface area that is burnt. Similarly, an increasing amount of liposuction trauma (increasing percentage of body-surface area subjected to liposuction) increases the risk of unconsciousness, coma, and death.
Small Monthly Doses are Safer
Drinking a moderate amount of alcohol on three separate occasions at least a month apart is not as dangerous as drinking three times that amount on one occasion. Similarly doing a moderate amount of liposuction on three separate occasions at least a month apart is not as dangerous as doing three times that amount of liposuction on a single occasion.
Tumescence for the Wrong Reasons
Tumescent liposuction totally by local anesthesia was invented to improve patient safety. However, some surgeons and anesthesiologists use the tumescent technique in order to maximize the volume of fat removed during a single surgery. Liposuction of 5 liters or more of fat in a single liposuction procedure is overly aggressive, and potentially life threatening.
Ability to Survive Trauma has Limits
The body cannot tolerate an unlimited amount of trauma. Increasing degrees of liposuction-associated trauma produce increasing degrees of tissue injury and blood coagulation. Eventually, there is either excessive bleeding or excessive clotting and then death. Excessive liposuction is also associated with prolonged recovery, and disappointing cosmetic results.
Too Many Unrelated Surgical Procedures
The risk of complications is greatly increased by combining liposuction with multiple unrelated surgical procedures such as facelift, breast surgery, nose surgery, or laser surgery. The combination of an intra-abdominal gynecologic surgery and abdominal liposuction is also very dangerous. This risk of complications when a patient has multiple unrelated surgical procedures explains why non-cosmetic surgeries are rarely combined. Because of the fear of complications, surgeons do not expose patients to the risks of simultaneous but unrelated therapeutic surgeries such as gallbladder surgery, hip surgery, and colonoscopy. The risks associated with having multiple cosmetic procedures including liposuction on the same day may often out weigh the benefits of having only one convalescent period. Liposuction is probably the safest of all cosmetic surgery procedures provided that it is not combined with other unrelated surgical procedures.
Mega-liposuction is defined as the liposuction of a huge volume of fat on a single day. The volume of fat that is generally regarded as huge is about 8 liters (two gallons). Because patients have died as a result of mega-liposuction, it cannot be regarded as safe. Even in a hospital setting, mega-liposuction should be regarded as a dangerous experimental procedure. Mega-liposuction is associated with mega-complications. Serial liposuction procedures on separate days are far safer than a single heroic mega-liposuction procedure.
Utilitarian Definition of "Too Much Liposuction"
If nausea, vomiting, excessive pain, bruising and swelling occur regularly after liposuction, then perhaps that surgeon regularly does too much liposuction. If a liposuction surgeon cannot expect all patients to be ambulatory within 30 to 60 minutes after surgery, then perhaps the amount of liposuction and anesthesia are excessive. Liposuction might be excessive if 1) pain regularly confines patients to bed for more than 24 hours, 2) nausea regularly prevents patients from eating a normal meal soon after surgery, or 3) discomfort regularly prevents the return to desk-type work within one to two days after surgery.