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Key Points
- Organizations such as the American Academy of Cosmetic Surgery (AACS), the American Society for Dermatologic Surgery (ASDS) and the American Society of Plastic Surgeons (ASPS) have established liposuction guidelines that cover everything from recommended training and procedural issues to documentation and patient communication guidelines.
- An important issue is criteria for monitoring and documentation in all procedures.
- A key issue that has been emphasized in recent revisions of AACS guidelines is the importance of patient communication.
Surgeons who perform liposuction ideally have extensive training and routines that guide them through procedures, but in following established guidelines for liposuction, doctors can have an important added layer of protection — and an organized method of procedures — that could be critical if and when physicians find themselves in the spot of having to defend themselves, according to Ronald A. Fragen, M.D.
Organizations such as the American Academy of Cosmetic Surgery (AACS), the American Society for Dermatologic Surgery (ASDS) and the American Society of Plastic Surgeons (ASPS) have established liposuction guidelines that cover everything from recommended training and procedural issues to documentation and patient communication guidelines. (See Liposuction Guidelines at the end of this article.)
Dr. Fragen, who helped craft the AACS guidelines, says the guidelines' key benefits are not just in giving doctors a checklist of points to remember, but in making sure patients are also well-informed of what they are agreeing to and what lies ahead.
"The purpose of the guidelines is to give people not rules but suggestions on things like how to get training, how to get privileging to do procedures at hospitals, what should constitute adequate demonstration of ability, and, importantly, things to explain to the patient," says Dr. Fragen, a cosmetic surgeon practicing in Palm Springs, Calif. "The beauty of the guidelines is that regardless of the liposuction modality that you use, you will have better informed patients and you can know that you have looked at more of the things you should be looking at."
TECHNIQUE TRAINING
The AACS recommends adequate training and experience in the field, either through residency training, cosmetic surgery fellowship training, CME accredited post-graduate didactic and live surgical programs, one-on-one observational training and another means to acquire proper training of surgical techniques.
For some surgeons, that may involve playing a game of catch-up, Dr. Fragen says.
"A lot of surgeons may not have necessarily learned liposuction in their training, so they may need more instruction on proper techniques."
The guidelines address proper settings that are appropriate for performing liposuction, which can include outpatient clinic-based surgical facilities, free-standing surgical facilities or hospital settings, and the essential need for a sterile technique, no matter where the procedure is performed.
Another important issue is criteria for monitoring and documentation in all procedures. "It's extremely important to document what the patient's skin and physical condition are like prior to the procedure," Dr. Fragen says. "If the patient has a hernia, for instance, you need to be aware of that."
"If you want to be safe, you simply must document these things," he added. "Doctors often forget to do that documentation and it really can get them in trouble later."
A PATIENT PARTNERSHIP
A key issue that has been emphasized in recent revisions of AACS guidelines is the importance of patient communication, which simply cannot be overestimated, Dr. Fragen says.
"Patients often have unrealistic expectations about liposuction," he says. "A woman in her 50s, for instance, may have liposuction and expect the body she had when she was 20, or there may be a little dent or small complication that can easily be fixed, but they don't understand that and think it never should have happened because they were not forewarned."
And while a patient in his or her 20s may be able to expect their skin to contract after the procedure, older and heavier patients, or patients who have had pregnancies need to know that results may not be quite that perfect.
"If patients have had several pregnancies and their skin is not really elastic, they need to know that they can expect more irregularity when they have liposuction," Dr. Fragen says.
Heavier patients need to know that there will likely be multiple sessions and that skin removal may be necessary at some point, and, importantly, they need to be instructed to make efforts to lose weight.
"A key point in the guidelines is that patients are told that this is not a weight-loss procedure," Dr. Fragen says. "I tell them they have to be a partner with me in this and be responsible for the weight loss themselves, and I will instruct them to come back in several months so we can re-evaluate them."
