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Key Points
- Classification of megaliposuction varies
- Preoperative evaluation should include comprehensive lab testing, exam by cardiologist
- In addition to fat transfer, patients may undergo additional body contouring at same time as large-volume liposuction
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Dr. Salas
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Megaliposuction targeting multiple body sites can provide rewarding results for patients who are morbidly obese and resistant to undergoing bariatric surgery. These procedures can be very safe when performed with the involvement of an expert team to ensure appropriate patient selection and management, according to Jose Salas, M.D., who spoke at the International Society of Cosmetogynecology workshop held before the 27th annual scientific meeting of the American Academy of Cosmetic Surgery (AACS) in Phoenix in January.
"In the past, I would refuse to perform liposuction in patients who I felt would be better served by referral to a bariatric surgeon. However, some individuals do not want to undergo bariatric surgery, and for those patients, liposuction can have an important role in improving their physical appearance and self-esteem," says Dr. Salas, a board-certified cosmetic surgeon and director, Clinica de Cirugia Cosmetica, Tijuana, Mexico.
"Certainly, there are potential risks, and they are all explained in the informed consent, and the final cosmetic outcome in these cases does not match that achieved when less-extensive liposuction procedures are performed for body contouring in persons who are not obese," he says. "However, with my approach, megaliposuction and large-volume liposuction have been very safe; they may even sometimes be combined with other surgeries, and the patients who've undergone these procedures are uniformly happy with the result."
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Before (top) and approximately two-and-a-half years after Brazilian buttlift (buttocks fat grafting), during which 900 cc were transferred to each buttock (480 cc subdermal, 420 cc submuscular). (All photos credit: Jose Salas, M.D.)
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DEFINITIONS, DEFINED Dr. Salas notes that the definition for megaliposuction varies. For example, the AACS classification considers it megaliposuction when more than 5,000 cc are removed, but according to his personal classification system, Dr. Salas considers large-volume liposuction to be procedures involving 4,000 cc to 10,000 cc of fat removal and megaliposuction to be cases in which than 10,000 cc of fat is aspirated. In a review of nearly 200 liposuction cases he performed in 2008, he found that 34 percent were large-volume procedures and
2.5 percent were megaliposuction cases.
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Before (top) and approximately two-and-a-half years after large-volume liposuction of the abdomen, waist and back, during which 4,800 cc of fat were aspirated (2,200 cc anterior/2,600 cc posterior).
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SCREENING FOR SAFETY Appropriate patient selection and careful monitoring during the procedure are paramount for safety in the large-volume and megaliposuction procedures. Patients are only considered candidates if they are in good health as determined by a careful preoperative evaluation that includes comprehensive laboratory testing and examination by a cardiologist for patients age 40 years and older. During the procedure, an anesthesiologist is on hand to monitor systemic functions, including oxygen saturation, pulse rate, blood pressure, respiratory rate and urine output.
