How much fat can liposuction remove?
Although there's no magic bullet for weight loss, new research suggests that surgeons may be able to safely remove more fat during liposuction surgery than previously believed.
Right now, surgeons follow guidelines that set a maximum extraction limit of 5,000 milliliters of fat (11 pounds) for all patients, regardless of variations in weight or body fat status. But the new study suggests surgeons could use a patient's body mass index (BMI) to determine how much fat extraction is safe. BMI is a rough estimate of a person's body fat based on height and weight measurements.
"The problem is that this guideline seems like it was picked out of a hat," said study co-author Dr. Karol Gutowski, a board-certified plastic surgeon and a clinical associate professor at the University of Illinois at Chicago.
"And though the guideline itself is just a recommendation, not the law, some states -- like California -- have passed legislation based on this guideline. But there's no data behind it. No science," he explained.
Fifteen years ago, Gutowski and his colleagues set up a database to track the outcomes of liposuctions performed by board-certified plastic surgeons. "And we found that if you have a higher BMI, you can remove more fat safely, which means that the calculation should be based on each patient's unique body status," he said.
Dr. Scot Glasberg, president of the American Society of Plastic Surgeons (ASPS), said the new analysis is "an innovative and more current approach than what we have out there at the moment."
Glasberg said the "reality is liposuction is incredibly safe. But obviously if you set out to take [more than 10 pounds] of fat from a person who weighs 130 pounds, versus someone who is 230, you're looking at a very different situation. So I think that the notion of a sliding scale based on BMI makes a lot of sense."
Gutowski and his colleagues' findings were published in the September issue of Plastic and Reconstructive Surgery.
Liposuction is not covered by most insurance, and the ASPS estimates a $3,000 out-of-pocket price tag.
The organization said that more than 211,000 American men and women underwent liposuction in 2014, representing a 5 percent increase from the year before. The procedure now ranks number three among all plastic surgery options, after nose reshaping and breast augmentation, the ASPS said.
Most liposuction patients are women, the study found. However, Gutowski said that men now account for between 10 to 15 percent of patients, a figure that rises to as high as 20 percent if male breast-reduction surgeries are also included.
He said most patients are treated as outpatients and go home the same day as the procedure. And despite short-term soreness, patients are typically up and moving right away. Most people can resume their usual daily routine within a couple of weeks, he added.
As for risk, the study team described the current complication rate as "very low," with serious problems occurring among fewer than one in every 1,000 patients.
For the study, the investigators tracked more than 4,500 liposuction patients. None of the patients died following fat extraction, and the total complication rate was less than 1.5 percent. Most of the complications weren't considered serious, the researchers said.
However, the researchers found that the complication risk rose as the amount of fat removed increased. They noted that while fat extraction averaged about 4.5 pounds per patient, those who had over 11 pounds of fat removed had a higher-than-average complication rate of 3.7 percent.
The research team also found that the key factor in complication risk turned out to be BMI. Those with a higher BMI were better able to tolerate large-scale fat removal than those with a lower BMI, the study authors said.
Still, the researchers cautioned that while BMI could be a useful yardstick for pre-determining safe levels of fat removal, each patient's individual risk factors must be considered.
Liposuction is not risk-free, however.
According to the U.S. Food and Drug Administration, potential complications include infections, clots of fat in the lungs, possible puncture of internal organs and even death.
Some studies estimate the risk of death as low as three deaths for every 100,000 procedures performed. Other studies have suggested the risk is between 20 and 100 deaths per 100,000 surgeries, the FDA said.