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Liposuction is the most commonly performed cosmetic body contouring procedure, both by number of patients and body surface area. It has undergone a lot of technical improvements over the past third-five years from patient indications to the technical equipment needed to perform it.

While understandably viewed as an aesthetic procedure, its traumatic impact on the body is often overlooked. The small skin entrances for the introduction of the fat-sucking cannulas belies the generalized injury to the subcutaneous tissues which has been treated. The trauma to the fatty tissues and all that runs through it is considerable. Any patient that has had the procedure can testify that its recovery is usually greater than they could have anticipated both in terms of swelling and bruising and the time it takes for its resolution.

The trauma to the body and how it responds to it has been well appreciated with the most extreme form of it in large volume liposuction. This term has become known as any amount of fat removal that exceeds five (5) liters. When fat is removed in a singe setting at greater than this volume, the effects on the body result in fluid shifts and blood loss that can result in potentially major complications. At the least it prolongs the recovery time and can take more than month after surgery for the patient to feel more normal again. Numerous adverse outcomes from the 1990s, when large volume liposuction became popular, proved that whether it can be done should be preceded by whether it would be done.

If one wants a large amount of fat removed it should be done in stages given that liposuction is an elective procedure.  While the five liter limit is not an absolute, as it should really be based on body weight or even body surface area, it does serve as a good clinical guideline.

Dr. Barry Eppley

Indianapolis, Indiana

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