Liposuction is the most commonly performed surgical procedure in the world and has been for at least the last 10 years. The methodology has changed since its inception in the 1970’s, but the results achieved have remained good through the years. The use of tumescent fluid was an important change making the procedure available to more patients as an office procedure not requiring general anesthesia. Liposculpture evolved to accommodate a wider variety of patients and their requests. Liposculpture, or superficial liposuction, allowed better body contouring for them without large fat deposits. Ultrasonic and laser have been used more recently to facilitate fat removal with less pain and swelling with the hope that superficial lower wattage lasers could be used beneath the skin to effect skin shrinkage and tightening. As with many extensively marketed technologies, the hype for skin tightening seems over sold and is being shown to be minimal at best.

Billions of dollars have been invested in these new liposuction technologies requiring extensive and exaggerated claims of the benefits of each new liposuction “platform.” As with the pharmaceutical industry, these machines are being marketed directly to the potential patients as well as to the physicians performing liposuction. It is smart marketing to increase the target physician pool of possible purchasers by taking advantage of the gray areas of credentialing and market this expensive, complex, and even dangerous technology to doctors who are untrained but not forbidden to do liposuction. Most manufacturers have catchy names for their products and encourage physicians who buy these machines to “cross market” by using their trademarked name taking advantage of any branding the company may have achieved to cross over to the physician’s practice. It seems very clear that these companies will sell this sophisticated technology to ANY physician who can afford the price.

There are two constraints in the technical evolution of liposuction. The most important with respect to complications is that each successive iteration, while minimally improving results, has increased the complexity and therefore the danger of the procedure. So called “large volume liposuction” evolved due to the tumescent technologies and now is probably the number one cause of plastic surgery fatalities in the world. Performing liposuction more aggressively by attacking the more superficial fat deposits has led to a spate of contour and skin deformities including full thickness skin burns with the laser liposuction. It seems that we see, more recently, complications associated with damage to deeper structures such as fascia, muscle, and even peritoneal penetration. The irony is that as liposuction has progressed to a more complicated procedure, the number of physicians performing liposuction that are NOT plastic surgical trained, or not even surgically trained is exploding. Whereby the least experienced most poorly trained doctors are using the newest, most complicated and most dangerous technologies. To a certain extent, the public is at fault as many seek plastic surgical services through marketing and ad campaigns that are artfully done, impressive, and deceptive. First and foremost, it must be understood that liposuction is a real surgical procedure with real complications and can lead to real disasters. To search out the least of us to perform a potentially dangerous procedure in an office setting is asking for trouble and that seems to be what is occurring. It is no different and makes no common sense to price shop liposuction and not open-heart surgery or brain surgery.

The second constant with liposuction technical evolution is that the newer, most complicated, and advanced technology leads to the most challenging and even devastating problems. It appears that the least of us, while utilizing complex technology for marketing gain, are causing the most horrific post-operative complications. The benefits of the newest laser technologies are small, but the new laser liposuction makes it more difficult to determine the depth and “feel” experienced plastic surgeons use in contouring fat pockets. This loss of “feel” leads the inexperienced to laser either too deep damaging muscle or too superficial burning and scarring the overlying skin.

For many years, revision liposuction entailed a second liposuction procedure to improve contour and to harvest fat to be grafted to depressed areas where too much fat was removed. In most cases, contours could be drastically improved with this rather supple complication of fat harvesting and grafting. As the technologies advanced so did the number and severity of the complications. Muscle and fascia damage caused complex contour and physical problems whereas skin damage will test even the most experienced and talented plastic usrgeons, not a description of the new practitioner. In a patient who cost-shopped their liposuction (or any other cosmetic plastic surgery), the cost to repair these deformities usually exceeds the cost of the original mishap. There is no applicable insurance for secondary liposuction procedures and, as a rule, the most experienced plastic surgeons should be sought after for the complex problems.

Unfortunately, there are no guarantees that board certified plastic surgeons will not have complications, but it is clear that one’s odds are improved by choosing the best trained surgeon who practices the skills taught as a resident in the field of plastic surgery. All other certifications are short-cuts to proper training and proper plastic surgical training leads to better results, patient care, and as a whole, better surgical decisions.

Dr. Paul Howard is a leader in revision liposuction procedures having treated numerous patients who fell victim to swift marketing, very low prices, and deceptive board certification credentials.