Liposuction 20-Year Learned Experience (Part 1): Physician Qualifications, Preoperative Risk Assessment, and Perioperative Surgical Management

Introduction: A 20-year liposuction single-surgeon experience investigating physician qualifications, identifying a preoperative risk assessment, and confirming a perioperative surgical management protocol with Part 1 of the project. The progression of surgical technique and implementation of new technologies optimized the aesthetic results while minimizing complications and side effects in Part 2. Materials and Methods: Both retrospective and prospective clinical studies and PubMed literature searches were carried out on all variables involved in the different surgical techniques to include microcannula suction-assisted liposuction (mSAL), standard cannula size suction-assisted liposuction (SAL), water-jet–assisted liposuction (WAL), third-generation ultrasound (Vibration Amplification of Sound Energy at Resonance [VASER]) liposuction, laser-assisted liposuction (LAL), nutational infrasonic liposuction (NIL), high-definition VASER liposuction, helium-based plasma radiofrequency technology (HBT), and lipoabdominoplasty. Results: The evolution of liposuction reviewing the historical transformations in surgical technique and technologies is presented. Physician qualifications regarding training and education guidelines highlighting interspecialty published differences. Noting the minimum accepted duration, degree, and type of liposuction training to practice liposuction safely for our patients. Identifying the standard of care controversies to avoid medical malpractice litigation. The preoperative evaluation details a comprehensive body analysis, weight loss consultation reviewing all options for medical and surgical weight loss management, liposuction clinical indications, informed consent process, risk assessment strategies regarding avoiding lidocaine toxicity prevention, fluid overload prevention, minimizing and estimating blood loss and bruising, analyzing maximum fat output, thromboembolism risk calculation and prophylaxis, and analysis of simultaneous and staged ancillary aesthetic procedures. The day of surgery includes preoperative medical assessment, photographic documentation, surgical marking, anesthesia delivery and airway concerns, postsurgical therapeutic options, and postoperative pain management to minimize narcotic use with the risk of addiction, all to minimize side effects and complications and optimize aesthetic outcomes. Discussion: Review of the medical literature reviewing the historical highlights on the evolution of the liposuction technique and implementation of new technologies and use of personal clinical studies comparing different variables in a controlled setting, identified best practices. Conclusions: The current clinical liposuction technique used by the author offers a superior methodology in both an awake patient in an office-based setting and surgery setting environment by implementing a comprehensive preoperative risk assessment and risk avoidance strategies to minimize side effects and complications in Part 1 of this liposuction protocol. Employing the optimal defined surgical step variables with VASER high-definition liposculpting to achieve a slender, muscular appearance and adding HBT to maximize skin tightening along with postoperative maneuvers using fitted compression, therapeutic ultrasound, and lymphatic massage attains best practices in liposuction.