Is it normal to do 360 Lipo in two parts, 2 weeks apart?

Question

I visited a surgeon and was told that due to my BMI (36) I should do 360 Lipo in two session. Each session 2 weeks apart. I would do upper and lower abs and then come back two weeks later for flanks and back. Is this normally how this is done? Just wanting a second opinion. Thank you

Kenneth Hughes, MD · Answer

Different surgeons will have different opinions and comfort levels with regard to this so it is best to ask the individual surgeon at your in-office consultation.  The two main reasons for targeting a BMI close to 30 is to lower the risks of complications during and after surgery and to raise the probability of attaining your ultimate goals in one surgery. Staging the lipo may be related to the limitation of only 5 liters of aspirate removal per surgery.
Kenneth Hughes, MD, ABPS Board Certified Plastic Surgeon
Los Angeles, CA

Alex Campbell, MD · Answer

Thanks for your question. While you can liposuction several areas at once there is a limit to how much fat can be removed safely. Risks from liposuction increase significantly when over 5 liters of fat are suctioned out. We usually stay below this limit for patient safety. We’ve found that we’re able to achieve dramatic improvements for our patients with 2 to 4 liters of liposuction, depending on their needs.

Daniel Barrett, MD · Answer

Dear jid8,
most plastic surgeons don't recommend elective procedures for patients which have BMI over 30 because of higher complication rate. For right candidates liposuction of abdomen, flanks and back can be done at the same time. If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD

Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Robert M. Tornambe, MD · Answer

jid8 I am sorry, however most board-certified plastic surgeons would not recommend liposuction with a BMI of 36. Liposuction is not a weight-loss procedure and I strongly recommend that you try to lower your BMI to around 30 before undergoing any liposuction procedure. Studies indicate a higher complication rate in patients with a BMI over 30. Get a second opinion with a board-certified plastic surgeon in your area. Good luck.

Tania Medina de Garcia, MD · Answer

Hello dear!
Thanks for the question and provided information as well.
Actually, your BMI needs to be 33 or less, for you to be considered a good candidate for plastic surgery.
l recommend you to make an appointment with a board certified plastic surgeon to talk about your goals and the best options for you.
Good luck :)

Ali Mosharrafa, MD · Answer

Generally speaking, safety always comes first with liposuction surgery.  The most important considerations are your own medical history and the planned removal of fatty tissue measured in liters.  If you are cleared medically, then the removal of less than 5 liters in a safe surgical setting are the most important issues.
Hope this helps.
Dr. Ali Mosharrafa

Paul B. Mills, MD · Answer

The literature strongly supports a limit to how much liposuction can safely be performed at the same time as an outpatient.  Most surgeons use the estimate of 5 liters of aspirate.  If you have a significant amount of fat (i.e. high BMI) that needs to be removed, then more than one session may be necessary in order to keep you safe through the whole process.  With respect to the 2 week separation, your surgeon is allowing enough time for your body to recover from the 1st surgery before proceeding with the 2nd surgery.  At the same time, I would think that your surgeon is performing the procedures that close together so that you achieve your end result as quickly as possible with as little downtime as possible.  Hope this helps!

Ven Erella, MD · Answer

Thank you for your question. Some times if it can not be done in one session because of limitation of tumescent or large patients I stage them. Without seeing pictures it is hard to comment

Mats Hagstrom, MD (license on probation) · Answer

The correct approach would be to lose weight before even considering liposuction.  Mini plastic surgeons would not offer this procedure because of your high BMI  Let me put this in perspective. The recommendations from the American Society of plastic surgeons is that no more than 5 L of total aspirate to be removed in a single setting.  This typically equates to about 4 L of fat. This is about 8 pounds.  someone who is 5'8" with a BMI of 36 would weigh approximately 235 pounds. Removing 8 pounds with a single session of liposuction would bring their weight down to 227 pounds. With a second round of liposuction removing another 5 L another 8 pounds of fat is removed.  The person has now gone from 235 pounds to approximately  219 pounds. The BMI has gone from 36 to 33.  Most people who weigh 235 pounds can shed 16 pounds in a month and a half without too much effort.  Obesity is complex but eating a normal healthy diet is a good start.  This is why liposuction is not recommended for people above a BMI of 30.  As people drift over 200 pounds the procedure becomes more and more pointless.  Just like people who are skinny don't see benefits from liposuction either.  It's a procedure for people who have moderate amounts of undesirable fat in undesirable areas.  This is simply not a great procedure for you.  I'm a big fan of high-volume liposuction. Some of my most satisfied patients have had well over 5 L of fat removed with two procedures.  I believe heavyset patients are better candidates for liposuction than what is taught and preached in the plastic surgery community, textbooks and residency programs.  My cut off hovers around 220 pounds. Of course height , BMI and fat distribution all contribute greatly to the candidacy of someone for liposuction. You could have this procedure done as a single operation and only remove 5 L which as you probably gather at this point would be a drop in the bucket.  Your surgeon is doing an appropriate and safe thing by splitting this into two procedures. If anything he or she should be question for doing liposuction on someone with a BMI of 36.  My best suggestion for you is to lose weight on your own.  The sad truth is that many people drift back to their pre-procedure weight losing some of the results from liposuction.  Liposuction when done correctly will leave a better affect distribution that's more desirable. Still, obesity is not treated with liposuction and should be dealt with before proceeding with cosmetic surgery. Check some of the before and after pictures of cases I've posted on real self under my profile.  They include several high volume, high BMI patients.  The cases go to show what's able to be accomplished and the inherent limitations.  To date I've performed over 7000 liposuction procedure is. I am one of very few board-certified plastic surgeon's this practice is devoted exclusively to this procedure.  Best, Mats Hagstrom MD

John E. Nees, MD - Account Suspended · Answer

Hi and welcome to our forum!Every State has laws regarding the absolute maximum amount of fat to be removed in one sitting. In Florida, for example, we can remove 4 liters of supernatant fat (approx 6-8 lbs.). If more fat removal is anticipated, the procedure can be broken up into segments, separating the procedures by a period of time necessary to recover and achieve fluid equilibrium. If laboratory results are satisfactory, a 2 week delay between procedures may be adequate. Please note that liposuction was not designed as a weight loss procedure. It is designed as a reshaping procedure. There are much more satisfactory ways to achieve significant weight loss, such as the gastric sleeve, a bariatric surgical procedure. With a sleeve, you can reduce your weight by 60-150 lbs with one procedure, while with liposuction, you can only remove 8 lbs,/ procedure. In our practice, we find that if your BMI is > 30 the result will be less than satisfactory, and if your BMI is >35, your complication rate will climb. Try to lose weight PRIOR to your procedure.Best wishes...

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