How Can There Be One Number (5 Liters) Used As the 'Safe' Limit of Adipose Tissue to Remove Across the Board?

Since people are so incredibly varied by height, size and fitness levels, how can one number represent the 'safe' amount to remove in liposuction? In so many answers on this board, I see that surgeons refer to this as the industry standard. Surgery is not 'one size fits all'. For a small, fit person, removing 5 liters (or even much less) adipose tissue would be deadly. Shouldn't the industry standards be clearly adjusted for the health and safety of all individuals, petite or otherwise?

Doctor Answers 8

Standards for Liposuction

Good question.  Five liters is really just a guideline.  You are correct that five liters removed from a 100 pound person is really not equivalent to five liters removed from a someone who weighs 50% more.  There are other factors as well including the components of the tumescent solution that is infused and the aspirate that is removed.  Sometimes the aspirate (the fluid that is suctioned) has a high percentage of fat and other times it doesn't. Other procedures performed at the same time also need to be factored in to the decision regarding how much liposuction aspirate is safe to remove. 

Dallas Plastic Surgeon
5.0 out of 5 stars 99 reviews

How Can There Be One Number (5 Liters) Used As the 'Safe' Limit of Adipose Tissue to Remove Across the Board?

You are right, the 5 liter number is basically arbitrary.  How much adipose tissue can safely be aspirated during liposuction is primarily at the discretion of the surgeon.  A qualified and experienced plastic surgeon can make that judgement based on the patient's ht and wt as well as BMI, general health, risk factors, etc.  One basic rule of thumb, though, is that someone who can spare more than 5 liters of adipose tissue probably has a weight problem and needs to primarily lose weight because many studies as well as experience have shown that liposuction does not work in excessively obese individuals and it either will not result in a significant improvement or if it does the fat is bound to return in no time.  The closer an individual is to their ideal weight the more effective the procedure will be.

Ruben B. Abrams, MD, FACS
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 19 reviews

Liposuction safety guidelines

As much as possible your surgery should be tailored to your specific needs, and a single number (in this case 5 liters of liposuction) doesn't necessarily apply to everyone. However, a patient's safety is the most important part of any procedure. The research that is available demonstrated increases in serious and potentially life-threatening complications when volumes of liposuction greater than 5 liters were performed. Therefore the recommendation was made to have patients who have undergone more than 5 liters of liposuction should remain in a monitored setting, typically a hospital, to watch for these potential complications. Many plastic surgeons want to avoid the increased risk to the patient's health and attempt to keep the single operation volumes of lipoaspirate under 5 liters. 

Shannon O'Brien, MD
Portland Plastic Surgeon
5.0 out of 5 stars 4 reviews

Liposuction safe limit

Thank you for your question about the safe limit for liposuction.

  • The liposuction outpatient limit of 5 liters comes from a study showing that serious complications from fat and blood clots and fluid imbalance rise above 5 L. 
  • Most surgery centers ban liposuction above 5 L for this reason.
  • Studies are based on groups - surgery is based on individuals.
  • The surgeon's judges what is safe for you - your health may require hospital surgery even if less than 5 L is removed. Hence it is wiser to have a Board Certified Plastic Surgeon treat you - we understand the complexity of surgery. Hope this helps.

Elizabeth Morgan, MD, PhD
Atlanta Plastic Surgeon
4.6 out of 5 stars 43 reviews

Liposuction safety


You are absolutely correct.  Surgery is NOT "one size fits all" and the amount of lipoaspirate that can safely be removed from any one patient can be tailored.  However, our industry, just like any other, has to define some guidelines that are applicable to the majority of situations in order to insure the safety of our interventions.  For liposuction the guideline is 5000cc of aspirate for the average patient in an outpatient setting.  Deviation in either direction can depend on the patient's medical status, body habitus, quality of lipoaspirate and other factors, and is acceptable dependent on those factors. 

Kenneth R. Francis, MD, FACS
Manhattan Plastic Surgeon
4.6 out of 5 stars 47 reviews

Why 5 Liters is the Safe Limit of Liposuction

Five liters is the upper limit of fat that should be removed as an outpatient. The general lower end to consider keeping someone overnight is somewhere around 3 liters. Both are just guidelines. Think of these as a percentage of body size, not mass. Although liposuction seems like minimal surgery because there are only a few small incisions, the fact is that there is a lot of injury to the tissues below the surface. This injury is like a burn. The body responds to it by pouring fluid and other substances into the area. We estimate how much fluid to give a burn by calculating the percentage of body surface area burned. With liposuction, we cannot use the area under which we liposuctioned because liposuction is done in three dimensions. Therefore, the most convenient way to determine how much damage is done to the underlying tissues is to measure what is removed. This comes close to predicting the fluid shifts and whether we can handle this replacement by what we give you at the time of surgery and orally at home, or whether we need to keep you and give you more fluids overnight. This estimate works on almost everyone. Remember that blood volume is about the same in everyone and the fluid put into the liposuctioned are comes from the blood volume. We don't, however, use the number as a one size fits all. We will remove close to 5 liters as an outpatient only if you are very healthy. If you have moderate medical problems, we will remove no more than 3 liters as an outpatient. If you have significant renal or cardiac problems, much less liposuction will prompt an overnight stay. With hospitalization and careful monitoring, some centers have routinely removed up to 10 liters.

Robert T. Buchanan, MD
Highlands Plastic Surgeon
5.0 out of 5 stars 6 reviews

5 liter liposuction limits

There is no specific defined liposuction limit and some surgeons will still do high volume lipos( >5 liters). However, several studies suggest that liposcution of >5 liters may increase the risk of complications.  In an out patient setting which is where most liposuction is performed the numerous plastic surgery societies and some states have recommended/limited these  large volume cases in office based facilities.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

How Can There Be One Number (5 Liters) Used As the 'Safe' Limit of Adipose Tissue to Remove Across the Board?

     This issue is not nearly as simple as it would seem.  The amount of fluid used along with the concentration of lidocaine can be an issue with regard to massive fluid shifts, pulmonary edema, and lidocaine toxicity.  In addition, the amount of fat removed is highly variable in the lipoaspirate.  For instance, one surgeon may remove 1.5 liters of fat and another may remove 3 liters of fat.  The amount of fluid infused can be highly variable surgeon to surgeon as well.  Blood loss is largely inconsequential as is the amount of fat removed with regard to causes to death.    Find a plastic surgeon with ELITE credentials who performs hundreds of liposuction procedures each year.  Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results.  Kenneth Hughes, MD Los Angeles, CA

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 492 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.