How much can be removed safely in hospital?

Question

For lipedema liposuction in a patient with a normal BMI (under 21), what percentage of fat/fluids/blood can be removed safely ? Is it unlimited if in a hospital setting even if the patients BMI is normal since they have thicker legs from lipedema? Or even if it’s in a hospital, is it dangerous at a certain percentage of fat removed? For example, 6+ liters on someone 190 pounds vs 6 liters on 110 pounds. Does it matter if it’s lipedema liposuction? Can a smaller weight get high volume?

Thomas Wright, MD · Answer

ALY2020,  Yes you are right the safe amount no matter the setting depends then size of person. The best way to answer your question is to think of the safety of liposuction surgery is to remember it is a trauma to the subcutaneous fat.   The percent of area of person body undergoing liposuction varies by the size of the person.  A small person like you BMI 21, maybe 110 lbs will be at higher risk for complications if a surgeon tried to remove 6 liters. Where someone who is 190 lbs may be at lower risk for complication if 6 Liters are removed.  It does not matter where the surgery was performed out patient or in a hospital, its the amount of aspirate vs the body size.  Chow et al published a nice study that looked at this in 2015 . It was published in Plastic Reconstructive Surgery.

Mats Hagstrom, MD (license on probation) · Answer

Rules or guidelines for how much fat can be removed is usually based on total volume aspirate.
It should be milliliters per kilogram, but it is not.
Each state has their own regulations.
The national guideline is a maximum of 5 L if it is an outpatient procedure, even if it’s done in a hospital.
To remove more than 5 L guidelines state that the patient needs to be observed.
If there are no legal restrictions, then it’s up to Dr. discretion.
To be able to remove more than 5 L of fat patients typically have to be at least 160 pounds.
Even at that weight 5 L typically means liposuction of the entire bodyFor patients to need more than 5 L of fat removed the typically need to be over 170 pounds.
I suggest having a few in person consultations with plastic surgeons in your community.
Best,
Mats Hagstrom MD

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