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Safety Studies in the Field of Liposuction

A Systematic Review

Halk, Anne B., MD*,†; Habbema, Louis, MD; Genders, Roel E., MD*,‡; Hanke, C. William, MD, MPH, FACP§

doi: 10.1097/DSS.0000000000001707
Review Article

BACKGROUND There is an increasing demand for safety standards for cosmetic treatments. With regard to liposuction, interdisciplinary consensus is lacking, especially regarding treatment setting and physician specialty.

OBJECTIVE A solid, independent interpretation of scientific data on safety requires a systematic approach, which is the aim of this study.

METHODS A systematic literature search was conducted for safety studies about liposuction through April 2017. Fatalities and/or reported serious adverse events served as outcome measures for safety.

RESULTS Twenty-four studies were included. Factors that contributed to increased serious complication and mortality risk were: use of the (super)wet technique; use of systemic anesthetics, especially general anesthesia and intravenous sedation; execution by a plastic surgeon; execution in an operating room; and combination with other procedures.

CONCLUSION Liposuction using tumescent local anesthesia has been shown to be the safest method of fat removal, especially if no or only minimal systemic anesthesia is used. Performance of this technique in an office-based setting has been proven to be safe beyond doubt. When systemic anesthesia is used, an outpatient or ambulatory surgery facility seems also safe. Regardless of the physician specialty, knowledge and training on the execution of the tumescent procedure are vital to ensure optimal safety.

*Department of Dermatology, Leiden University Medical Center (LUMC), Leiden University, the Netherlands;

Medisch Centrum 't Gooi, Bussum, the Netherlands;

Roosevelt Kliniek, Leiden, the Netherlands;

§Laser and Skin Surgery Center of Indiana, Indianapolis, Indiana

Address correspondence and reprint requests to: Anne B. Halk, MD, Department of Dermatology, Leids Universitair Medisch Centrum (LUMC), Leiden University, Albinusdreef 2, 2333 ZA Leiden, the Netherlands, or e-mail:

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

The authors have indicated no significant interest with commercial supporters.

© 2019 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.
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