Liposuction

Liposuction is an operation aimed at reducing the fat tissue under the skin; it does not take the place of losing weight or of treatment for obesity.¹ In assessing the extent of the procedure, not only the amount of fat but also the state of the skin, the limit on the volume that can be removed, the burden of recovery and the appearance that remains are addressed together. This article describes liposuction techniques carried out for aesthetic purposes, their care and their risks; treatments carried out for lipoedema or lymphoedema are not assessed within the same scope.²

What is liposuction?

Liposuction removes fat tissue from under the skin through cannulas inserted via small incisions in the skin.³ Unlike weight loss, which only shrinks fat cells, it removes part of this tissue from the body.⁴ It is not, however, a method that takes the place of diet, activity and weight control.¹

The fat under the skin and the fat inside the abdominal cavity, around the internal organs, are in different places. Liposuction does not remove the fat around the internal organs; for that reason not every fullness of the abdomen is expected to be resolved by this operation.⁴ Excess skin, laxity of the abdominal wall and the distribution of fat are also separate problems.

It is assessed not for losing weight but for contouring the body after a target weight has been reached. The target weight here does not mean the same number or a single clothing size for everyone. The change on the scales can remain small; that alone is not interpreted as the operation having failed.⁴ Increasing the number of litres removed, or taking the most tissue possible, is not an aim of success.

Who is it suitable for?

People with a particular expectation about the distribution of fat, whose general health is suitable for surgery and who accept the limits of their skin are assessed.⁵ Where a weight loss target has not yet been reached, that target and the timing of surgery are separated first. It should be known that the skin may not recover sufficiently after fat is removed.¹

The American Society of Plastic Surgeons (ASPS) emphasises that the decision should rest on the person's own wish, and should not be made in order to meet someone else's expectation or to conform to a particular ideal image.⁵ How far the appearance affects daily life, whether the expected change is realistic, and the limits of the operation are assessed at the examination.

Illnesses that could affect healing, anaemia, clotting problems and medication in use are part of the preoperative assessment.² Postponing surgery, or making a more limited plan, can also be the outcome of that assessment. Being able to take a break from work, to get help in the first days and to keep up with check-ups is a practical part of the decision.

What does the examination assess?

Which areas the fat tissue gathers in, skin elasticity, stretch marks, existing sagging and asymmetry at the outset are examined. Which area looks full because of fat and which because of skin or deeper structures is distinguished. Health, previous operations, allergies, medication and the person's aims are addressed together.⁶

Areas where liposuction has been carried out before, old scars, a hernia of the abdominal wall or tissue damage are declared; these can affect the plan and its safety.² Assessing the tissue by hand matters as much as the shape seen while standing. The volume to be removed or the technique to be used is not determined by looking at an appearance in a photograph.

All the areas on which a procedure is wanted in the same session are stated at the outset. The plan is built not only on the suitability of each area separately, but on the total extent and the state of health.⁷ It does not follow that an additional procedure is needed for every difference identified at examination; which features may remain is also explained.

How is the operation planned?

Which areas is it applied to?

It is applied to the neck, the abdomen, the waist, the hips, the arms and the legs. Because the relationship between skin, fat and the underlying structures differs in each area, the extent is determined by examination. Although more than one area can be addressed in the same session, it is not obligatory for all areas to be done together.¹⁷

Removing the fat under the skin of the neck is not the same as a lifting procedure directed at the neck skin or the platysma. Similarly, reducing fat in the arm or the leg does not mean that excess skin will be removed.¹ It should not be concluded from the name of the procedure that the whole area will change to the same degree.

Which technique is chosen?

Traditional, power-assisted, ultrasound-assisted, laser-assisted and water-assisted liposuction are used. These names describe different ways of separating and removing the fat.³

Traditional, suction-assisted liposuction: Fat tissue loosened by the movement of the cannula is removed by suction.³

Power-assisted liposuction: The mechanical vibrating movement of the cannula helps to loosen the fat.³

Ultrasound-assisted liposuction: Ultrasonic energy applied to the fat tissue accompanies the step of removing the fat.³

Laser-assisted liposuction: Laser energy is applied to the fat tissue and used together with the step of removing the fat.³

Water-assisted liposuction: A pressurised stream of fluid helps to loosen the fat tissue.³

Each technique has its uses and its limitations; no single technique is the most suitable for all people and all areas.⁸ Nor is the use of energy a guarantee of a better result, and heat injury associated with ultrasound is a separately reported risk.⁹ The choice of technique is made by the surgeon according to the person's tissues and the total plan; less swelling or a more lasting result is not assumed from the name of a technique.

What does the 5-litre threshold mean?

In the ASPS safety advisory, a total aspirate of 5 litres or more in a single procedure is defined as large-volume liposuction.⁷ The aspirate is the total of the fat and the fluid removed; 5 litres does not mean 5 litres of pure fat or 5 kilograms of weight loss.⁷ A procedure above 5 litres is assessed as large-volume liposuction; as the volume and the number of areas treated increase, the risk can increase.⁷

This threshold is not a licence. Remaining below it does not mean an absence of risk, and going above it does not mean the same outcome for everyone. The person's general condition, body structure, the total operation and the monitoring needed are what count.⁷ The joint BAAPS/BAPRAS safety document recommends considering dividing into separate sessions any plan expected to exceed 5 litres in an aesthetic procedure.² That assessment is made by examination and the surgeon's decision.

Do skin laxity and cellulite improve?

Liposuction is not a treatment for cellulite and does not remove stretch marks.¹⁰ The expectation that both of these problems will improve while fat is removed is addressed separately. Where the skin does not recover sufficiently, laxity can remain or sagging can become more prominent.¹

Adding energy-based methods to the operation can be assessed as a supporting option in a selected person. That decision is not the same as removing excess skin, and it is not claimed to produce the same degree of recovery in everyone. Where there is marked excess skin, a tummy tuck or another skin-removing operation directed at that area may be needed.¹¹ The aim and the limit of any additional method are explained separately at the examination.

Where are the incisions made?

Small skin incisions suited to the area are made so that the cannula can be advanced; over a wide area more than one entry point may be needed.¹⁰ Their number and position are determined by the structure of the area and the procedure to be carried out. A small incision does not mean that no scar will remain.¹⁰

The relationship of the incision sites to clothing, and any existing scars, are addressed in planning. That the cannula entry is small does not mean the area treated under the skin is also small; the care and movement plan does not consist of the visible incision alone.

How is it added to other operations?

It can be used as a supporting technique during a breast reduction.¹ This use does not take the place of the tissue removal and shaping plan of a breast reduction. Transferring the removed fat to another area is fat injection and carries a separate aim; not every liposuction procedure involves fat injection.

Where a combined plan is made with a tummy tuck or other operations, the total operating time and the burden of recovery are assessed separately.² Combining large-volume fat removal with other procedures in particular calls for additional care.² Carrying out more procedures in the same session does not automatically mean a more suitable plan.

How do you prepare for surgery?

Smoking and nicotine: Smoking is a risk factor for wound healing problems after surgery. Direct surgical data on nicotine products other than cigarettes are scarcer. The practice reference of the American Society of Plastic Surgeons notes a lack of clinical data on e-cigarette use and surgical risk, but states that because nicotine is known to reduce blood flow, e-cigarettes and other nicotine products are regarded as a potential risk factor.¹² Stopping smoking, vaping and other nicotine-containing products at least 1 month before the operation, and not using them after surgery until healing is complete, is therefore advised. The studies below concern smoking cessation; their results do not establish the same reduction in risk for every nicotine product. A review pooling 6 randomised and 15 observational studies showed that every week of abstinence added benefit, and that studies with at least 4 weeks of abstinence produced markedly better results than shorter ones.¹³ A study appraising systematic reviews together reported that cessation interventions beginning at least 4 weeks before surgery and combining multiple behavioural support sessions with pharmacotherapy reduced complications. The same study notes that interventions with only one component, even when started more than 4 weeks before surgery, raise quit rates without reducing complications.¹⁴ Shorter intervals are not useless either: in a meta-analysis of 55 studies covering adults undergoing a range of operations, the risk of pulmonary complications was 27 per cent lower in relative terms among those who stopped at least 2 weeks before surgery, and 29 per cent lower among those who stopped at least 4 weeks before, compared with those who continued smoking.¹⁵ The benefit therefore grows as the interval lengthens; being late does not make stopping pointless. The interval applied and the nicotine policy can vary from surgeon to surgeon.

Coexisting illness: Diabetes and blood pressure are expected to be under control before surgery. Where there is an active infection in the body, surgery is postponed.

Medication: Blood thinners and some herbal products can increase bleeding. Every medicine and supplement you take needs to be declared. Prescribed medication should not be stopped on your own decision.

Tests and anaesthetic assessment: The tests required are determined by general health and by the anaesthetic assessment.¹⁶ Any previous problem with anaesthesia or drug allergy should be declared. The instructions given about fasting and about how to take medication on the day of surgery are followed.

Home and transport: Someone is arranged to accompany you home on discharge.¹⁶ The timing of check-ups, the help you may need in the first days and the plan for time off work are organised beforehand. Follow the surgical team's guidance on preparing the operation area; do not shave or prepare the incision area at home on your own initiative.

Help is planned for putting on and taking off the compression garment, getting into bed, going to the toilet and the first walks. Where more than one area is treated, it is taken into account that the use of the arms, sitting and walking may all be affected at once. Any part of the instructions about dressings and the compression garment that is not understood is clarified before discharge.

What is recovery like?

The operation is carried out under general anaesthesia. 1-3 hours are planned for the operation and 1-2 nights for the hospital stay. The width of that range reflects how the number of areas treated and the extent of the procedure vary from person to person. The volume to be removed, the technique to be used and any additional operations are assessed together; two plans bearing the same technique name may not be of the same size.

The first check-up is within the first week. Stitch removal is planned within 1-2 weeks, after the incisions have been assessed. Checking the incision sites and the end of all swelling are not the same process.

7-10 days are expected for bruising to settle and 1-2 weeks for marked oedema to subside. The shape becomes assessable within 1-2 months; residual slight swelling can also last 1-2 months. That these intervals are the same does not mean that swelling and shape will reach their final state on the same day in every area. The 2-4 weeks given for a full return to daily life does not describe the maturing of the scar.

At check-ups, not only the time that has passed but the closure of the incisions, the direction in which swelling is decreasing, pain and the state of movement are examined. Where swelling is one-sided or steadily growing, the completion of the timetable is not waited for. Where recovery proceeds more slowly, the return to work and to activities is rearranged.

What to pay attention to after surgery

The following is a general framework. Where the instructions you were given differ, your surgeon's instructions apply.

Dressings: These are continued according to your surgeon's advice until the wound has healed. The manner of incision care is explained on discharge.¹⁷ A dressing is not replaced with a different product on your own initiative; where it becomes wet or loose, or there is discharge from an incision, the contact and check-up plan given is followed.

Compression garment: It is worn for 2-4 weeks, including at night. It is given to support the treated area and to help control swelling.¹⁷ The arrangements for putting it on, taking it off and cleaning it are determined by the surgical team's instructions. The garment is not tightened in the belief that firmer use will give a better result. Where the pressure leads to marked pain, a change in skin colour or difficulty breathing, assessment is requested. Finishing the period of compression garment use does not mean that all physical activities are permitted.

Sleeping: Rest with the head elevated. Your surgeon decides how long that position and the avoidance of physical strain are continued. A sleeping position that puts no pressure on the incision is preferred. Returning to sleeping on the side or front is assessed according to the state of the incision and the swelling.

Lying position according to the area treated: The same arrangement of support may not be used for the neck, abdomen, waist, hips, arms and legs. Beyond elevating the head, the way of lying shown by your surgeon, which does not compress the area treated, is followed.

Cold application: Cold is applied to the operated area without pressing on it. The form and duration of the application are determined by your surgeon's instructions.

Showering, wound and dressings: When you may shower depends on the dressing used. If there is a skin incision, once allowed you can shower without rubbing the wound and pat the area dry gently. Baths, swimming pools and the sea wait until the wound has closed completely.

Shower timetable: A return to showering is assessed within 5-7 days, according to the state of the wound and the dressing. Where there is more than one cannula entry point, the care instructions given for each incision are followed; crusts are not picked off. Permission to shower does not mean that use of the compression garment has ended; taking it off and putting it back on continues according to the plan given.

Lymphatic drainage: It is carried out to help control oedema, on your surgeon's advice, 1-2 weeks after surgery. The decision to begin is made according to the check-up findings; where there is increasing swelling or pain, the cause of these is assessed first. Lymphatic drainage does not mean massaging yourself firmly.

In a small study assessing 18 women, lymphatic drainage was applied together with therapeutic ultrasound and a reduction in pain, oedema and firmness was reported.¹⁸ The groups were divided according to whether liposuction or liposuction combined with a tummy tuck was carried out; both groups received the same combined care.¹⁸ This design does not isolate the effect of lymphatic drainage on its own, and is not evidence for the timing of starting used here. No promise is made about how much the oedema will decrease or that the result will necessarily be better.

Movement: Strain such as bending the head down, straining and heavy lifting is limited in the early period. Movements that stretch or rub the incision area are avoided. Even if you feel well, do not return to strenuous activity suddenly. Activity and rest through the day are organised according to the plan given on discharge.

Pain: There can be tenderness, tightness and pain in the treated areas.⁸ The painkillers given are used as instructed. Pain that markedly prevents walking or changing position is reported to the team; rather than abandoning the movement plan altogether, pain control and the need for help are assessed. No new painkiller or additional medicine is started on your own decision.

Returning to work and sport: 1-2 weeks are set aside for a return to work. In jobs involving heavy lifting or constant strain on the treated area, suitability is assessed separately. A return to sport is planned in stages within 2-4 weeks. 2-4 weeks are likewise expected for a full return to daily life. That the same interval is used does not mean that all work and all sports are permitted on the same day; the area treated and the nature of the movement are assessed.

Driving: A return can be assessed within 1-2 weeks. There must be no effect of medication reducing attention, no dizziness and no pain preventing movement. You need to be able to sit with a seat belt, to check your surroundings and to brake suddenly or manoeuvre comfortably. Where these conditions are not met, driving is not undertaken even if the timetable has run its course. Someone accompanies you home on discharge.

Sexual activity: A return can be assessed once everyday movements no longer cause marked pain and you feel comfortable. Pressure on the treated area, movements that stretch the incision line, and marked straining are avoided. Rather than a fixed day, the course of healing and the surgeon's advice are taken as the guide.

Smoking: Smoking impairs wound healing after surgery as well; cigarettes and nicotine products should be avoided until healing is complete.

Findings that are normal: Bruising, swelling, tenderness, temporary altered sensation and palpable irregularities can occur.⁸ What matters is that the findings are decreasing. It is not assumed that every area of firmness has to be broken down by massage; a newly growing or painful area is checked. Early waviness in appearance and a lasting contour problem are distinguished by the check-up findings.¹¹

How are early walking and prevention of clots planned?

Walking is begun 6-8 hours after leaving the operation, on the assessment of the healthcare team. This early walking is not the same thing as a return to sport. The need for rest does not mean remaining motionless in bed throughout the day; the movement plan given by your surgeon is a basic part of care. Help is taken at the outset; where there is dizziness or marked weakness, you do not push on and the team is informed.

The risk of clots is assessed routinely before surgery. A compression stocking is put on before the operation; after surgery it is removed by the surgeon's decision once you have begun to walk comfortably. A liposuction compression garment and a compression stocking are not used for the same purpose. The garment supports the treated area; the stocking is part of the plan for preventing clots, and they are not used in place of one another.¹⁷²

Where operations will be long, or where there are risk factors creating a predisposition to clots, prevention with medication is assessed. Which measures are applied together is determined according to the person's risk. Following the movement plan should not be neglected; equally, walking or any other measure should not be thought of as removing the possibility of a clot altogether.

How do the scars change?

Small skin scars remain at the cannula entry points.¹⁰ These scars are different from firmness felt under the skin or waviness at the surface. Although the incision is small, no promise is made that the scar will disappear entirely or be hidden under every garment.

6 months to 1 year is expected for the scar to mature. At check-ups the colour and thickness around the incision, and whether there is any indentation, are assessed. That stitches have been removed or that everyday activities have been resumed does not show that the scar process is complete. The result, and any further correction that may be needed, vary from person to person.¹¹

Scar care: Silicone gel or a silicone sheet is used after the wound has closed and your surgeon considers it suitable. No product is applied on your own initiative to an incision that is open, discharging or not yet healed. Which form of product is used, when and how, is determined by the check-up findings. Where irritation develops, an assessment by your doctor is sought regarding use of the product.

Silicone care for an incision scar and the lymphatic drainage planned for oedema in the treated area are separate applications. Using one does not mean it covers all the purposes of the other. Care is not presented as an assurance that a scar or a contour irregularity will be entirely resolved.¹¹

Risks and complications

Problems of shape and medical complications are assessed separately after liposuction.⁹ In a review covering 39 publications and 29,368 patients, the pooled rate of any complication was reported as 2.62 per cent, with a 95 per cent confidence interval of 1.78-3.84.¹⁹ That review assesses studies of liposuction carried out on its own, and the results of the studies differ markedly from one another.¹⁹

In the reporting database of ambulatory surgery facilities, 0.40 per cent was calculated from the 984 people with a detailed record of a complication among an estimated 246,119 procedures.²⁰ When the 577 reports that carried notes without any details are also included, the rate becomes 0.63 per cent.²⁰ This registry cannot separate people who had liposuction alone from those who had additional operations, and the total number of procedures is itself an estimate.²⁰

Because the patient groups, the follow-up and the way events were recorded differ, these rates are not two different answers to the same individual risk. Nor are the contour and mortality rates below added to them to calculate a total risk. Knowing the risks does not mean that they will develop in everyone.

Problems with shape, symmetry and firmness

Indentation, waviness, asymmetry, remaining skin laxity and palpable firmness can occur.⁹⁸ A further procedure may be needed for correction; it may not be possible to resolve every irregularity completely.¹¹

In the Comerci review covering 39 publications, the pooled rate for the outcome of contour deformity or need for further correction was reported as 2.35 per cent, with a 95 per cent confidence interval of 1.05-5.16 per cent.¹⁹ In Table 1, the extremes among the studies reporting this outcome are 0 events in 75 people and 63 events in 361 people; these are not the confidence interval of the pooled figure.¹⁹ The denominator of this outcome is not all the patients included in the review; because of differences in follow-up and reporting, the figure should not be read as an individual risk or as a probability within a particular month.¹⁹

Where new firmness develops, swelling, a collection of fluid and a change in the tissue are distinguished by examination. It is not decided that fat should be removed again or that massage is needed merely because an area feels firm. The timing of any further intervention is assessed together with the healing of the tissues and the nature of the problem.

Bleeding, seroma and wound problems

A haematoma is a collection of blood and a seroma a collection of tissue fluid. After liposuction, bleeding, a collection of fluid, infection and wound healing problems can develop.¹⁰⁹ Using a compression garment, or the incision being small, does not remove these possibilities.

Growing swelling, progressing pain, spreading redness or discharge calls for a check-up.¹⁰ A minor wound problem and an infection requiring treatment in hospital are not of the same severity; in some situations the fluid may need to be drained or a further surgical procedure may be needed.⁷ No incision is opened at home, no needle is applied to the area, and no attempt is made to press out fluid.

Fluid balance, body temperature and anaesthesia

The fluid given and the fluid removed during fat removal are assessed together; fluid overload can lead to a collection of fluid in the lungs.¹⁰ Bleeding and changes in the circulation are also part of this monitoring. The BAAPS/BAPRAS document lists calculating fluids, monitoring vital signs and maintaining body temperature among the safety measures.²

Hypothermia is a fall in body temperature. Because of the areas treated and the conditions of surgery, attention is paid to maintaining temperature.² The use of general anaesthesia does not mean that the total effect of the local anaesthetics delivered into the area of fat removal is unimportant; at inappropriate total doses, systemic toxicity can develop.² Amounts of medication and fluid are therefore monitored by the team; the amount to be given to a patient is not calculated from this article.

Clots and fat embolism

Blood clots: A clot forming in the leg veins and travelling to the lungs is serious. One-sided leg pain and swelling, sudden shortness of breath or chest pain need urgent assessment.

The approach to preventing clots is decided according to the person's risk and the operation planned. The measures to be used are explained in the discharge and care plan. No blood thinner is started without being prescribed, and existing treatment is not altered on the person's own decision.

A fat embolism is different from a blood clot formed in the leg travelling to the lung. Fat tissue entering the circulation can affect the lungs and other organs; it can present with disturbed breathing and altered consciousness.⁷ Care given to prevent one does not mean the other will never occur. Distinguishing between these conditions at home is not expected.

In a study examining QUAD A accredited ambulatory surgery centres in the United States between 2019 and 2021, 21 deaths were reported among an estimated 246,119 procedures involving liposuction, a rate of 0.009 per cent.²⁰ The registry could not separate isolated liposuction from cases with additional operations, and did not provide follow-up of the same length for everyone; this figure is not the current individual risk of death for liposuction alone.²⁰ Because a reporting system can miss late-developing outcomes, a low reported rate does not mean an absence of risk.²⁰

This registry is not a study of fat embolism counting only one cause of death. All 21 events are not interpreted as fat embolism. Urgent signs need early assessment; a possibility being rare is not a reason to delay seeking help.

Injury to deeper structures and additional procedures

Nerves, vessels, muscle or deeper organs along the path of the cannula can be injured.⁹ Injury to an intra-abdominal organ is a rare but serious complication; marked or progressing abdominal pain should not be waited out as ordinary tenderness.¹⁰ Lasting changes in sensation, changes in skin colour and heat injury are also assessed separately.⁹

Where fat injection, a tummy tuck or a breast reduction is added, the risks of that operation enter the plan as well.² Data on liposuction alone does not show the whole risk of a combined operation. The decision between a single session and dividing into stages is made according to the total extent and the state of health.

Does the removed fat come back?

That the removed fat cells have been taken out of the body does not mean the result will be unaffected by changes in weight. The fat cells remaining in the area can enlarge; weight gain can change the contour again.⁴ It should therefore not be concluded that "the fat has been removed, weight control is no longer needed".

In a randomised study of 32 women without obesity, 14 people underwent small-volume liposuction and 18 were followed as a control group.²¹ The abstract reports that the between-group difference in total body fat percentage seen at 6 weeks was no longer significant at 1 year.²¹ The course was not the same across areas. at the end of 1 year the reduction in the thigh region persisted while fat reaccumulated in the abdominal region. The authors summarise this as body fat being restored and redistributed from the thigh to the abdomen.²¹ This is the finding of a single study with 32 participants across the surgery and control groups; it does not mean that fat will return to the same place in every patient, or that the operation loses its effect entirely within 1 year.

Keeping weight stable matters in preserving the result; changes in the skin and tissues with ageing can still continue.¹¹ The cells that have been removed and the fat volume that can increase again over time should not be confused. No number of years of durability, and no timetable for a repeat operation, is given for everyone.

What can be expected from the result?

The change expected is directed at the assessed distribution of fat under the skin. It is not an aim for every body to look the same, to reach a particular clothing size, or for all areas to be perfectly symmetrical. The person's starting structure and the quality of their skin affect the limits of the result.⁸

The absence of a large reduction on the scales is not by itself a failure; the procedure does not take the place of losing weight.¹ The same result is not expected for cellulite, stretch marks, fat around the internal organs or marked excess skin.¹⁰⁴ Where an additional method is proposed, which separate problem it addresses is explained.

Returning to work, the end of compression garment use, a full return to daily life, assessing the shape and the maturing of the scar are separate processes. A final assessment is not made on the appearance during the early period of swelling. Further procedures may be needed for remaining problems; it is not guaranteed that the first operation will meet all expectations.¹¹

When should you contact a doctor?

Do not wait for the scheduled check-up in the following situations.

• Swelling in the treated area that increases rapidly or gathers markedly on one side
• Pain that increases rather than settling, or becomes marked despite the pain treatment given
• Fever, spreading redness or discharge from the incision line
• The wound opening or bleeding that does not stop
• Newly developing marked pallor, darkening or blistering of the skin
• Steadily increasing pain, pressure or numbness under the compression garment

These findings may call for assessment for bleeding, a collection of fluid, infection or tissue damage.⁹¹⁰ Rather than trying to work out the cause of a new swelling at home, inform the surgical team. Tightening the compression garment or increasing lymphatic drainage does not take the place of a check-up.

One-sided leg pain and swelling, sudden shortness of breath or chest pain are emergencies. Fainting, a new alteration in consciousness, swelling of the neck affecting breathing, or widespread abdominal pain that worsens after a procedure on the abdomen should also be assessed without delay.⁷⁹ Where there is a sudden breathing problem in particular, urgent assessment should not be delayed while trying to reach your doctor. That a preventive measure has been used does not reduce the importance of these signs.

About the numbers in this article

The periods for the operation, the hospital stay, stitches, the compression garment, showering, lymphatic drainage, walking and returning to activities, and the ranges for bruising, swelling, shape and the scar, are the framework of practice approved by the surgeon. Different recovery periods from institutional pages have not been carried over into this timetable. The conditions of suitability for activities appearing in the same interval in the fact box are assessed separately.

5 litres is a definition of volume relating to the total aspirate; it is not a figure in kilograms or a calculation of individual safety.⁷ The confidence interval of the contour meta-analysis and the raw event counts of the individual studies give different information.¹⁹ The mortality registry is a report from a particular period and setting; it is not a follow-up study limited to liposuction alone.²⁰ These figures are not added together to calculate a general complication percentage.

The common paragraph on smoking cessation reports research covering a range of operations. A relative reduction in risk is not an absolute complication rate specific to liposuction, nor does it mean that all nicotine products have been researched separately with the same effect.¹³¹⁴¹⁵

References

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2. British Association of Aesthetic Plastic Surgeons; British Association of Plastic, Reconstructive and Aesthetic Surgeons. Summary document on liposuction safety and recommendations. Joint BAAPS/BAPRAS expert liposuction group. Accessed 8 September 2026. Institutional document ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶ ↩⁷ ↩⁸ ↩⁹ ↩¹⁰ ↩¹¹

3. American Society of Plastic Surgeons. Liposuction Procedure Steps. Accessed 8 September 2026. Institutional text ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶ ↩⁷

4. Carman W. Expert article on the American Society of Plastic Surgeons website. Ten common misconceptions about liposuction. 30 January 2018. Accessed 8 September 2026. Institutional text ↩ ↩² ↩³ ↩⁴ ↩⁵

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8. British Association of Plastic, Reconstructive and Aesthetic Surgeons. Liposuction. Accessed 8 September 2026. Institutional text ↩ ↩² ↩³ ↩⁴ ↩⁵

9. American Society of Plastic Surgeons. Liposuction Risks and Safety. Accessed 8 September 2026. Institutional text ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶ ↩⁷ ↩⁸

10. National Health Service. Liposuction. Accessed 8 September 2026. Institutional text ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶ ↩⁷ ↩⁸ ↩⁹ ↩¹⁰

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12. American Society of Plastic Surgeons. Managing the risks of smoking in plastic surgery patients. Practice reference, 9 October 2024. Accessed 8 September 2026. plasticsurgery.org ↩

13. Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8. doi:10.1016/j.amjmed.2010.09.013 ↩ ↩²

14. Fiddes RA, McCaffrey N. Preoperative smoking-cessation interventions to prevent postoperative complications: a quality assessment and overview of systematic review evidence. Anesth Analg. 2025;140(6):1377-1387. doi:10.1213/ANE.0000000000007187 ↩ ↩²

15. Tang E, Rodriguez RM, Srivastava A, et al. Impact of short duration smoking cessation on post-operative complications: a systematic review and meta-analysis. J Clin Anesth. 2025;106:111967. doi:10.1016/j.jclinane.2025.111967 ↩ ↩²

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