Liposuction and Patient Safety and Credentialing Providers
In a recent article submitted to the journal of plastic and reconstructive surgery, Liposuction and Patient Safety: Appropriately Credentialing Providers, Teven, et al. discussed the importance of knowing the credentials of your surgeon who is performing your liposuction and Brazilian buttlift or BBL surgery. The summary of the key points are provided below. These same recommendations have been provided before by plastic surgeons and the American Society of Plastic Surgeons. Dr. Kenneth Hughes has trained at only the most rigorous and well known plastic surgery programs and fellowship programs within the United States.
The American Society of Plastic Surgeons reports that more than 1.8 million cosmetic surgical procedures were performed in the United States in 2018, translating to an annual expenditure of more than $16 billion. As overall reimbursement across multiple medical disciplines declines, the financial remuneration of aesthetic surgery may be attractive to medical professionals. As such, a growing number of physicians without formal plastic surgery training are offering cosmetic procedures. However, recent publications examining performance of aesthetic surgery by nonplastic surgeons have found that a lack of plastic surgery training is associated with increased complications and potentially devastating outcomes.
Among cosmetic procedures in the United States, liposuction has become the second most popular procedure, totaling 258,558 procedures in 2018. Owing to the relative ease of liposuction compared with more complex aesthetic operations (e.g., rhytidectomy), liposuction has emerged as a frequently offered procedure by medical professionals outside of plastic surgery, including general surgeons, obstetricians, otolaryngologists, and dermatologists. Similar to cosmetic surgery, regenerative medicine is trending; often, nonplastic surgeon specialists perform liposuction to obtain stem cells, frequently without proper training or credentialing. However, to reduce the risk of major complications, physicians must understand the significant safety concerns associated with liposuction.
Potential Complications Associated with Liposuction
|Local||Swelling, bruising, seroma/hematoma, contour irregularity, asymmetry, hyperpigmentation/hypopigmentation, unfavorable scarring||Wound infection, skin necrosis, neurologic injury|
|Systemic||Limited blood loss, nausea/vomiting, dizziness/lightheadedness||Hemorrhage, deep venous thrombosis, pulmonary embolism, stroke, fat embolism syndrome, sepsis/septic shock, necrotizing fasciitis, hypothermia, visceral perforation, lidocaine toxicity, death|
|Other||Patient dissatisfaction (e.g., overcorrection/undercorrection)|
In 2013, the American Society of Plastic Surgeons have as a goal to raise awareness that not all physicians are appropriately trained to perform procedures they offer. Patients were advised on ways to validate that their physician was indeed qualified, for example, by ensuring applicable board certification. Despite such efforts, confusion among patients in identifying appropriate physicians has persisted. Using a 19-question survey disseminated to a representative sample of the U.S. population, Shah et al. found that 87 percent of patients believe or are unsure of whether surgeons must be appropriately credentialed to legally advertise services. In addition, 61 percent believe or are unsure of whether surgeons must be board certified in plastic surgery to perform appearance-improving surgery. Several factors may account for this confusion, including problematic advertising, numerous recognized and unrecognized boards, variable physician categorization, and overlap in scope of practice among different specialties.
Despite previous efforts to improve patient education, plastic surgeons must continue advocating for measures that optimize patient safety. This is particularly true for liposuction, given the increasing number of nonplastic surgeons offering it. To ensure proper patient care quality, we believe that physicians seeking hospital or surgical center privileges to perform liposuction must meet certain minimum criteria. While plastic surgery training is ideal, nonplastic surgeons with formal training in liposuction techniques recognized by a governing body (e.g., American Board of Medical Specialties) may be considered. In addition, physicians should have hospital admitting privileges, as patients may require admission both in straightforward cases and for complications. Likewise, surgeons unable to recognize or manage complications should not be credentialed. Finally, physicians must demonstrate the ability to appropriately counsel patients. This requires a comprehensive understanding of the objectives, indications, and inherent limitations of liposuction. While these recommendations are insufficient to guarantee the safety of all patients seeking liposuction, they are a necessary starting point to ensure that only providers with appropriate training and expertise are credentialed.
Measures to Ensure Proper Patient Care Quality and Safety in Liposuction and Brazilian Buttlift or BBL
|• Plastic surgery training or other formal training in liposuction methods that is recognized as sufficient by a governing medical body (e.g., American Board of Medical Specialties)|
|• Liposuction training as part of board-specific requirements and maintenance of certification activities|
|• Hospital admitting privileges|
|• Ability to recognize and manage potential complications|
|• Demonstrate understanding of objectives, indications, and limitations of liposuction and associated procedures (e.g., autologous fat transfer) in order to appropriately counsel patients and manage expectations|
Brazilian buttlift or BBL providers should also have plastic surgery training of three years or more from an accredited program within the US. Individual programs within the US are accredited as such and patients should realize this. Dr. Kenneth Hughes, attended an integrated fully accredited integrated plastic surgery program and then had additional fellowship training at Harvard Medical School.