Liposuction in a doctor's office?

Liposuction, as you may have heard in the popular media, is the most commonly performed surgical procedure each year in the United States. Here's a statistic that you may not have heard: the majority of physicians performing liposuction in the United States are not plastic surgeons; in fact, many do not have any formal surgical training whatsoever. It seems hard to believe, but many physicians performing liposuction have had no more training in liposuction than a 'weekend course'. One way to determine whether or not a physician has had appropriate training in a particular surgery is to confirm that they have hospital privileges for that procedure.

I fear that some practitioners view liposuction as a 'simple' surgery, since it does not involve making large incisions, and it requires little, if any, suturing. Nothing could be further from the truth. Liposuction, in my mind, is a very challenging operation that requires careful planning and preparation, and a great deal of care and finesse when it is actually performed. It requires a three-dimensional understanding of the layers of human anatomy, an understanding that is second nature to a surgeon alone. I think that it is often an inadequate understanding of anatomy (and, perhaps, of the body's response to surgery) which leads to the poor results in liposuction and body contouring that unfortunately are so often seen.

It is important that your physician has hospital priveleges for the procedure you are interested in having performed.  A hospital has access to information and records that the general public does not. Hospitals also have tremendous exposure to liability for cosmetic surgery procedures performed within them. They therefore will only grant surgical privileges to physicians that can demonstrate appropriate training and experience.

Although many aesthetic cosmetic surgery procedures are not performed in hospital operating rooms, the fact that a hospital has granted a surgeon privileges for a given procedure ensures that the surgeon has met an accepted standard of competence. It also means that your surgeon will be able to take care of you at a hospital should any complications from cosmetic surgery arise.

If you are planning to have cosmetic surgery performed, you should do your due diligence to determine if your surgeon has the appropriate credentials. This issue can be settled by the following simple question: Does my surgeon have hospital privileges to perform my cosmetic surgery?

Liposuction should be performed in an accredited surgical facility, not an office.  Many patients refer to an accredited surgical facility next to a doctor's office as the doctor's office, but there is a difference.

Accreditation of the surgical center means the surgery center is safe to perform surgery.  All the necessary emergency equipment is there.  All the emergency medications are there.  Monitoring of the heart and vital signs is there.  The surgery center has cleanliness standards and sterility standards.  There are filters in the ceiling to filter the air.  Every surgery requires an RN, a surgical technician.  Safety procedures are followed.  All these things cost money.  That is why surgery is more expensive in an accredited surgery center than a doctor's office.  If God forbid you have an allergic reaction, develop malignant hyperthermia, have a complication, you do not want to have any of these items missing.

Liposuction is a surgical procedure.  You may want to inquire if your surgeon is credentialed in a hospital to perform the surgery.  The hospital takes screening of physicians seriously and checks backgrounds, credentials, etc. before they issue operating room privileges. 

Is the surgeon performing the anesthesia himself or is there an anesthesiologist present?  The anesthesiologist's only job is your safety and your comfort.  He is equipped if an airway problem or allergic reaction results, or a complication results.

This is why board certification, accredited facilities, and proper anesthesia support are so important to patient safety. 

The safety of tumescent liposuction in an office setting is well established since its inception two decades ago. Risks exist in the hospital and ambulatory surgical setting as well as the office and thorough discussion of the procedure and its risks must be held with you and your surgeon.

There are two major important factors to consider when choosing to have Liposuction or any other surgical procedure.

First, what are the qualifications of your surgeon? Board Certification by the American Board of Plastic Surgery (ABPS) is the gold-standard for credentialing to perform cosmetic surgery of all types. When in doubt about the qualifications of your surgeon, you should ask whether he or she has privileges in your local hospital to perform a given procedure.

Contrary to the claims of equivalent training by the Dermatologists and Facial Plastic Surgeons, you will find that they DO NOT have privileges to perform these procedures in a hospital setting, and therefore can ONLY perform them in an outpatient surgical center.

Second, what is the environment in which your procedure will be performed? Plastic Surgeons certified by ABPS and members of the American Society of Plastic Surgeons are obligated to perform surgery ONLY in a hospital or outpatient surgery center accredited by JCAHO, Medicare, AAAHC, AAAASF, or a state licensing authority.

You should ask to see the certificate under which the facility operates, to ensure that it is current. This implies that the facility meets accepted patient safety standards and is properly equipped to deal with emergencies.

A nice bedside manner is a bonus, but do your homework: check the credentials first.

Seee Dr. Singer's answer for a lot of great information.

Check the facility credentials and make sure the anesthesiologist is board certified.

If you are going to have less than 5000 milliliters removed with liposuction, by all means do it in the office. Anything more than this is considered HIGH volume liposuction, and in my opinion should be done in the hospital.

I do not need to repeat the excellent answers from the previous surgeons. Make sure you fully evaluate both the doctors credentials and that of his facility. Also ask to speak with former patients who have had surgery in his office. Meeting with the nurse manager or OR director during your tour is very helpful. You will either feel comfortable or not after you ask the right questions and get the answers from the staff.

I agree with the comments by the previous doctors. I personally remove only 3 liters in the office at one time if I am combining it with other surgeries on the same patient. Other surgeons may remove up to 5 liters at one time which is probably fine but not more.

As described by the answers already given, safe outpatient surgical procedures are regularly performed in a physician's office as long as the office and its surgical suite have been properly accredited. Dr. Singer (answer below) has been one of the major proponents of office accreditation and has been largely responsible for the improved safety of outpatient surgery done in these appropriate settings.

So check this carefully just as you have carefully checked the credentials and skills of your doctor. It is rare these days to have liposuction done in a hospital setting.