What You Should Know About the
Safety of Outpatient Plastic Surgery
When considering plastic surgery, itís natural to focus more on the expected
result than on the surgical process. However, to be fully informed, itís
important to learn about the safety of the procedure as well as the expected
outcome. Although thousands of people have plastic surgery every year without
complications, no surgical procedure is risk-free. To maximize safety, ensure
The American Society of Plastic Surgeons (ASPS), an
organization of board-certified plastic surgeons who are dedicated to the
highest standards of patient care, has prepared this document to help you get
the safety information you need. It contains recommendations developed by the
societyís expert task forces, whose members have consulted the most recent
research available. If you have questions about these guidelines or any
specific concerns not covered in this document, talk with your
board-certified plastic surgeon. Only ASPS members are entitled to display
the logo above.
your surgeon is adequately trained and is board certified by the American
Board of Plastic Surgery
the facility where your surgery will be performed conforms to strict safety
your surgeon is informed of any drugs you are taking and your full medical
history, especially if you have had any circulation disorders, heart or lung
ailments or problems with blood clots
the surgical facility will use skilled, licensed personnel to administer and
monitor your anesthesia and your recovery immediately following the procedure
extra safety measures are taken if you are having a more extensive
How can I be sure that my surgeon has adequate training?
Good credentials canít guarantee a successful outcome; however, they can
significantly increase the likelihood of it. Patients are advised to find a
doctor who is certified by the American Board of Plastic Surgery (ABPS), the
only board recognized by the American Board of Medical Specialties to certify
a surgeon in plastic surgery of the face and of the entire body.
Certification by the ABPS is "the gold standard" for plastic surgeons because
it signifies that the surgeon has had formal training in an accredited
plastic surgery residency program. If your surgeon is ABPS-certified, you can
be assured that your doctor:
has completed at least five years of surgical residency training after
medical school, including at least two years in plastic surgery
has passed comprehensive cosmetic and reconstructive surgery exams
is qualified to perform cosmetic and reconstructive procedures Ė everything
from liposuction and facelifts to intricate wound repair
How can I determine if my plastic surgeonís surgical facility meets
acceptable safety standards?
The American Society of Plastic Surgeons and the American Society for
Aesthetic Plastic Surgery have issued a statement to their members that by
July 1, 2002 all plastic surgery performed under anesthesia, other than minor
local anesthesia and/or minimal oral tranquilization, must be performed in a
surgical facility that meets at least one of the following criteria:
Accredited by a national or state recognized accrediting agency/organization
such as the American Association for Accreditation of Ambulatory Surgery
Facilities (AAAASF), Accreditation Association for Ambulatory Health Care
(AAAHC), or Joint Commission on Accreditation of Healthcare Organizations
Certified to participate in the Medicare program under Title XVIII
Licensed by the state in which the facility is located
Patients should ensure
that the facility is accredited or is in the process of being accredited.
Plastic surgery procedures performed in accredited surgical facilities by
board-certified plastic surgeons have an excellent safety record. A 1997
survey 1 based on more than 400,000 operations performed in accredited
facilities found that:
The rate of serious complications was less than half of 1 percent.
The mortality rate was extremely low Ė only one in 57,000 cases.
The overall risk of serious complications in an accredited office surgical
facility is comparable with the risk in a freestanding surgical center or
hospital ambulatory surgical facility.
Why is it so important for my plastic surgeon to know detailed information
about my personal and family health history, even if I am only having a
simple cosmetic procedure?
There is always risk with any surgical procedure. However, as a patient, you
can play an important role in reducing your risk by providing a full and
complete health history to your surgeon.
Although rare, one of the most serious complications associated with surgery
is the development of blood clots in the large veins of the abdomen and legs.
This complication can lead to a potentially fatal pulmonary embolism (blocked
lung artery). Therefore, it is extremely important to tell your plastic
surgeon if you or any of your family members have a history of blood clots or
if you have had a family member who died suddenly, shortly after surgery or
You will also be evaluated for other factors that may increase the risk of
blood clots. These include:
being extremely overweight
having recent traumatic injury
any disorder of the heart, lungs or central nervous system
a history of cancer, recurrent severe infection or genetic problems that
affect blood clotting
For women, additional risk factors include:
taking oral contraceptives or having recently ceased taking them
undergoing hormone-replacement therapy
Safety measures to prevent blood clots
will be determined by your individual degree of risk. If you are considered
low risk, your doctor may simply ensure that you are positioned on the
operating table in a way that allows for adequate blood circulation to the
legs. If you are of moderate or high risk for developing blood clots, you may
also be advised to wear elastic stockings before, during and after your
procedure, or to take special anti-clotting medications. Compression devices
on the legs may be used during surgery to support your normal circulation.
How can I be sure that the anesthesia care I receive in my plastic surgeonís
surgical facility is adequate?
Anesthesia care in an accredited or licensed facility has reached a level of
sophistication that is absolutely comparable to the care received in the
hospital. For maximum safety, ASPS recommends that:
Any planned anesthesia should be administered by skilled, licensed personnel
acting under the direction of an anesthesiologist or the operating surgeon.
Before any type of anesthesia is used, the surgeon or anesthetist must take a
full medical history. A physical examination and appropriate lab tests may
also be performed. Your surgeon needs to know if you have any serious medical
problems or have had previous adverse reaction to any other type of
anesthesia. Also, you must let the anesthetist know about any medications you
are taking (including herbal supplements), any known drug allergies, when you
last ate and whether you smoke cigarettes or use alcohol or illegal drugs.
You should be assured that you will receive individual monitoring by skilled,
licensed personnel before, during and after the procedure. Staff who are
familiar with the warning signs of cardiac or respiratory distress and are
trained in advanced cardiac life support (ACLS), should be on hand to monitor
your procedure and recovery following your surgery.
If you are told that you will be kept overnight at the surgical facility
while you recuperate, make sure that the facility is accredited by a
recognized agency. In an accredited facility you will receive
around-the-clock care and monitoring by two or more skilled and licensed
staff members with at least one trained in ACLS. You will also be assured
that the facility has the necessary equipment and medications to handle
complications that may arise and an emergency plan in case you need to be
transferred to the hospital.
To achieve the cosmetic results I want, my
plastic surgeon has recommended "large-volume" liposuction. What types of
safety measures should I expect my surgeon to take?
Due to recent advances in technique and technology, serious medical
complications in liposuction are quite rare. However, the risk of
complications increases with the number of areas treated and the amount of
fat removed. A liposuction procedure is classified as "large volume" when 11
pounds (5,000 cc) or more of fat and fluid are removed.
Factors that may increase the risk of complication are:
excessive amounts of local anesthesia or excessive amounts of fluid
administered intravenously or within the tissues at the surgical site
- unrelated procedures performed during the same surgery
being in poor health prior to surgery
having a personal or family history of blood clots of the legs or a blocked
having a personal or family history of breathing or bronchial disorders or
other lung problems
- for women:
current use of oral contraceptives
For maximum safety, a patient
planning to have either large-volume liposuction or ultrasound-assisted
liposuction (known as UAL) should be aware of the following:
Large-volume liposuction requires specialized knowledge. Therefore, itís
important for your surgeon to have additional training specifically in UAL or
Your surgeon should keep track of the amount of fluid that is infused into
your body and the amount that is withdrawn from your body. The surgeon should
also have systems to record intravenous fluid, the amount of fat removed and
Extended post-operative monitoring of vital signs and urinary output is
critical following large-volume liposuction. An overnight stay in a hospital
or other overnight-stay-accredited facility may be required. ASPS believes
that in the hands of an appropriately trained specialist, liposuction is a
generally safe procedure. Still, ASPS is collecting additional data on the
safety and effectiveness of liposuction. The Liposuction Outcomes Study
will yield valuable data in the near future.
Safety is a team effort
Quality patient care, safety and successful surgical outcomes are the result
of the patient, the surgeon and the surgical staff working together. The ASPS
has supported this concept by establishing task forces on liposuction, deep
vein thrombosis prophylaxis and outpatient surgical safety. These
professional groups have thoroughly investigated the surgical techniques,
equipment and medications commonly used in outpatient plastic surgery and
have set safety guidelines for use by all plastic surgeons, their staffs and
their facilities. The task forces have also supplied the patient-safety
information for this document.
As the ASPS continues to support the safety research being conducted by its
Educational Foundation and the National Endowment for Plastic Surgery,
patients are encouraged to learn everything they can about the procedures
they are considering and to ask a lot of questions. Your concerns about
safety should be discussed in detail with your plastic surgeon. This will
help promote a safe outpatient surgery experience as well as fulfilling your
1. Morello, D.C., Colon, G.A., Fredericks, S., Iverson, R., Singer, R.
Patient safety in accredited office surgical facilities. Plast. Reconstr.
Surg. 99: 1496, 1997.
Statement approved by the ASPS Board of Directors, June 24, 2000
The American Society of Plastic Surgeons (ASPS), founded in 1931, represents
physicians certified by the American Board of Plastic Surgery (ABPS) or the
Royal College of Physicians and Surgeons of Canada.