What are the eligibility criteria for a patient to undergo abdominoplasty with liposuction, considering their medical history, age, weight, and comorbidities?

Assessment of Patient Eligibility for Abdominoplasty with Liposuction

Abdominoplasty with liposuction is primarily a cosmetic body-contouring procedure, not a treatment for obesity or medical comorbidities, and patient selection should focus on surgical safety, realistic expectations, and optimization of modifiable risk factors rather than specific BMI cutoffs. 1, 2

Key Distinction from Bariatric Surgery

Abdominoplasty with liposuction is fundamentally different from bariatric surgery—it is not indicated for weight loss or treatment of obesity-related comorbidities. 1 The procedure is recommended for localized fat deposits and excess skin, not for obesity management. 1

Essential Eligibility Criteria

Medical History Assessment

• Cardiovascular status: Severe cardiovascular disease is an absolute contraindication. 1 Patients with hypertension, dyslipidemia, or prediabetes require intensive management of these risk factors before surgery. 3
• Coagulation disorders: Severe coagulation disorders including thrombophilia are absolute contraindications. 1
• Pregnancy: Abdominoplasty is contraindicated during pregnancy. 1
• Diabetes control: If poorly controlled diabetes is present, delay surgery to improve glycemic control. 4
• Smoking status: If nicotine dependence exists, delay surgery for nicotine cessation. 4

Physical Examination Requirements

• General fitness assessment: Determine overall physical health and fitness for surgery. 1
• Site-specific evaluation: Examine the abdomen and areas requiring liposuction for potential anatomical problems. 1
• Intraabdominal fat assessment: Evaluate intraabdominal fat content, as this impacts surgical outcome and the decision to perform rectus sheath plication. 2

Required Preoperative Laboratory Studies

• Complete blood count including hemoglobin and platelet counts 1
• Bleeding and clotting time (or PT/aPTT) 1
• Blood chemistry profile 1
• Electrocardiogram 1
• Liver function tests as indicated 1
• Pregnancy test for women of childbearing age 1

Weight and BMI Considerations

There is no specific BMI threshold that automatically disqualifies patients from abdominoplasty with liposuction, but higher BMI increases surgical risk. 3, 4 The decision should be based on:

• Cardiovascular fitness and comorbidity burden: Age, male sex, cardiorespiratory fitness, electrolyte disorders, and congestive heart failure are independent risk factors for surgical mortality. 3
• BMI ≥50 kg/m²: Associated with higher surgical risk. 3
• Obesity-related comorbidities: Patients with multiple severe comorbidities require comprehensive evaluation and optimization before proceeding. 4

Age Considerations

Patients over age 65 have an exponential increase in surgical mortality risk. 3 More cautious patient selection and thorough preoperative evaluation are warranted in this age group.

Surgical Safety Parameters

Volume Limitations

• Maximum fat removal: Should not exceed 5000 mL in a single operative session. 1
• Large volume or mega-liposuctions: Not recommended. 1
• Lidocaine dosing: Recommended dose is 35-45 mg/kg, not to exceed 55 mg/kg body weight. 1
• Epinephrine dosing: Should not exceed 50 mcg/kg. 1

Facility Requirements

• Surgery should be performed in an outpatient day care surgical facility or hospital operating room equipped with monitoring and emergency handling capabilities. 1
• A physician trained in emergency medical care and acute cardiac emergencies must be available on premises. 1

Informed Consent Requirements

The patient must sign a detailed consent form that:

• Lists procedure details and possible complications 1
• Specifically states the limitations of the procedure 1
• Mentions whether additional procedures may be needed for proper results 1
• Provides adequate opportunity for the patient to seek information through brochures, computer presentations, and personal discussions 1

Common Pitfalls to Avoid

• Combining procedures inappropriately: Avoid combining liposuction with other procedures if the total required lidocaine dose would exceed maximum recommended dosage. 1
• Underestimating complication risk: The complication rate after abdominoplasty (50%) is substantially higher than after liposuction alone (4.2%). 5 Approximately half of abdominoplasty complications are minor scar deformities, but seromas occur in 5.4% of cases. 5
• Inadequate risk factor optimization: Patients with obesity-related comorbidities (hypertension, diabetes, sleep apnea) require intensive management regardless of whether they proceed with surgery. 3

Contraindications Summary

Absolute contraindications:

• Severe cardiovascular disease 1
• Severe coagulation disorders including thrombophilia 1
• Pregnancy 1

Relative contraindications requiring optimization:

• Poorly controlled diabetes 4
• Active smoking 4
• Uncontrolled hypertension 3
• Age >65 years (requires enhanced scrutiny) 3
• BMI ≥50 kg/m² (higher risk) 3