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Evolution Of Clinical Practice Patterns In Liposuction: A Sixteen-year Review Of Continuous Certification Tracer Data From The American Board Of Plastic Surgery
Daniel C. Sasson, BA¹, Michael J. Stein, MD, FRCSC², John J. Harrast, PhD³, Amy Alderman, MD, MPH, FACS⁴, Alan Matarasso, MD, FACS², Arun K. Gosain, MD, FACS¹.
¹Division of Plastic Surgery, Ann and Robert H. Lurie Children's Hospital, Chicago, IL, USA, ²Department of Plastic and Reconstructive Surgery, Lenox Hill Hospital, New York, NY, USA, ³Data Harbor Solutions, Chicago, IL, USA, ⁴American Board of Plastic Surgery, Philadelphia, PA, USA.

Purpose
A sixteen-year review of liposuction tracer data collected from diplomates of the American Board of Plastic Surgery (ABPS) as part of the Continuous Certification process was performed to evaluate for predominant practice patterns and changes in specific practice patterns over this time.
Methods
Liposuction tracer data were collected from 2005-2021, comparing tracer data from 2005-2014 to those from 2015-2021 using Fisher's exact test and Student's t-test.
Results
2810 patients with an average age of 42 years were evaluated, of which 84% were female. In the later cohort (2015-2021), in-office procedures increased significantly (Table 1). Concerning the body area of liposuction, abdomen, flank, and back have increased, while thighs and knees have decreased. Power-assisted lipectomy has grown in popularity, and significant increases were noted in the volume of wetting solution and lipoaspirate. Surgeons are performing procedures concomitantly with liposuction more often, and more mid-surgical position changes from prone to supine were noted. Perioperative heparin and low-molecular-weight heparin (LMWH) use have significantly increased.

Table 1: Trends in liposuction practice patterns from the ABPS tracer data (n = 2810).

Procedure Characteristic	2005-2014 (n = 1150)	2015-2021 (n = 1660)	P-value	Procedure Characteristic	2005-2014 (n = 1150)	2015-2021 (n = 1660)	P-value
1. In-office procedures	36%	41%	< 0.01	10. Lipoaspirate volume	2076cc	2363cc	< 0.0001
2. Location: Abdomen	64%	69%	< 0.01	11. Concomitant procedures	28%	36%	< 0.0001
3. Location: Flank	60%	64%	< 0.05	12. Mid-surgical position change from prone to supine	30%	37%	< 0.0001
4. Location: Back	22%	34%	< 0.0001	13. Perioperative heparin/LMWH	2%	7%	< 0.0001
5. Location: Thighs	36%	23%	< 0.0001
6. Location: Knees	8%	5%	< 0.01
7. Technique: Power-assisted lipectomy	24%	40%	< 0.0001
8. Technique: Traditional lipectomy	50%	40%	< 0.0001
9. Wetting solution volume	2425cc	2808cc	< 0.0001

Conclusions
The present study is the first to objectively assess evolving trends in the clinical practice of liposuction over the last sixteen years. These data illustrate an increase in outpatient procedures, a shift in technique towards power-assisted liposuction, and greater surgical focus on the trunk (abdomen, flanks, and back).

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