Dermatologists have been leaders in the field of cosmetic surgery. Some dermatologists complete fellowships in surgical dermatology. Many are trained in their residency on the use of botulinum toxin, fillers, and laser surgery. Some dermatologists perform cosmetic procedures including liposuction, blepharoplasty, and face lifts. Most dermatologists limit their cosmetic practice to minimally invasive procedures. Despite an absence of formal guidelines from the American Board of Dermatology, many cosmetic fellowships are offered in both surgery and laser medicine.

There are two different uses for liposuction: cosmetic liposuction to change the body's contour or shape and reconstructive, medically necessary liposuction. Reconstructive uses include treatment of lipedema., to remove excess fat in the chronic medical condition lymphedema. and to remove lipomas from areas of the body.

Cosmetic liposuction should not be used as a weight-loss plan but to aesthetically improve the appearance of body parts and contour. Benefits from cosmetic liposuction appears to be of a short term nature with little long term effect. After a few months fat typically returns and redistributes. Liposuction does not help obesity related metabolic disorders like insulin resistance.

There are many articles and references to liposuction as "cosmetic" and not reimbursed by medical insurance companies. Most of this information is outdated. If the documentation supports the liposuction for a medical reason (lipedema, lymphedema, lipomas) as reconstructive, and not investigational, experimental, or unproven, the claim is medically necessary and should be reimbursed. While most insurance companies may initially deny the claim, many can be won upon appeal if the documentation and patient's need supports the criteria for reconstructive surgery.

The techniques and terms listed below: tumescent, lymph-sparing, Tumescent Local Anesthesia (TLA), Water-Assisted Liposuction (WAL), Power-Assisted Liposuction (PAL), Laser-Assisted Liposuction (LAL) all apply to reconstructive, medically necessary liposuction.

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Kathy Andrews
Journal Manager
Journal of Clinical & Experimental Dermatology Research
Email: derma@peerreviewedjournals.com