Patient Profile
The patient must have realistic expectations. The patient should be in good physical health. A healthy well-balanced diet is important in maintaining the postoperative results as well as in ensuring excellent healing during the convalescence. Crash diets immediately prior to the consultation to be considered a candidate for surgery may increase the risk of complications as a consequence of electrolyte imbalances or nutritional deficiencies. The physician should be confident that patients' motives are well founded and that the discontent with their physique is not a displaced unhappiness with a distinctly separate situation in their life, such as marital or employment difficulties.
Patient Safety
Some patients have tried to diet many times in their life but tend to regain the weight. Not uncommonly, patients who undergo liposuction notice that their appetite decreases for several months postoperatively. The decreased appetite can provide the impetus for the patient to protect his or her investment by not overindulging in the future. Furthermore, some patients who are fixated on losing that little bulge may adversely affect the quality of their life by excessively exercising at the expense of time that could be spent with their family, with their friends, or at work. Because that bulge may be refractory to exercise-induced volume reduction, they may increase their efforts unsuccessfully and further detract from other elements of their life. Liposuction could provide them an instantaneous relief. Another recently described benefit of liposuction in women is possible breast enlargement in patients undergoing liposuction in other body areas.

Consultation Required
The ideal candidate is physically fit and eats well balanced meals but is unable to reduce a fatty deposit that is well localized and often seems to involve a genetic susceptibility. Liposuction is generally performed for the reduction of focal adipose accumulations unresponsive to diet and exercise. Common anatomic areas for liposuction include the upper and lower abdomen, the flanks (love handles), outer and inner thighs, inner knees, arms and back, the neck, ankles, and calves. Although controversial, liposuction alone has recently been used for breast reduction as an alternative to traditional breast reduction surgery, which can leave inverted-T scars.

Other situations exist that may benefit from tumescent liposuction. These include lipoma removal, Madelung disease, axillary hyperhidrosis, axillary bromhidrosis, evacuation of hematomas, pseudogynecomastia, and the controversial staged liposuction for persons who are morbidly obese. Megaliposuction for persons who are morbidly obese performed in one session is extremely controversial because of the higher risk of mortality from fluid shifts. The Medscape CME course Management of Gynaecomastia: And Update may be of interest.

The patient should be seen in consultation where the history is explored in detail. Medication intake; medication allergies; prior surgeries and results, including scarring; history of medical diseases, especially bleeding diatheses; personal and family history of cerebral vascular events; phlebitis; seizures; myocardial infarctions or angina; congestive heart failure; and hepatic disease all should be discussed. The patient's goal should be understood. Explanation of the procedure, its risks, alternatives, benefits, and convalescence should be explained, and questions should be answered. The insertion marks should be planned, if at all possible, to be placed in hidden areas while the patient is wearing the typical item of clothing (eg, swimwear, undergarment).