Liposuction Surgery Research Articles

Lipedema resistance after bariatric surgery: case reports

Introduction: Lipedema is a loose connective tissue disease characterized by painful fibrotic fat nodules in the limbs. Obesity is the comorbidity most frequently associated with lipedema; however, lipedema fat is resistant to traditional weight loss measures, including metabolic bariatric surgery (MBS). We present seven cases of women with distinct types, stages, and symptoms of lipedema who had already undergone MBS for the treatment of obesity and its complications. Case Presentations: Women with diagnostic features of lipedema were voluntarily recruited for a project involving the dissemination of research on lipedema. Among these women, seven (15.6%) had already undergone MBS, and their case reports are described in this study. The volunteers were interviewed regarding their clinical history and evaluated the impact of MBS on overall weight loss and weight regain, as well as the impact of these processes on the volume and the presence of symptoms and comorbidities of lipedema. Conclusions: MBS was effective in providing significant weight loss in the cases evaluated but had limited effects on lipedema fat. The treatment of lipedema should be paired with the treatment of obesity by employing conservative methods, such as dietary plans, or liposuction surgery. A previous diagnosis of lipedema associated with obesity in patients who undergo MBS may improve pre- and postoperative management and, consequently, lead to a better outcome, improving the quality of life of the patient.

Complications of Submentonian and Cervical Liposuction Surgery Associated With Platysmaplasty.

The aim of this study was to report a series of 3 cases of complications following submentonian and cervical liposuction associated with platysmaplasty. The complications include hemorrhage, Ludwig's angina, and paralysis caused by injury to the marginal mandibular nerve. The procedure was performed by the same operator using the same technique, and the patients were informed of the risks. It is important to emphasize that the surgeon must be prepared to manage any of these complications, and treatment should be immediate and appropriate. The management of complications following submentonian and cervical liposuction associated with platysmaplasty must be prompt and effective to prevent further risks and damage. The approaches are discussed and referenced by the authors. Submentonian and cervical liposuction surgery associated with platysmaplasty is a valuable tool for reducing neck fat and enhancing esthetic outcomes, but there is a possibility of postoperative complications, which, although rare, can occur. Proper patient selection and thorough explanation of risks are crucial to preventing some of these situations.

Improvement in Health-Related Quality of Life and Symptoms Following Lipedema Liposuction: A Longitudinal Study.

Lipedema is a chronic fat disorder characterized by disproportionate fat deposition in the lower limbs, leading to pain, mobility issues and reduced health related quality of life (HRQoL).There is growing evidence that liposuction of the excess fat not only reduces soft tissue pain but also improves HRQoL. The published data, however, remain limited, and there are no studies of liposuction in the UK lipedema population. This study aimed to evaluate the effectiveness of liposuction on HRQoL and symptoms in UK lipedema patients using 2 HRQoL instruments and a Lipedema Symptom Scale. Lipedema patients undergoing liposuction between January 2016 and December 2021 completed Short-Form Health Survey (SF-36), World Health Organization Quality-of-Life Assessment (WHOQOL-BREF), and 17-question Lipedema Symptom Scale preoperatively and postoperatively. Paired t test was used to compare the preoperative and postoperative mean scores of the different domains of the SF-36 and WHOQOL-BREF and preoperative and postoperative mean scores for the lipedema symptom scale. Paired t test was also used to compare preoperative and postoperative SF-36 scores to age-matched normative data for the English population to assess the extent of HRQoL improvement relative to the general population. Seventy-six women were included in the study with a mean age of 46.4 ± 12 years. Mean follow-up (interval between first liposuction surgery and postoperative completion of the instruments) was 25.3 ± 23.2 months. There was significant improvement in all SF-36 and WHOQOL-BREF domains postoperatively ( P < 0.001). Compared with age-matched normative data, postoperative SF-36 scores remained lower in physical functioning, social functioning, and general health. Postoperative results also showed a highly significant improvement ( P < 0.001) across all 17 items of the Lipedema Symptom Scale. This longitudinal study indicates liposuction is an effective treatment for improving HRQoL and symptoms in lipedema patients, although it may not completely restore HRQoL to normative levels. Limitations include potential selection bias, sampling bias, and the need for longer follow-up. The findings support liposuction as a first-line treatment for lipedema and could inform decision-making for both patients and policymakers.

"Comparative study of adipose-derived stem cells from localized scleroderma patients and healthy donors in treating skin fibrosis".

Localized scleroderma (LoS) is an autoimmune disease characterized by fibrosis of the skin and atrophy of the subcutaneous fat tissue. Adipose-derived mesenchymal stem cells (ASCs) is a promising treatment approach for LoS. However, ASCs from scleroderma patients (LoS-ASCs) have been shown to exhibit altered characteristics compared to ASCs from healthy donors (healthy-ASCs). This study aimed to compare the abilities of LoS-ASCs and healthy-ASCs in treating skin fibrosis. The paracrine ability of ASCs was tested with cytokine array. Bleomycin-challenged mice models received subcutaneous injection of LoS-ASCs and healthy-ASCs. Pathological staining and western blotting of COL1, α-SMA was performed. Fibroblasts derived from LoS lesions (LoS-FB) was co-cultured with ASCs, and subjected to RNA sequencing to further explore the similarities and differences in the treatment mechanism. In vivo comparison revealed that healthy ASCs had a stronger proliferation ability and secreted higher levels of growth factors and cytokines, including VEGFA, PDGFB, and IL-10. Pathological staining of the skin in mice models treated with ASCs demonstrated that healthy ASCs were more effective in reducing dermal thickness and collagen deposition, while increasing microvessel density and the proportion of M2 macrophages. Co-culture with both healthy-ASCs and LoS-ASCs reduced the proliferation and migration abilities of LoS-FB, as well as the protein expression of α-SMA and COL1. RNA sequencing and validation revealed potential difference in the canonical Wnt pathway. Healthy-ASCs exhibited stronger proliferation, paracrine, anti-fibrosis, pro-angiogenesis, and immunomodulation abilities in treating skin fibrosis in scleroderma mouse models. Allogenic ASCs obtained from healthy donors are more efficient in treating skin fibrosis, and could serve as a potential alternative for patients who are not suitable candidates for liposuction surgery in the future.

Autologous Cryopreserved Adipose Tissue Using an Innovative Technique: An In Vitro Biological Characterization.

Utilization of autologous adipose tissue transplantation in plastic and orthopedic surgery such as breast reconstruction and intra-articular injection has become an attractive surgical treatment with satisfactory clinical outcomes. Nevertheless, repeated liposuctions necessary to harvest fatty tissue, normally performed with sedation or general anesthesia, may represent a noteworthy concern. The aim of this study was to demonstrate through an in vitro characterization the validity of the surgical option of cryopreserved autologous adipose tissue harvested in a single shot for repeated graft transfer in breast reconstruction without impairment of cell viability and sterility. Adipose tissue was collected by standard liposuction from patients who needed numerous fat grafting procedures for breast reconstruction. According to an innovative and patented cryopreservation method, autologous adipose tissue was subsequently fractioned in a sterile bag system and frozen at the RER Tissue Bank of the Emilia Romagna Region. Each graft was evaluated for sterility and cell viability immediately after harvesting, and 1, 3, 6, 12, and preliminarily 18 months after cryopreservation and thawing. In vitro results showed that after processing, middle-term and long-term cryopreservation, and subsequent thawing, autologous cryopreserved adipose tissue retained absence of bacterial contamination, high cellular viability, and unmodified histomorphological properties, thereby ensuring maintenance of the stromal vascular niche and the filling properties in different multistep surgical procedures. In vitro study and sterility assessment showed that autologous cryopreserved adipose tissue grafting is a safe procedure, making it possible to avoid multiple liposuction surgery. No impairment of sterility, cell viability, or morphology was observed over time.

Subanesthetic Dose of Esketamine Improves the Sedative and Analgesic Effects of Dexmedetomidine and Remifentanil in Liposuction Anesthesia: A Prospective, Double-Blinded, Randomized Controlled Trial.

Esketamine have anesthetic and analgesic properties. This study aimed to observe the enhancing effect of subanesthetic doses of esketamine (0.15-0.3 mg/kg/h) with dexmedetomidine and remifentanil during anesthesia for liposuction surgery. A total of 155 subjects were randomized with a 1:1 ratio to Group E (esketamine-dexmedetomidine/remifentanil, n=78) or Group C (saline-dexmedetomidine/remifentanil group, n=77). The primary outcome was satisfaction of patient and surgical team with the procedure. The secondary outcomes were the postoperative Athens Insomnia Scale (AIS) and Hospital Anxiety and Depression Scale (HADS) scores, hemodynamic and respiratory changes, drug consumption, adverse event rates, and predictors associated with patient satisfaction. Patient and surgical team satisfaction with the procedure was significantly higher in Group E than in Group C (4.7 ± 0.6 vs 4.2 ± 0.7, P < 0.001; 4.7 ± 0.5 vs 4.4 ± 0.7, P = 0.005). The postoperative AIS (4 [1, 6] vs 5 [2, 9], P = 0.012) and HADS-A (1 [0, 3] vs 2 [0, 6], P = 0.012) scores were significantly lower in Group E than in Group C. Hemodynamic and respiratory parameters were more stable in Group E than in Group C, with the lower opioids consumption of sufentanil (0 [0, 4] vs 5 [2.5, 7.7], P < 0.001) and remifentanil (700 [480, 900] vs 800 [500, 1200], P = 0.023) in Group E compared to Group C. On ordinal logistics regression, postoperative sleep quality (OR, 0.70; 95% CI, 0.62-0.79), anxiety level (OR, 0.77; 95% CI, 0.62-0.95) and recovery time in post-anesthesia care unit (PACU) (OR, 0.69; 95% CI, 0.56-0.98) were identified as significant predictors associated with patient satisfaction. A subanesthetic dose of esketamine (0.15-0.3 mg/kg/h) as an adjuvant can improves the sedative and analgesic effects of dexmedetomidine and remifentanil during anesthesia for liposuction surgery. ChiCTR2400080363.

Comparative Study of 1444 nm Laser Monotherapy versus Integrated Liposuction in the Treatment of Axillary Osmidrosis.

Background and Objectives: The 1444 nm wavelength Neodymium:Yttrium-Aluminum-Garnet (Nd:YAG) laser treatment is an efficient method for treating axillary osmidrosis (AO); however, it has a relatively low treatment persistence. To address this issue, we performed integrated liposuction surgery with a laser to treat AO and compared the results with those of a group treated only with a laser. Materials and Methods: This study compared the outcomes of AO treatment between the two groups up to six months postoperatively. The first group of 18 patients underwent laser treatment alone, and the second group of 12 patients underwent integrated liposuction surgery in addition to laser treatment. Outcomes were assessed using the following variables: degree of malodor (DOM), sweating area, patient satisfaction, pain levels, and complications, such as burns, swelling, and contractures. Results: Compared to the laser-only group, the integrated liposuction group demonstrated significantly superior outcomes in terms of DOM (p = 0.002) and patient satisfaction (p = 0.006), as well as a reduction in the sweating area (p = 0.012). The pain rating was higher in the liposuction group, but the difference was not statistically significant (p = 0.054). Compared with the patients in the integrated liposuction treatment group, those in the laser treatment group exhibited a significantly higher number of burns under the axillae (p = 0.025). However, no significant differences were observed in the swelling or contracture between the groups. Conclusions: Integrated liposuction with laser therapy significantly improved treatment outcomes, including malodor, patient satisfaction, sweat test results, and decreased complication rates.

The impacto of mammaplasty and lipectomy on self concept and body self-perception image: integrative review

The impacto of mammaplasty and lipectomy on self concept and body self-perception image: integrative review

Awake Look-assisted Intubation in a Patient with Antiretroviral Therapy-induced Neck Lipodystrophy Posted for Liposuction Surgery

Abstract Highly active antiretroviral therapy (HAART)-induced lipodystrophy refers to a serious metabolic syndrome in human immunodeficiency virus-infected patients, characterised by the development of dyslipidaemia, insulin resistance, glucose intolerance and abnormal redistribution of body fat (peripheral lipoatrophy and lipohypertrophy). Lipohypertrophy refers to abnormal fat accumulation occurring commonly in the intra-abdominal compartment, breast, dorsocervical area (buffalo hump) or under the skin (lipomas). We report a case of HAART-induced lipodystrophy with a massive accumulation of adipose tissue in the dorsocervical region posted for liposuction.

Intraoperative Cardiac Arrest During Liposuction: A Case Report.

With the popularity of liposuction surgery, more awareness should be obtained regarding complications. Liposuction has been thought of as a safe procedure with a very low incidence of major complications. However, life-threatening risks of liposuction have rarely been reported. We present a case of a 36-year-old woman who developed cardiac arrest during a liposuction procedure, and we present a literature review. She was previously healthy and had no risk factors for pulmonary embolism. The diagnosis was made based on clinical presentation and the presence of an electrolyte disorder and a positive sign on computed tomography pulmonary angiogram (CTPA). Mild hypothermia treatment, symptomatic treatment, and supportive therapy were applied. As the respiratory and circulation were smooth, she was discharged to a rehabilitation hospital. Seven months after discharge, the patient was still in a coma with eye opening. Spinal anesthesia, pulmonary embolism, and hyperkalemia are the most probable contributors to the cardiac arrest observed during the liposuction procedure in this specific case. There is a heightened imperative to vigilantly monitor for critical incidents during these operations and to meticulously identify associated risk factors during liposuction.

Liposuction Sonrası D Vitamini Durumundaki Dinamik Değişimler: Hasta İzleme ve Sağlık Açısından Etkileri

Aim: Liposuction, a prevalent plastic surgery procedure, has gained a significant popularity in recent years. Vitamin D, a crucial fat-soluble vitamin, plays a vital role in numerous metabolic pathways, with emerging importance beyond skeletal health. This study aims to assess vitamin D status before and after liposuction surgery and examine the impact of removed adipose tissue on serum 25(OH)D levels. Material and Method: This cross-sectional study included patients undergoing liposuction between January 2022 and February 2023. Criteria for inclusion and evaluation of vitamin D status followed established guidelines. Vitamin D status and serum 25(OH)D levels were assessed and measured on the follow-up points. Results: Participants (n=21) exhibited a significant decrease in BMI postoperatively. Serum 25(OH)D levels showed a decline, reaching the lowest in the 1st month post-surgery. The distribution of vitamin D status shifted postoperatively, with an increased incidence of deficiency. Conclusion: The study underscores the dynamic relationship between BMI, adipose tissue, and vitamin D levels following liposuction. Research has associated vitamin D deficiency with adverse surgical outcomes and emphasizes the need for monitoring this parameter in elective surgeries. Findings suggest a dynamic shift in vitamin D status post-liposuction, advocating for continuous monitoring and potential supplementation.

Comparative analysis of the effects of limbal and adipose‐derived mesenchymal stem cell conditioned media on oxidative stress‐induced damage in retinal pigment epithelial cells

Aims/Purpose: The purpose of this investigation was to evaluate the impact of adipose and limbal tissue‐derived mesenchymal stem cell‐conditioned media on survival, and inflammation in H2O2‐induced retinal pigment epithelial cells.Methods: Following national regulations and with the approval of the Koç University Ethics and Investigation Committee, human limbal (L) and adipose‐derived (Ad) mesenchymal stem cells (MSCs) were isolated from cadaveric corneaoscleral rims from donors that originated from the cornea bank of Ministry of Health in Turkey and adipose tissue from discarded human liposuction surgery specimens, respectively. Conditioned medium (CM) that obtained by culturing MSCs in absence of serum was concentrated by filtration. Following a 24‐h pre‐treatment with H2O2, retinal pigment epithelial (RPE) cells were treated with MSC‐CM. Groups were defined as follows: Control, H2O2‐treatment (OS), OS‐Basal Medium, OS‐AdMSC‐CM and OS‐LMSC‐CM. Cell viability was assessed using MTT assay. Gene expression levels of pro‐ and anti‐inflammatory cytokines were analysed by qRT‐PCR.Results: Based on MTT assay, H2O2 inhibited the growth of RPE cells with IC50 values of 150 μM at 24 h. We found that MSC‐CM attenuated H2O2‐induced loss of cell viability. In comparison to the OS group, the LMSC‐CM and AdMSC‐CM treatments demonstrated significantly decreased levels of IL‐6, IL‐8, IL‐10 and TGF‐β1 gene expression.Conclusions: MSC‐CM ameliorated H2O2‐induced retinal pigment epithelial cell damage by alleviating inflammation.

Intraoperative fluid management of large volume liposuction surgery, cardiometry guided stroke volume variation versus Rohrich formula, a prospective randomized trial

Intraoperative fluid management of large volume liposuction surgery, cardiometry guided stroke volume variation versus Rohrich formula, a prospective randomized trial

Paracetamol Versus Ondansetron for Prevention of Postoperative Shivering in Liposuction Surgeries Under Combined General Epidural Anaesthesia: A Randomized Controlled Trial.

Postoperative shivering (POS) is considered one of the most common complications that is encountered by the anaesthetists worldwide. Despite using several treatment options, there has not been a clear consensus regarding this issue. This trial was conducted to investigate the efficacy and safety of paracetamol and ondansetron in preventing POS in patients undergoing liposuction procedures under combined general epidural anaesthesia. One hundred twenty patients scheduled for liposuction were randomly allocated to one of three groups: group P (paracetamol group) which received 1 g paracetamol intravenously, group O (ondansetron group) which received 8 mg of ondansetron intravenously, and group S (saline group), which received 100 mL normal saline intravenously; all medications were given postoperatively. The primary outcome was the incidence of POS, and the secondary outcomes included shivering score, tympanic temperature, and the occurrence of side effects. The incidence of occurrence of POS was found to be lower in groups P and O compared to group S with values of 25% and 37.50% vs. 77.50%, respectively, with a P value <0.001. Additionally, the severity of POS was found to be lower in groups P and O compared to group S (P <0.001). Tympanic temperature and complications were comparable between the groups with no significant differences. Prophylactic use of paracetamol or ondansetron at the end of the procedure was shown to be of great value in reducing the incidence and severity of POS, with no statistically significant difference between the paracetamol and ondansetron groups. Moreover, no significant drawbacks were reported as a result of using these medications.

Pulmonary Fat Embolism Syndrome: A Case Report and Literature Review

Background: Fat embolism syndrome (FES) is caused by a systemic inflammatory response arising from embolized fat particles that block blood vessels and disrupt blood supply, particularly in the respiratory microcirculation. Despite its high morbidity and mortality, FES is still challenging to diagnose due to its versatile symptoms. Case Presentation: In this article, we describe case reports of two patients with pulmonary FES from Zhongnan Hospital of Wuhan University, Wuhan, China. The two patients were diagnosed based on their detailed medical histories, such as a history of liposuction surgery, low oxygen saturation, dyspnea, and chest computed tomography (CT). Both of them received continuous oxygen inhalation therapy and antibiotic treatment. The first patient received additional anti-inflammation and anticoagulation treatment. The symptoms and CT improved after treatments. They were discharged and completely cured. Literature Review: We obtained and analyzed the clinical manifestations, treatments, and prognosis data of 206 patients diagnosed with pulmonary FES between January 1900 and July 2021 from the China National Knowledge Infrastructure database. Conclusion: The analysis of our two cases and the literature review suggest that patients with symptoms (such as respiratory system symptoms, nervous system symptoms, cardiovascular system symptoms, and mucocutaneous bleeding) combined with a history of fracture and other risk factors should be considered pulmonary FES cases. Furthermore, respiratory support and glucocorticoid treatment may be effective in preventing the death of pulmonary FES patients.

Tracking Symptoms of Patients With Lymphedema Before and After Power-Assisted Liposuction Surgery.

Lymphedema negatively impacts patients from a psychosocial standpoint and consequently affects patient's quality of life. Debulking procedures using power-assisted liposuction (PAL) are currently deemed an effective treatment for fat-dominant lymphedema and improves anthropometric measurements as well as quality of life. However, there have been no studies specifically evaluating changes in symptoms related to lymphedema after PAL. An understanding of how symptoms change after this procedure would be valuable for preoperative counseling and to guide patient expectations. A cross-sectional study was performed in patients with extremity lymphedema who underwent PAL from January 2018 to December 2020 at a tertiary care facility. A retrospective chart review and follow-up phone survey were conducted to compare signs and symptoms related to lymphedema before and after PAL. Forty-five patients were included in this study. Of these, 27 patients (60%) underwent upper extremity PAL and 18 patients (40%) underwent lower extremity PAL. The mean follow-up time was 15.5±7.9 months. After PAL, patients with upper extremity lymphedema reported having resolved heaviness (44%), as well as improved achiness (79%) and swelling (78%). In patients with lower extremity lymphedema, they reported having improved all signs and symptoms, particularly swelling (78%), tightness (72%), and achiness (71%). In patients with fat-dominant lymphedema, PAL positively impacts patient-reported outcomes in a sustained fashion over time. Continuous surveillance of postoperative studies is required to elucidate factors independently associated with the outcomes found in our study. Moreover, further studies using a mixed method approach will help us better understand patient's expectations to achieve informed decision and adequate treatment goals.

Current Standards of Liposuction Surgery and the Effect of Tumescent Anesthesia on Patient Recovery

One of the most popular cosmetic surgery procedures, liposuction and its techniques have evolved rapidly since its development in the 1970s. Not only with aesthetic but also systemic advantages, liposuction surgery, its safety profile and operative efficiency techniques have progressed to aid both surgeon and patient in gaining the best result.

OZONIOTHERAPY

In recent years there has been a significant increase in the demand for aesthetic procedures aimed at Orofacial Harmonization, attracting both men and women. An integral component of facial rejuvenation is the restoration of an aesthetic neck contour. To treat this, the localized fat accumulation is removed through the aesthetic procedure of liposuction surgery, leading to an improvement in the facial contour. Fat removal is done using cannulas. Small incisions are made in the skin, where the cannulas will be introduced and will aspirate the localized fats through negative pressure. Liposuction, as with any surgical procedure, can have complications. Fibrosis is one of the main ones, being a direct consequence of post-injury repair. A complementary therapeutic procedure integrated with surgical practices and bringing several benefits is ozone therapy, a technique that uses ozone gas as a therapeutic agent. Due to the fact that ozone has been correlated with numerous benefits for the treatment of conditions, the present work aims to correlate the clinical experience of its application in the submental region, to improve the condition of fibrosis intercurrence in patients who underwent lipoplasty surgery. There was a significant improvement in the patient’s fibrosis, however, further studies are still needed on the subject, in order to allow well-defined and safe parameters of use.

The preliminary study of exosomes derived from thymosin beta 4-treated adipose-derived stem cells in fat grafting.

The retention rate in autologous fat grafting is an increasing concern for surgeons and patients. Our previous research verified that thymosin beta 4 (Tβ4) positively affected fat survival, while the mechanism was unknown. The endothelial cells (ECs) and exosomes derived from adipose-derived stem cells (ADSCs) were regarded to play a critical role in fat transplantation. This study aimed to evaluate the effect of exosomes derived from Tβ4-treated ADSCs on EC proliferation and to identify the exosomal microRNA (miRNA) profile compared with the Tβ4-untreated group. Additionally, this research intended to recognize the related molecules and signaling pathways in the Tβ4-treated group with potential roles in fat transplants. ADSCs were collected from patients who underwent liposuction surgery. Depending on whether the medium was supplemented with exogenous Tβ4 or not, exosomes derived from cultured ADSCs were divided into the Tβ4-Exos group and Con-Exos group. Exosome uptake and cell counting kit-8 (CCK-8) assays assessed the influence of Tβ4-Exos on EC proliferation. The exosomal miRNAs of the two groups were analyzed by next-generation sequencing. With the criteria at the |log2 (fold change)| ≥ 1 and p-value < 0.05, up-regulated and down-regulated differentially expressed miRNAs (DEMs) were obtained. Prediction databases were used to predict the downstream mRNAs for DEMs. And then, overlapping genes for the up-regulated DEMs and the down-regulated were screened out, followed by enrichment analysis, protein-protein interaction network construction, and the gene cluster and hub gene identification. ADSCs were obtained from four female patients. The exosome uptake and CCK-8 assays showed that the Tβ4-Exos could increase cell growth rate compared with the control group (DMEM-H + PBS). In Tβ4-Exos and Con-Exos groups, 2651 exosomal miRNAs were recognized, with 80 up-regulated and 99 down-regulated DEMs according to the criteria. After the prediction, 621 overlapping genes for the up-regulated and 572 for the down-regulated DEMs were screened. The subsequent bioinformatics analysis found specific molecules and pathways related to the positive effect on fat survival. The exosomes derived from Tβ4-treated ADSCs probably positively affect EC proliferation. Compared with the Con-Exos group, several exosomal DEMs, genes, and pathways were distinguished. These findings of this exploratory study provide the potential direction for future in-depth research on fat grafting.

An explainable machine learning method for assessing surgical skill in liposuction surgery.

Surgical skill assessment has received growing interest in surgery training and quality control due to its essential role in competency assessment and trainee feedback. However, the current assessment methods rarely provide corresponding feedback guidance while giving ability evaluation. We aim to validate an explainable surgical skill assessment method that automatically evaluates the trainee performance of liposuction surgery and provides visual postoperative and real-time feedback. In this study, machine learning using a model-agnostic interpretable method based on stroke segmentation was introduced to objectively evaluate surgical skills. We evaluated the method on liposuction surgery datasets that consisted of motion and force data for classification tasks. Our classifier achieved optimistic accuracy in clinical and imitation liposuction surgery models, ranging from 89 to 94%. With the help of SHapley Additive exPlanations (SHAP), we deeply explore the potential rules of liposuction operation between surgeons with variant experiences and provide real-time feedback based on the ML model to surgeons with undesirable skills. Our results demonstrate the strong abilities of explainable machine learning methods in objective surgical skill assessment. We believe that the machine learning model based on interpretive methods proposed in this article can improve the evaluation and training of liposuction surgery and provide objective assessment and training guidance for other surgeries.