Liposuction of >5 L of total aspirate at one setting is defined as large volume liposuction (LVL). A retrospective chart review was performed on all patients who underwent LVL from January 1990 to June 2005. Sixty-two patients underwent LVL. The mean volume of total aspirate was 8 L (5.0-11.7 L). There were a total of 6 patients who had complications. These included symptomatic postoperative anemia requiring blood transfusions on postoperative day 1 (n = 5), and an expanding hematoma requiring operative evacuation without transfusion (n = 1). Two of the patients who had blood transfusions had a history of gastric bypass and all of the patients were preoperatively anemic (<11.5 mg/dL). The mean follow up was 38 months. LVL is safe when performed in healthy patients under strict guidelines. Hemoglobin levels of all potential LVL patients should be checked preoperatively, and surgery should be withheld for levels <12 g/dL.