"I don't think I would be very confident hanging my hat on those numbers," says Walter Erhardt, MD, president-elect of the American Society of Plastic Surgeons and a practitioner in Albany, Ga. "I think there is a great concern for the duplication of numbers. Plastic surgery is a relatively small community. When things happen, word does get around. So I do see a tremendous tendency for duplication."
But de Jong says that's not likely the case -- and that, if anything, the survey turned up a best-case scenario with liposuction deaths, given that it only queried the 'cream of the crop' of those doing the procedure, and not those with minimal training and experience. "Let's face it," he says, "When we got these numbers back, we didn't believe them ourselves. It's an elective procedure. It's reputedly safe. It came as a great surprise."
Perhaps even more of a surprise is that the death rate has actually gone up in the past 13 years, according to de Jong, despite the introduction of new, less drastic surgical techniques. He says that may not be coincidental -- which seems odd, considering what "having liposuction done" used to mean.
Now, instead of having the fat literally carved from the body, patients can have it sucked out through a small tube -- while lying awake in a doctor's office. The procedure, known as "tumescent liposuction," uses two drugs: lidocaine (to kill the pain) and epinephrine (to stop the bleeding). De Jong thinks the apparent increase in liposuction deaths may have something to do with the lidocaine -- the drug can be extremely toxic to the heart -- although he has no data to support his hypothesis.
Even if they don't agree with its conclusions, critics of the study say it has served a good purpose: to remind patients and physicians alike that liposuction, minor as it looks these days, is nonetheless surgery.
"There are some studies that indicate this is a very safe procedure," says Erhardt. "But it has been around for 18 years, and there is some tendency for us to forget the surgical reality. ... This is not popping in to get the hair done. This is surgery. Patients have to respect that."
Along those lines, Erhardt says that patients ought to be very careful about who they choose for a surgeon. "Stay away from the hucksterism," he advises. "Unfortunately, patients aren't as careful about choosing their cosmetic surgeon as they are about choosing where to buy a new car or get their hair done."
And patients have to be reasonable about expectations. "It's very easy to blame the surgeon or doctor" when something goes wrong, de Jong says. "But I think the patient -- the consumer -- has to accept some of the blame, too. Because a lot of people, obese people, come in basically to lose their girth. They don't just want a little bit out, they want a lot out. And that's a problem."