Rohrich is referring to the "census survey" method used in the study, in which more than 1,200 board-certified plastic surgeons were sent one-page questionnaires -- twice -- asking whether they knew of, or had experience with, deaths from liposuction procedures. More than 900 physicians responded, giving the authors a death count of 130.
"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.