Jan. 21, 2000 (Atlanta) -- New techniques have made liposuction a more attractive cosmetic procedure, both for physicians and for patients. But a new survey concludes that there is still an unacceptable death rate following the surgery.
The study, which appears in the latest issue of Plastic and Reconstructive Surgery, showed a death rate of about 20 in every 100,000 patients who underwent liposuction between 1994 and 1998. The authors point out that this number is higher than the death rate for motor vehicle accidents in the United States. But it's a dramatic improvement from what most would consider the "bad old days" of liposuction -- the 1970s -- when death rates were eight times higher.
However, a statement released by the American Society for Aesthetic Plastic Surgery (ASAPS) offers some explanations for the study's findings. According to the statement, the ASAPS assembled a task force of plastic surgeons who attempted to uncover the reasons behind the increasing reports of liposuction deaths and complications. The group determined that the main factors increasing the risks of liposuction are poor patient health, excessive fat removal, using too much fluid and local anesthesia during the procedure, and performing multiple procedures during the same surgical session.
"As a result of the task force's investigation and recommendations, many plastic surgeons have altered their approach to [liposuction]. Consequently, since about 1998, we have seen the rate of serious complications plummet," ASAPS president Fritz E. Barton Jr., MD, is quoted as saying in the statement.
Still, one of the authors says there's reason for concern. "Liposuction has become trivialized, really," Rudolph H. de Jong, MD, from Thomas Jefferson Medical College in Philadelphia, tells WebMD. "It's a far more major procedure than it appears on the surface. The article was published as a way to warn the medical community. ... [T]his serves as a precautionary yellow traffic light."
Other plastic surgeons contacted by WebMD agree with the 'yellow light' symbolism, but they say it mainly applies in this respect: Be careful about what you read into the study.
"This data is nowhere near being valid," says Rod J. Rohrich, MD, professor and chairman of the department of plastic surgery at the University of Texas Southwestern Medical Center in Dallas, who says that recent studies have put the liposuction death rate much lower than this one. "This is one study. Obviously, it caught all of our attention, but I don't think some of the data is necessarily valid because of how it was collected."
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.
"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."
Rohrich seconds that notion. "The most important point is: Liposuction is for healthy people only," he says. "It is not a cure for obesity. It is absolutely contraindicated. In obesity, you don't need liposuction; you need diet, exercise, and lifestyle changes."
Erhardt, de Jong, and Rohrich agree that there needs to be more research to make liposuction as safe as possible.