What's the Safest Form of Liposuction?

Dermatologists, Cosmetic Surgeons Strongly Disagree

From the WebMD Archives

Jan. 15, 2003 -- Just how safe is liposuction? A widely reported study released three years ago found that it was not safe at all, with a death reported for every 5,000 procedures. But newly published research found no deaths among 66,000 people who had the cosmetic surgery under local anesthesia -- in which the liposuction area is numbed but the person is still awake.

The study's researchers say their findings prove the technique -- known as tumescent liposuction, is less risky than surgery performed while the patient is unconscious. But cosmetic surgeons that WebMD spoke to strongly disagree. The debate pits dermatologists favoring the local anesthesia approach against plastic surgeons, who still routinely use general anesthesia -- putting the person to sleep -- when they perform the elective procedure.

"In my opinion there is no good reason to perform liposuction under general anesthesia," study researcher and dermatologist Naomi Lawrence, MD, tells WebMD. "The bottom line is this is a very safe procedure that has gotten a bad rap, basically because there are two types of procedures being performed."

Lawrence and colleagues surveyed 261 dermatologic surgeons who performed more than 66,000 liposuctions on patients given local anesthesia between 1994 and 2000. No deaths were reported, and the rate of serious adverse events was less than 1 per 1,000 patients. The findings were reported in the November issue of Dermatologic Surgery.

In contrast, about 20 deaths per 100,000 procedures performed between 1994 and 1998 were reported in a survey of 1,200 plastic surgeons published in the January 2000 edition of the journal Plastics and Reconstructive Surgery. Most of the patients in the survey received general anesthesia or sedation.

"One death in 5,000 patients is a very scary number, and there is just no reason for it," New York dermatologist Bruce E. Katz, MD, tells WebMD. "Plastic surgeons who are concerned about the safety of their patients should switch to the tumescent anesthesia approach."

Katz says there is no good reason for sedating liposuction patients, but Los Angeles plastic surgeon Peter B. Fodor, MD, strongly disagrees. Fodor says general anesthesia is the only safe way to remove large amounts of fat through liposuction -- up to 5,000 cubic centimeters (169 ounces), compared with a maximum of about 1,000 cubic centimeters (34 ounces) under local anesthesia.

"When you tell a patient they have to have four or five procedures instead of one, that doesn't make them happy," Fodor tells WebMD. "The average patient needs at least 2,000 [cubic centimeters] of fat removed, and you can't do that under local anesthesia."

Indianapolis plastic surgeon Charles Hughes, who performs liposuctions under both general and local anesthesia, agrees that office-based surgery under local anesthesia is fine for patients who do not need large amounts of fat removed.

"In truth, the dermatologists are making a big deal out of this because they are not surgeons and they don't have surgical privileges in hospitals," he tells WebMD. "They can't do this surgery under general anesthesia, but patients do want that option."

Hughes says many of the liposuction deaths reported in the 2000 study occurred because surgeons performed too many other cosmetic procedures at the same time. Chairman of the American Society for Aesthetic Plastic Surgery's body contouring committee, Hughes says education efforts have dramatically reduced the number of combined cosmetic surgeries.

"Some surgeries were taking 11 and 12 hours, because so many procedures were being done," he says. "That is a lot for the body to take. The bottom line is that liposuction in and of itself is pretty safe, regardless of the anesthetic used. But patients get into trouble when surgeons try to do too much."

Show Sources

SOURCES: Dermatologic Surgery, December 2002 • Naomi Lawrence, MD, director of dermatologic surgery, Cooper Affiliated Health Systems, Marlton, N.J. • Bruce Katz, MD, associate clinical professor, College of Physicians and Surgeons, Columbia University; and director, Juva Skin and Laser Center, New York • Charles Hughes, chairman, Body Contouring Committee, American Society for Aesthetic Plastic Surgery • Peter Fodor, vice president, American Society for Aesthetic Plastic Surgery; and associate professor of plastic surgery, UCLA.
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