Liposuction: Benefits vs. the Risks, Deaths and Liposuction

by Food and Drug Administration (FDA)

(Page 2 of 3)

Understanding the Benefits vs. the Risks

In a society in which beauty is often measured by slender bodies and youth, it is no wonder that thousands of Americans chase the "perfect" look by means of liposuction. Portrayed in upbeat tones and associated with Hollywood glamour, liposuction seems to offer instant help for unsightly bulges. Consumers checking out liposuction Web sites on the Internet are further assured by the positive information they find.

"There are probably hundreds of thousands of patients who have had body sculpting without complications," says Ann Graham, senior nurse consultant in CDRH's Office of Surveillance and Biometrics. "But we are concerned about the published reports of patients who have not had a good outcome. They have undergone liposuction for weight reduction, not just body sculpting. Liposuction, in general, is a purely elective procedure. As such, our tolerance for an unsafe or harmful outcome is extremely low."

Although many consumers think of liposuction as a quick and permanent fix, it's likely that few understand its risks and frequently temporary results. There is no national group of consumers, nor one group representative of all clinicians, that is organized to oversee liposuction procedures and results. Although FDA is aware of problems published in medical literature and described by other sources, "very few adverse event reports are coming into the agency through its formal reporting channels" according to Anita Kedas, a nurse consultant in CDRH's Office of Surveillance and Biometrics. But the small number of reports may simply mean that negative outcomes aren't being reported.

Office-based procedures may present the greatest reporting problem. There's no requirement that adverse events from office procedures be reported, and most procedures are done in offices, according to Graham. Even if offices are well equipped, she adds, patients often need days of continuous support such as rehydration, pressure dressings, and good nursing care, while others actually need resuscitation and hospitalization to recover. And if a patient goes to the emergency room for care, FDA doesn't hear about it, adds Graham.

Whether reported or not, liposuction problems are real enough — though some, such as wavy or uneven skin after fat removal, are not medically serious.

But others are. Overworking the heart can be a serious side effect of the tumescent technique. "Let's say they plan to remove 5,000 cc's of aspirate," says plastic surgeon Fodor, "so they inject a dangerously large amount of fluid. The patient would be practically 'drowning' in fluids. The heart can't handle this fluid overload."

Another potential complication is infection, says Brown. Infections can occur after any surgery. Sometimes, infections may be serious or life threatening such as in cases of necrotizing fasciitis (when bacteria eat away at tissue) or toxic shock syndrome, a serious infection which has been associated with tampon use but may also be associated with surgery, says Brown.

Other possible problems Brown lists are burns, embolisms, cardiac arrhythmia, edema, and nerve compression, which are all reported in the medical literature. Often, too, Graham notes, cannulas are inserted in several different locations, resulting in puncture wounds that need to heal.

A condition called seroma, or an oozing or pooling of serum, or body fluid, may be a problem after the more aggressive ultrasound techniques during which some skin is detached from underlying tissue and fluid accumulates in a subcutaneous pocket.

Deaths and Liposuction

According to a survey conducted by the American Society of Plastic Surgeons (ASPS) of more than 1,500 plastic and reconstructive surgeons in January, 1999, the death rate of one in every 5,000 (or 20 out of 100,000) liposuction patients between 1994 and 1998 was much higher than anyone anticipated — higher even than death rates from traffic accidents. And higher than acceptable death rates from other kinds of surgeries, admits Jack Bruner, M.D., associate clinical professor of plastic surgery at the University of California, Davis, and chairman of the task force on liposuction for ASPS. Although the survey data are not considered scientific information, they are useful when establishing practice guidelines, and they led ASPS to recommend some practice changes when performing liposuction.

It is encouraging, Bruner says, that more recent statistics from The Doctor's Company, an insurance company located in California, show that no liposuction-related deaths have been reported there in the last 18 months. However, he notes, this survey only addresses what's happening among board-certified plastic surgeons, not with other doctor groups performing liposuction.

Deaths among liposuction patients can happen for a number of reasons, Bruner says, including thromboembolism, or a blood clot that forms in the deep veins of the pelvis or legs. "That can happen during any surgery," he adds, "and I wish I could say that it is always preventable, but it is not." Next, he cites perforation of the abdominal wall or bowels, the latter being especially serious. "If you perforate the bowel, there's a high mortality rate if it's not fixed in the first 24 to 48 hours," he says. Physicians are essentially blind as they perform liposuction because they can't see what is in front of the cannula, notes FDA's Horbowyj.

Finally, Bruner notes that shock and hemodilution, or diluting of the blood, may lead to a patient's death. This can occur when patients have had large amounts of fluids injected and then both fat and fluids removed, about 11 pounds worth in all during a larger-scale procedure.

Further, although virtually no hard data exist, says Bruner, he and others worry that too much lidocaine may also lead to death. Lidocaine use poses particular hazards, especially since experts do not agree on safe injectable levels. "If you get too much lidocaine for too long," says Bruner, "the heart muscles become lazy. On the other hand, the brain becomes very agitated at first, which may cause a seizure, before coma sets in."

At least one study links possible lidocaine toxicity to liposuction deaths, says Horbowyj, adding that people with less than normal liver function or those who have been drinking alcohol may not be able to metabolize lidocaine well.

About the Author

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FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.