SUNDAY, March 23, 2003 (HealthDayNews) -- Liposuction once conjured up frightening images of botched surgeries, massive scarring and, sometimes, even death.
But while the procedure to surgically remove excess body fat still carries a few small risks, big changes during the past decade in how liposuction is performed have turned it into one of the safer cosmetic surgery options available today, experts say.
"Liposuction has really advanced, compared to even just a few years ago. Not only is it possible to achieve a more refined result, the safety profile is extremely impressive," says Dr. Naomi Lawrence, an assistant professor of clinical medicine at Cooper Hospital/University Medical Center in Camden, N.J.
What's made the difference, says Lawrence, was the development of a technique known as "tumescent" liposuction -- a kinder, gentler way of removing the fat.
How and why is it different?
All liposuction involves inserting a "cannula" -- or tube -- into a pocket of flesh, and siphoning out fat cells. In the early days of liposuction -- the early 1980s -- this required general anesthesia and the use of large incisions and large tubes. These factors could all contribute to significant blood loss, long recovery times and, ultimately, a series of operative and post-operative complications.
In tumescent liposuction, the pockets of excess fat are injected with a controlled amount of anesthetic liquid and other fluids, such as a saline solution. This not only shrinks capillaries, reducing bleeding, it causes the fat cells to become swollen and firm -- or "tumesced." This, in turn, lets the cannula travel more easily beneath the surface of the skin while removing the fat. It also allows for a smaller cannula to be used, and -- perhaps more important -- general anesthesia to be avoided.
The end result: Fewer skin irregularities, less bleeding, reduced bruising and a faster recovery time -- with no risk of the operative or post-operative complications normally linked to general anesthesia, Lawrence says.
Dr. Rhoda Narins was among the first U.S. dermatologists to perform tumescent liposuction, starting more than a decade ago.
"I could see immediately that this technique was going to revolutionize the liposuction procedure. And from the first time I tried it, I never went back to the old methods, the difference was that dramatic," says Narins, president-elect of the American Society for Dermatologic Surgery.
Just how dramatic was demonstrated recently in a survey conducted by Lawrence and researchers at Wake Forest University School of Medicine that appeared in the journal Dermatologic Surgery. In the tightly controlled study, the researchers tallied the experiences of some 260 dermatologists who collectively performed more than 66,000 tumescent liposuction procedures.
What they found: A zero death rate, and just 45 cases of post-operative or operative complications -- an overall rate of just 0.68 per 1,000 procedures.
"When complications did occur, they were more likely to happen in conjunction with intravenous or intramuscular anesthesia," says Lawrence, which is sometimes used in a hospital or ambulatory surgery setting, as opposed to a doctor's office.
While nearly all physicians agree that tumescent liposuction is a much safer way to perform this procedure, not everyone agrees that local anesthesia is always the best option.
According to the American Society of Plastic Surgery, there are times when general anesthesia may benefit the patient without compromising safety. The key, experts say, is finding a doctor who is experienced enough with both procedures and the use of anesthesia to make the right decision for each patient.
Dr. Stephen Colen says the best way to do that is by seeking out a doctor who has hospital privileges, even if your procedure will be done in an office setting.
"In order for a doctor to gain privileges at a hospital, he or she must meet certain education and skill requirements," says Colen, a plastic surgeon and associate professor of surgery at New York University School of Medicine.
By choosing a doctor who has a hospital affiliation, you are taking advantage of a system designed to weed out the less capable practitioners, Colen says.
The American Academy of Dermatologic Surgery (AADS), as well as Lawrence and Narins, offer these additional suggestions:
- If your procedure is to be done by a dermatologist, particularly if it will take place in an office setting, make certain the doctor is a dermatologic surgeon. If you are unsure of your doctor's credentials, check with AADS.
- Find out how many liposuction procedures your doctor has performed. The average number of cases handled by the doctors in the Wake Forest survey was 255, and their experience with tumescent liposuction averaged about eight years. Your doctor's record should meet or exceed these numbers.
- Avoid liposuction treatments that promise to remove large amounts of fat, or a doctor who offers to combine liposuction with other procedures. Ideally, liposuction should be done alone. And the maximum amount of fat removed in a single session should be no more than eight pounds.
More information
To learn more about tumescent liposuction, see the University of Washington Dermatologic Surgery Center. To check the credentials of a doctor, visit LipoSite.
