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Liposuction on More Solid Ground Now

New survey shows lower mortality rates

SATURDAY, Oct. 13, 2001 (HealthDayNews) -- After a decade of surging popularity for liposuction and a concurrent high rate of mortality as a result, plastic surgeons now report a significant increase in the safety of the elective procedure.

Studies before 1998 reported a death rate of 1-in-5,000 patients, which "for elective surgery, is not good," says Dr. Mark Jewell, a spokesman for the American Society for Aesthetic Plastic Surgery (ASAPS).

But a new survey of plastic surgeons who performed 94,000 liposuction procedures from 1998 to 2000 found the death rate has dropped to 1-in-47,415 procedures.

The almost 10-fold decrease in deaths is a result of a host of improvements implemented by plastic surgeons across the country, says Jewell, a plastic surgeon in Eugene, Ore., who wrote the commentary accompanying the survey published in a recent issue of Aesthetic Surgery Journal.

Among the changes adopted by plastic surgeons, he says: the elimination of additional surgical procedures while liposuction is under way; tightening up the screening process for patients who will benefit from liposuction, and taking out less fat during the operation.

All are factors that had been shown to increase the risk of complications, which can include infection, heart problems from the injection of too much fluid into the body at one time, and swelling. The most serious threat, says Jewell, is deep vein thrombosis (DVT), in which blood clots form, usually in the leg, and can break loose and travel to the lungs where they can fatally block air passages.

Dartmouth College ethicist Ronald M. Green calls the number of deaths from liposuction during the 1990s "an abuse of medical ethics."

"Such terrible [mortality] statistics are justified if you are introducing a procedure that is potentially life-saving," he says, "but when you move to elective and cosmetic surgery, medical ethics dictates that the possible risks have to be significantly lower.

"When you have elective surgery that is very attractive to people -- liposuction seemed like a miracle to [be able to] have fat taken away -- the doctor has to be a gatekeeper conforming to the strictest standards of safety. He or she is not just a servant to the patient's request," he adds.

According to the survey, approximately one-third of the 754 physicians polled had changed the way they performed liposuction procedures in the previous two years, following efforts by plastic surgery organizations and doctors to improve safety issues.

The biggest change was not to piggyback other surgical procedures, like tummy tucks or facial cosmetic surgery, on top of a liposuction operation. Sixty-six percent of the procedures were liposuction only; 20 percent were liposuction combined with other surgeries, excluding abdominoplasty (tummy tucks); and 14 percent involved liposuction with abdominoplasty with or without additional procedures.

"Combined surgeries carry higher risks, and we are just starting to understand the effect of this," says Jewell.

"[Some doctors] would get into mega-session cosmetic surgery, and the procedure would last for hours. The longer the surgery, the higher the risk of complications," he notes.

Many doctors also have reduced the amount of fat they remove during a liposuction operation. According to the study, 85 percent of doctors remove no more than three-and-a-half liters of fat during the average procedure, and only about five percent practice "large-volume" liposuction, which is the removal of as much as five liters of fat. Removing less fat at a time reduces complications, Jewell says.

In addition, doctors have also become more selective in screening potential patients for the procedure. Ninety-seven percent refuse to perform the procedure on those who have unrealistic expectations.

"Liposuction is not a form of surgical weight reduction," Jewell says. It is, in fact, body-contouring surgery to remove fat deposits from parts of the body that are diet-resistant, including the stomach, inner thigh, hips or upper arms.

The survey also showed that 61 percent of the surgeries were performed in office-based surgical facilities, the majority of which met all licensing criteria. And the risk of complications for in-house procedures was no higher than for surgeries performed in accredited hospitals.

What to Do: Facts about liposuction, including its health risks, can be found at the Food and Drug Administration. A thorough explanation of liposuction procedures can be found at the American Society of Plastic Surgeons.

SOURCES: Interviews with Mark Jewell, M.D., secretary, American Society for Aesthetic Plastic Surgery, and plastic surgeon, Eugene, Ore.; Ronald M. Green, Ph.D., director, The Ethics Institute, and professor, Dartmouth College, Hanover, N.H., Aethestic Surgery Journal
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