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Liposuction

risks and complications
scars
satisfaction rates

liposuction risks and complications




List of possible complications:
Abnormal body contour
Anesthesia reaction
Bleeding
Burning
Death
Depression (mild depression is normally following elective surgery)
Dimples
Discoloration
DVT (Blood Clot)
Fat Embolus (less than 0.1%)
Heart Failure
Hematoma
Hypothermia
Infection
Keloid (heavy scar)
Nerve damage
Perforation of bowel or abdominal wall
Permanent numbness (risk is less than 1%)
Puckers
Reactions to medications
Seroma (fluid collection under skin)
Shock
Skin irregularities
Skin death (necrosis)
Slow healing
Swelling
Tingling
Visible scar

Deaths related to liposuction surgery can happen for a number of reasons: blood clot, perforation of the abdominal wall or bowels, shock and hemodilution (blood dilution), and possibly excess amounts of lidocaine.

Blood Clots
Blood clots (or deep venuous thrombosis, a DVT) can forms in the deep veins of the pelvis or legs after any surgery. A blood clot forms after prolonged immobility (people on international flights, women on bedrest during pregnancy and patients recovering from surgery are the most susceptible to blood clots). It is important to stand often (at least once an hour), flex the feet more often and generally keep the blood flowing in your legs. If the blood pools for too long in one area, you could be at risk for a blood clot.

Perforation
Perforation of the abdominal wall or bowels is preventable during surgery. Surgeons are limited in what they can see during surgery and must take extra caution. Choosing an highly experienced surgeon can reduce your risk of such complications.

Shock and hemodilution
Shock and blood dilution can occur after a patient has had excessive amounts of fluid injected and then excessive amounts of fat and body fluid removed (over 5,000 cc's, about 11 pounds). Large volume liposuction should be considered carefully. It is generally not recommended. However there are surgeons that specialize in it (See Reuters Health article).

Lidocaine
Lidocaine use poses particular hazards, especially since experts do not agree on safe injectable levels. At least one study links possible lidocaine toxicity to liposuction deaths. People with less than normal liver function or those who have been drinking alcohol may not be able to metabolize lidocaine well.

According to the FDA, a survey conducted by the American Society of Plastic Surgeons (ASPS) of more than 1,500 plastic and reconstructive surgeons in January 1999, there was an unexpected high death rate of one in every 5,000 (or 20 out of 100,000) liposuction patients between 1994 and 1998. These high numbers may be due to an increase in unqualified surgeons performing liposuction during that period. Since 1995, the number of deaths related to liposuction have decreased dramatically, to around 1 in 100,000 (approximately 25 deaths out of 250,000 liposuction procedures per year).

A study published in the scientific journal, Dermatologic Surgery, shows that office-based liposuction may be significantly safer than hospital-based liposuction. No deaths were reported by dermatologists performing approximately 300,000 procedures from 1995 - 2000.

A review of malpractice claims from the Physicians Insurance Association of America (PIAA) showed that of the 257 claims filed from January 1, 1995 through December 31,1997, less than 1 percent were against dermatologists even though dermatologic surgeons perform more than one-third of the liposuction procedures in the United States. In addition, 89% of claims were against plastic surgeons, with patients undergoing liposuction in a hospital setting accounting for 71% of malpractice claims.

According to statistics from their respective professional organizations, dermatologic surgeons currently perform about 100,000 liposuctions annually, with plastic surgeons accounting for more than 170,000 fat removal procedures per year. "Our study found that liposuction is safest when it is performed as a solo procedure under local (tumescent) anesthesia in an outpatient setting by a board-certified dermatologic surgeon. In fact, our data shows that there have been no deaths from liposuction by dermatologic surgeons." William P. Coleman, III, MD, president of the American Society for Dermatologic Surgery.

According to Dr. Coleman, more risks are associated with:
  • Extracting large amounts of fat
  • Using general anesthesia in a hospital setting
  • Performing multiple procedures during the same surgery
The PIAA study confirmed that patients who had liposuction performed under local anesthesia using the tumescent technique had no fatalities and fewer complications.

Source: http://www.asds-net.org/lipo_safety.html

According to a study by the ASPS Liposuction Task Force, released in October 1998, the rate of significant complications from liposuction is low. The Task Force reviewed 24,295 liposuction surgeries performed by board-certified plastic surgeons for the study and found that only .03 percent reported significant complications.

Factors that increase the risk of complications include: large volume liposuction, because of the use of greater amounts of fluid and anesthesia, as well as removal of more fat; extended length of surgery; multiple procedures; or a patient whose preoperative health is compromised.

Source: http://www.plasticsurgery.org/mediactr/homework.htm

In 1997 board certified plastic surgeons formed a task force to investigate liposuction safety. Their research led to increased efforts by ASAPS and other plastic surgery organizations to re-educate plastic surgeons about risk reduction in lipoplasty procedures. Several measures were identified as ways to increase patient safety, including: 1) using stricter patient selection criteria, 2) limiting the length of surgery, 3) avoiding pre-injection of excessive amounts of fluid and local anesthetic, 4) removing a smaller volume of fat, 5) avoiding the combination of liposuction and certain other procedures, and 6) careful postoperative monitoring.

Beginning in mid-1998, the safety record of lipoplasty performed by board-certified plastic surgeons appears to have improved dramatically. In May 2001, a major survey on lipoplasty safety was published in Aesthetic Surgery Journal, the peer-reviewed journal of the American Society for Aesthetic Plastic Surgery. The survey, covering many thousands of lipoplasty procedures performed by ASAPS members from September 1998 through August 2000, showed that the risk of death from lipoplasty performed as an isolated procedure (not in combination with any other surgeries) was 1 per 47,415 procedures, a nearly 10-fold decrease from rates suggested by earlier published surveys.

Source: http://www.surgery.org

The following tables record the data from that survey.

Nonfatal complications from lipoplasty and lipoplasty combination procedures
for 94,159 lipoplasty procedures performed by ASAPS members: Sept 1, 1998, through Aug 31, 2000


Complication Percent Rate (1 complication in every __ procedures)
Skin slough .0903% 1 per 1107
Ultrasound-assisted lipoplasty skin burns 0.0712% 1 per 1404
Deep vein thrombophlebitis 0.329% 1 per 3040
Pulmonary embolus 0.0266% 1 per 3759
Excessive blood loss 0.0149% 1 per 6711
Fluid overload 0.0138% 1 per 7246
Fat emboli 0.0053% 1 per 18.868
Cannula penetration of abdominal cavity 0.0021% 1 per 47,619
Lidocaine toxicity 0.0021% 1 per 47,619
Surgical shock 0.0011% 1 per 90,909


In the same study, the mortality rate was 0.0021%, or 1 death per 47,415 procedures. "Stated positively, the estimated non-mortality probability is 99.98%."
Source: CE Hughes, Reduction of lipoplasty risks and mortality: An ASAPS survey. Aesth Plast Surg 2001;21:120-127



Large-volume Liposuction May Also Improve Health
By Kathleen Doheny
Wednesday, May 1, 2002

LAS VEGAS (Reuters Health) - Removing large volumes of fat via liposuction may not only improve a woman's appearance, but can also improve her health, according to a new report.

"Being overweight is not just unattractive, it's unhealthy," said Dr. Sharon Y. Giese, a New York City aesthetic surgeon who will report Thursday on the health benefits of large-volume liposuction for women at the annual meeting of the American Society for Aesthetic Plastic Surgery in Las Vegas, Nevada.

In the wake of problems with large-volume liposuction in the last decade, including some patient deaths, professional organizations discouraged its practice. However, doctors still perform large-volume liposuction for very overweight but motivated patients.

For two years, Giese followed the progress of 14 of her patients who underwent "large-volume" liposuction, typically defined as the removal of more than 5 liters of fat at a single session.

Women had fat removed from their back, flanks, abdomen and thighs, as needed. They reduced body weight and achieved reduction of high blood pressure and a reversal of diabetes-related problems. Giese speculates that the reduced body weight may also help ward off problems such as heart attacks.

This approach, Giese cautioned in an interview with Reuters Health, is intended only for women who are 30 to 50 pounds overweight, who have tried diet and exercise to no avail, and who meet other strict criteria. They must, for instance, agree to make substantial lifestyle changes, such as engaging in regular exercise and watching what they eat. She won't perform the procedure on patients with medical problems such as an eating disorder or uncontrolled high blood pressure.

On average, the women studied were 39 years old and had a body mass index (BMI) of 28.8 before the operation. BMI, a measurement based on height and weight, is used to assess obesity and evaluate optimal healthy weight. Adults with a BMI of 25 or higher are considered at risk for diseases related to excess weight, such as high blood pressure. A person who is 5'5" and weighs 150 pounds or 6'0" and 185 pounds has a BMI of 25, for instance.

At the 2-year follow-up, their average weight had dropped from 181 pounds to 170 and their BMI dropped from 28.8 to 27.2. Ten of the 14 had continued successful weight maintenance, defined for the study as the ability to maintain weight at least 5% lower than their preoperative weight.

The only complication was minor, Giese noted. One woman had fluid under the skin temporarily.

It takes about 6 weeks, due partly to fluid retention, to see full results. "A woman who was 40 or 50 pounds overweight 6 weeks later can expect to be 10 to 15 pounds lighter and two clothing sizes smaller," she says. The waist typically shrinks by 4 inches, and Giese added that may also translate to better health, since fat around the middle has been linked to heart disease.

The large-volume operation takes about 4.5 hours, Giese explained, and is done in a hospital under general anesthesia. She charges $8,000 to $16,000 for the surgery, hospital and other fees, depending on how much fat is removed and other factors. Typically, patients return to work in 1 week and can resume normal physical activity after 2 weeks.

Another aesthetic surgeon, Dr. Charles Hughes of Indianapolis, Indiana, who heads the society's body contouring committee, pointed out that only a handful of surgeons around the United States now perform large-volume liposuction, with most of the 385,000 liposuction procedures done annually involving less than 5 liters of fat removal.

Despite earlier problems with the procedure, the large-volume technique may make sense for selected patients, Hughes suggested, if done by an experienced surgeon. He plans to offer the technique, but only after staffing his office with an exercise physiologist and nutrition expert. Patients who are considering the operation should be sure their surgeon is well-trained in the technique and has performed several, he advised.


liposuction scars


Surgical scars are permanent. However, usually only two small incisions (less than 1/4") are made for each area. Incisions are often placed in natural skin creases, are hidden in pubic hair, or inside the belly button so that they are not normally noticeable except on very close observation. Certain areas are easier to hid then others.

To keep scar tissue soft and minimize their appearance, massage them and keep them out of the sun. Massage them with scar minimizing/reduction creams such as Mederma.

Scars by area
Abdomen: at the belly button, bikini line, each side of the abdomen
Arms: along the arm
Breasts: in the breast crease (under the breast)
Chin: under the chin and behind each ear
Knees: usually two tiny incisions per knee, in skin creases
Thighs: depends on fat location, usually on the edge of suctioned area

liposuction satisfaction rates


Questionnaires were sent to 332 patients who had liposuction performed at Alia Clinic (in New South Wales, Australia) in 1999 and 2000. 123 patients responded. "87.8% of respondents were female. The mean body mass index (BMI) was 26.16. A large proportion of patients experienced positive lifestyle outcomes from the procedure: 80.5% were more confident, 74.8% noted an increase in self-esteem, and 87% were more comfortable in clothes. The time since surgery did not influence results."
Source: Goyen MR, Lifestyle outcomes of tumescent liposuction surgery. Dermatol Surg 2002 Jun;28(6):459-62


To view liposuction before and after pictures, check out our
Liposuction Before and After Pictures.


Information provided is for general education about ultrasonic liposuction, tumescent liposuction and other cosmetic surgery procedures. This information is subject to change. Smart Liposuction.com does not guarantee that it is accurate or complete, and is not responsible for any actions resulting from the use of this information. General information provided in this fashion should not be construed as specific medical advice or recommendation, and is not a substitute for a consultation and physical examination by a physician. Only discussion of your individual needs with a qualified physician will determine the best method of treatment for you. All board certified plastic surgeons listed are board certified by the American Board of Plastic Surgery. Board certified plastic surgeons are verified by the American Board of Medical Specialties.

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