One of America’s most common and popular cosmetic procedures – and supposedly one of its safest – can be fatal, researchers say.
Three New York City doctors identified five people who died as the result of “tumescent liposuction” – the latest refinement of the fat-sucking technique – between 1993 and 1998.
“Tumescent liposuction is not a trivial procedure because it has the potential to kill otherwise healthy persons,” the team writes in tomorrow’s issue of The New England Journal of Medicine.
The doctors – Rama Rao, Susan Ely and Robert Hoffman, all associated with New York University Medical Center – blamed the fatalities in part on “lidocaine toxicity or lidocaine-related drug interactions.”
Lidocaine is widely used to slow the heartbeat. It also can be used to deaden the nerve endings of the skin. At toxic levels, it can cause disorientation, slurred speech, respiratory depression and seizures.
Tumescent liposuction is a simple way to “sculpt” the body by recontouring fat deposits, plastic surgeons say.
A fat extractor, often a thin hollow stainless-steel tube, called a cannula, is inserted into the fatty areas between the skin and muscle through small skin incisions.
Then the extractor creates tiny tunnels to break up the fat cells, loosening them so they can be removed by a high-pressure vacuum attached to the end of the cannula.
The technique doesn’t require a hospital setting, can be done using local anesthesia and has a fast recovery rate – all factors that have made it one of America’s most popular plastic surgeries.
The five patients found to have died from the procedure by the New York doctors included two 33-year-old patients, one man and one woman; a 40-year-old woman with asthma, and a 54-year-old woman.
None had a medical condition that would seem to hint at problems to come.
“Deaths associated with earlier liposuction methods resulted primarily from pulmonary thromboembolism (blood clots in the lung) or fat emboli,” the doctors noted, adding that “anecdotes in the lay press suggest that these deaths after tumescent liposuction are not unique.”
One big problem for researchers is that there are “no mandatory reporting or review of adverse events associated with this private performed procedure, so the true incidence of complications and death is unknown,” the doctors added.
The procedure is booming, despite the horror tales.
The American Society of Plastic and Reconstructive Surgeons says the number of liposuction procedures performed by plastic surgeons jumped 200 percent from 1992 to 1997, with 149,042 procedures done in 1997.
But the most recent survey from the American Academy of Cosmetic Surgery reported that 292,942 liposuction procedures were performed in 1996, an increase of more than 300 percent from 1990, the New York researchers pointed out.
They suggested doctors need to re-evaluate certain aspects of the procedure, including the drugs and fluid administered and the amount of fat removed from the patient.
“Drug absorption and drug interactions, fluid management, prothrombogenic factors, and liposuction volume should be re-evaluated for this popular cosmetic procedure,” they said. “Deaths due to cosmetic surgery should be a matter for serious public concern.”