Definition of Liposuction
Liposuction: The most common cosmetic operation
in the U. S. with over 400,000 such surgical operations done
annually, liposuction involves the surgical suctioning of fat
deposits from specific parts of the body, the most common being the
abdomen (the "tummy"), buttocks ("behind"), hips,
thighs and knees, chin, upper arms, back, and calves.
Liposuction breaks up and "sucks" fat out of the body. This
is done through a canula (a hollow instrument) inserted
subdermally (under the skin). A strong (high-pressure)
vacuum is applied to the cannula.
In ultrasonic-assisted liposuction (UAL), the cannula is energized
with ultrasonic energy, causing the fat to melt away on contact, an
advantage in areas of scar tissue such as the male breast,
back, and in areas of prior liposuction. The disadvantages
of UAL include the need for longer incisions in the skin,
potential for skin or internal burns, greater cost, and
longer time.
The technique of tumescent liposuction has become especially
popular, in part because of its purported safety. It involves pumping
several quarts/liters of a solution below the skin (subcutaneously)
in the area to be suctioned. The solution is salt water (saline) to
which is added the local anesthetic lidocaine to numb the area
and the vessel-constrictor epinephrine (adrenaline) to help minimize
bleeding. The fat is suctioned out through microcannulas (small
suction tubes). Tumescent liposuction is now the most used form of
liposuction.
Five deaths after tumescent liposuction were found among 48,527
deaths referred to the Office of Chief Medical Examiner of the City
of New York from 1993 to 1998, according to a report published in The
New England Journal of Medicine.
The 5 victims ranged from 33 to 54. Four of the 5 were
women. All 5 had received lidocaine. Three died because their heart
rate became too slow (bradycardia) and their blood pressure dropped
precipitously (hypotension). It is well known that lidocaine lowers
the heart rate. In fact, it is sometimes used as an emergency measure
to slow dangerously rapid heart rates.
One patient died of fluid overload. She had been given more than
13 quarts of fluid, 7 intravenously and 6 pumped into the surgical
sites which included the breasts (for enlargement), chest, arms,
back, abdomen, thighs, buttocks and knees. The excess fluid collected
in her lungs (pulmonary edema) and she essentially drowned to death.
The fifth patient died of a blood clot in the lungs. She had
tumescent liposuction of the legs, developed thrombosis (clot) in her
calf veins, the clot broke loose (embolized) and
wedged in her lungs (pulmonary thromboembolism).
Tumescent liposuction can be fatal, conclude the authors of the
report, Drs Rama B. Rao and Robert S. Hoffman of New York
University Medical Center and Bellevue Hospital and Dr. Susan F. Ely,
forensic pathologist in the Office of the Chief Medical Examiner of
New York City. The danger of tumescent liposuction appears to be due,
at least in part, to the lidocaine -- the toxicity of lidocaine and
untoward interactions of lidocaine with other medications the patient
may be taking.
No matter how liposuction is done, it is considered completely
cosmetic and therefore completely elective (entirely optional). The
central question now looming with liposuction would seem to be:
"Are any deaths justifiable with a completely cosmetic procedure?"
(Source: N Engl J Med 1999;340:1471-5.)
Last Editorial Review: 12/16/1998 12:37:00 PMCommon Misspellings: lipo
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