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The Aftermath of Liposuction

Patients should expect discomfort after a surgery like liposuction, says Ann Graham, senior nurse consultant in CDRH's Office of Surveillance and Biometrics. "Patients are bloated, have wounds all over, and are feeling distended."

Surgeons should discuss such conditions with their patients beforehand, says Jack Bruner, M.D., associate clinical professor of plastic surgery at the University of California, Davis, and chairman of the task force on liposuction for American Society of Plastic Surgeons (ASPS).

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"We talk about excessive bruising and chronic and prolonged swelling," he says, adding, anytime there's an injury—and liposuction surgery is really a controlled injury—body fluid rushes to the site and the injured tissue becomes like a sponge, he explains. With liposuction, doctors have gone under the carpet of skin and have taken away the fat undercoating, so the raw surface oozes serum on the inside.

To control the swelling, Bruner has his patients wear a garment with elastic pressure, reaching from below the breast area to mid-thigh. "This gives good compression, and if we don't do that, the body swells up like the Michelin man," he says.

The skin sticks to the undersurface, and as it starts to heal the fluid stops oozing and the swelling goes away. "At the end of three weeks, 90 percent of the swelling and bruising are gone," he says, although patients may wear the elastic garment for up to six weeks.

Deaths and Liposuction

According to a survey conducted by the American Society of Plastic Surgeons of more than 1,500 plastic and reconstructive surgeons in January, 1999, the death rate of one in every 5,000 (or 20 out of 100,000) liposuction patients between 1994 and 1998 was much higher than anyone anticipated—higher even than death rates from traffic accidents.

And higher than acceptable death rates from other kinds of surgeries, admits Bruner. Although the survey data are not considered scientific information, they are useful when establishing practice guidelines, and they led ASPS to recommend some practice changes when performing liposuction.

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It is encouraging, Bruner says, that more recent statistics from The Doctor's Company, an insurance company located in California, show that no liposuction-related deaths have been reported there in the last 18 months. However, he notes, this survey only addresses what's happening among board-certified plastic surgeons, not with other doctor groups performing liposuction.

Deaths among liposuction patients can happen for a number of reasons, Bruner says, including thromboembolism, or a blood clot that forms in the deep veins of the pelvis or legs. "That can happen during any surgery," he adds, "and I wish I could say that it is always preventable, but it is not."

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Next, he cites perforation of the abdominal wall or bowels, the latter being especially serious. "If you perforate the bowel, there's a high mortality rate if it's not fixed in the first 24 to 48 hours," he says. Physicians are essentially blind as they perform liposuction because they can't see what is in front of the cannula, notes FDA's Horbowyj.

Finally, Bruner notes that shock and hemodilution, or diluting of the blood, may lead to a patient's death. This can occur when patients have had large amounts of fluids injected and then both fat and fluids removed, about 11 pounds worth in all during a larger-scale procedure.

Further, although virtually no hard data exist, says Bruner, he and others worry that too much lidocaine may also lead to death. Lidocaine use poses particular hazards, especially since experts do not agree on safe injectable levels. "If you get too much lidocaine for too long," says Bruner, "the heart muscles become lazy. On the other hand, the brain becomes very agitated at first, which may cause a seizure, before coma sets in."

At least one study links possible lidocaine toxicity to liposuction deaths, says Horbowyj, adding that people with less than normal liver function or those who have been drinking alcohol may not be able to metabolize lidocaine well.

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