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.)

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