Liposuction Safety Questioned
Researchers say at least five patients have died after liposuction in New York and one other U.S. city, raising questions about the safety of the nation's most popular type of cosmetic surgery.
Until now, there have been occasional news stories of patients dying after liposuction, a procedure in which unwanted body fat is vacuumed out. But a report in Thursday's issue of the New England Journal of Medicine is the first detailed account in a medical journal.
Doctors reviewing six years of autopsy records in New York City found four patients who had died after liposuction. A fifth death came from another state, which the doctors would not identify.
"We suspect it's a rare occurrence," Dr. Rama B. Rao said. "However, it's not rare enough. The bottom line is that a cosmetic procedure that is not necessary to maintain life or health of patients should have as close to zero risk as possible."
Vacuuming away fat has replaced the nose job as the most common cosmetic surgery in the U.S., reports CBS News Correspondent Maggie Cooper. As the procedure has become less complicated, more doctors are doing it, causing critics to claim that the risks have increased.
Plastic surgeons maintain liposuction is extremely safe, although they acknowledge rare deaths do occur. Some criticized Rao's report as unscientific and questioned the journal's decision to publish it.
Last year, 172,079 Americans underwent liposuction, according to the American Society of Plastic and Reconstructive Surgeons. The total has more than tripled since 1992.
CBS News Health Contributor Dr. Bernardine Healy describes the procedure as "a little bit gruesome," and she advises those who are considering liposuction to choose their doctors carefully.
During the procedure, doctors typically inject large amounts of salt water beneath the skin, along with the anesthetic lidocaine and adrenaline, which shrinks blood vessels and reduces bleeding. Then surgeons insert a tube into the fat layer and vacuum it out.
The procedure is typically done to flatten out thighs, tummies and love handles, but it is not recommended for general weight loss.
Rao and colleagues from the New York City Poison Control Center reviewed 48,527 city autopsies done between 1993 and 1998. They found four deaths linked to liposuction. The procedure was probably done tens of thousands of times in the city during this period. The fifth case came to light when it was referred to the New York City medical examiner's office for consultation.
Two of the patients died of cardiac arrest during the procedure. One was stricken by fluid buildup in the lungs two hours afterward. One suffered blood clots in the lungs the next day. The fifth died of complications of low blood pressure and slow heartbeat, but the family refused to allow the release of details.
While the autopsy reviews could not clearly pinpoint liposuction as the cause of the deaths, Rao said,
She speculated that a bad reaction to lidocaine could have caused the deaths of the three patients with heart problems. She noted that liposuction involves injecting considerably higher amounts of the anesthetic than is used for other procedures, such as dentistry.
Dr. Paul Schnur of the Mayo Clinic in Scottsdale, Ariz., said the plastic surgeons society anonymously surveyed its members two years ago and found five reports of deaths during plastic surgery. He was unsure whether any matched the ones in the journal report.
Schnur, the society's president, said it issued guidelines two years ago to help make the procedure safer, and new ones will be coming out soon on the use of anesthetics and preventing clots.
"The risks are surprising low, but it's not risk-free," said Dr. Gregory G. Gallico of Massachusetts General Hospital. "With all cosmetic surgery, there is a risk of death." However, he said the journal article "may overstate the issue and not examine it as scientifically as possible."
He and other plastic surgeons said the New York doctors offered no clear evidence to support their argument that too much lidocaine was to blame.
Dr. Rod Rohrich, chief of plastic surgery at the University of Texas Southwestern Medical Center in Dallas, argued that the report "should not have been accepted in any journal. They plucked five cases out of thousands done in New York City with no data on exactly how they died."