An article just released in Clinical Anesthesiology suggests that liposuction is no safer now than it was before and that it may actually be dangerous. Is that completely accurate? Yes and no.
To begin with, the article is a good overview and definitely points to some of the concerns that we all, as practitioners, have regarding safety issues. But the problem is that it seemingly lumps all practitioners into the same basket. And that is simply not the case.
The main concerns raised by the authors include the following:
- • Fat emboli
- • Toxic levels of local anesthetic
- • Anesthesia-related complications
- • Surgery by “Cosmetic Surgeons”
- • Limited oversight
Their first concern is that the process of liposuction itself can break off small pieces of fat that are then released into the bloodstream. When these fatty emboli travel, they can increase whole body inflammation and may even lead to greater complications. Does this happen? It probably does and potentially underscores the need for monitoring of all patients following this type of procedure (at least in the immediate post-operative period). Most importantly, it emphasizes the need for monitoring of patients during the actual procedure and raises the question of how safe the procedure really is when performed in an office setting.
Next, the authors suggest that patients who undergo tumescent liposuction may have extremely high blood levels of local anesthetic as a result of the “wetting solution” used to keep patients comfortable both during and after the actual procedure. While this may be a valid point in some cases, if practitioners adhere to safety recommendations made by the American Society of Plastic Surgery (ASPS), these levels should actually be safe. The problem occurs when more local anesthetic is needed because the practitioner is performing liposuction under local anesthesia alone. This can often be the case with in-office procedures. Under general anesthesia, you are completely asleep and pain is controlled through IV medications. When IV sedation or a pure local tumescent approach is used, there is far more reliance on high levels of local anesthesia to keep you comfortable. And when this happens, there is an increased risk for toxic blood levels of these local anesthetic agents.
The third concern raised is really questionable. The authors speak to complications related to the process of anesthesia itself. These complications can be secondary to a number of factors but several specific complications cited really have nothing specific to do with liposuction itself and can occur with many other procedures (both elective and non-elective). Here, the real question is how well trained your anesthesiologist is and how prepared he/she is to not only prevent complications before they occur but also to address them when they do.
The last two concerns are really the biggest and are the foundation for a tremendous amount of frustration among Plastic Surgeons nationwide. As the result of a number of global changes in US Healthcare including decreasing reimbursement, many physicians from both surgical as well as non-surgical backgrounds are suddenly entering the arena of Plastic Surgery. And many of them are doing so with very little training. The scary thing is that a good number of them have no surgical background whatsoever. These physicians are effectively calling themselves “Cosmetic Surgeons” and may have as little experience as a weekend course before they meet you, their first patient. Add to this the fact that there is very little oversight and the problem is compounded further.
Keep this scary thought in mind: my medical degree gives me full license to practice whatever type of medicine that I would like to. Tomorrow, I could actually open my own surgery center, perform open-heart surgery or brain surgery or transplant surgery even though my only experience was rotating on these services years ago as a physician-in-training. Now, consider the fact that some of these new “Cosmetic Surgeons” are physicians who have never even been exposed to surgical training other than a post-training weekend course and the problem becomes scarier. And when various surgical societies have tried to increase regulation, they are told that their efforts are simply meant to protect turf and their own interests. Believe me…I have been told that very statement.
In the end, the best way to increase your chances for a good outcome is to fully educate yourself before any procedure. You need to know who can safely perform your desired procedure, how many procedures they really have performed, what their success rate is, and what they are actually trained to do. Armed with information, you are taking your life into your own hands in a very positive way; without it, you are handing your life over to someone who may have never performed a Plastic Surgery procedure in the past and who may not have the skills to perform it safely.
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