Clarification of Answer by
19 Jan 2003 21:17 PST
Hi again smart26dude-ga,
I found you an excellent article that discusses everything about
liposuction, including pros, cons, and techniques. I've pasted an
excerpt below. Please have a read.
The important conclusion from the article is, "Fighting fat may be the
number one battle for many Americans, but liposuction may not be the
best weapon to win that slimmer, trimmer body." They also suggest that
"the ideal liposuction candidate is a mature adult between the ages of
30 and 50 years old, male or female, in good health, who has dieted
and exercised to lose unwanted pounds, with good skin tone, with a set
of realistic expectations, and who wants a limited procedure for body
contouring." Note that liposuction is recommended as an option only
AFTER the person has tried improving their diet and getting more
Also note the long-term problems associated with removing fat cells
from your body. This is discussed at toward the end of the article.
The fat may show up at strange places on your body years later.
Beware of what the surgeon tells you. Remember the old saying "Give a
man a hammer and everything starts to look like a nail". A plastic
surgeon may not necessarily have your best interests in mind, he has
Mercedes payments to make.
This is an excellent article worth reading in full. I would advise you
to take the time to read it before you make a decision. Again, my
personal advice is to focus on improving your diet (lots of fruits,
grains and greens, less meat) and to exercise more (weight training,
cardio), and to be 100% natural! I could play along and find you
articles on all the positives of plastic surgery and tell you to go
for it, and you may be satisfied with my answer, but I'd rather speak
the truth. And sometimes the truth may not always be what you want to
hear, but I believe it was no coincidence that I ended up being your
"advisor" on this topic. I have your best interests in mind, and this
is the same advice I would give to a loved one. Decades from now you
will think back and be glad that you made the right decision, and that
you made the best of what nature gave you and respected your body.
Smart26dude-ga, we live in a society that is obsessed with quick
fixes. This is not sustainable. The world as we know it is falling
apart around us. Come back to the basics, look beyond the superficial.
I don't know if you believe in God, but try this, pray about this
decision, or at least, speak to your inner self and ask yourself if
this is right.
Again, if you still need further information or more thoughts, I'm
Planning To Look Flab-u-less? Know the Facts About Liposuction
by Alexandra Greeley
But the rise in its popularity and changes in the techniques doctors
use to perform liposuction have raised concerns within FDA. There is
growing evidence that the increased aggressiveness with which the
procedure is performed--especially the amount of tissue sucked from
the body, the venues in which the procedures are performed, and the
amount of anesthesia used to sedate patients during increasingly
lengthy procedures--may be increasing the risk of post-surgical
complications and even death.
How Liposuction Works - Conceptually, liposuction (or lipoplasty) is a
straightforward technique in which excess fatty tissue is suctioned
from beneath the skin. Prior to surgery, doctors flush the targeted
area or areas with a solution composed of lidocaine (a local
anesthetic similar in its numbing effects to novocaine), saline, and
epinephrine (a drug that constricts blood vessels and thus reduces
bleeding during surgery).
Then doctors insert a hollow wand-like device called a cannula through
incisions in the skin. They push and pull the cannula around through
fatty deposits, breaking up the cells, which, along with other body
fluids, are suctioned out by an attached vacuuming device.
It's a simple system, says Stephen Rhodes, chief of the plastic and
reconstructive surgery devices branch in FDA's CDRH. "It's essentially
just a cannula and a vacuum." However, these products have only been
approved for body contouring, and are not intended for large-scale fat
removal, an increasingly popular use of liposuction.
There are several liposuction techniques available today. The amount
of injected fluid determines the technique used, explains Peter B.
Fodor, M.D., chief of plastic surgery at Century City Hospital in Los
Angeles and spokesman for the American Society for Aesthetic Plastic
In the "dry" technique, which few doctors use anymore, no fluid is
injected into the targeted area.
For "wet" liposuction, the surgeon injects only a small amount of
fluid, about six to eight ounces and usually containing small amounts
of ephinephrine, regardless of how much tissue is subsequently
The "superwet" technique evolved, says Fodor, because doctors found
that the more fluid they injected--up to a point--the less blood was
lost. "We found that by injecting one cc of solution for each cc of
aspirate [amount of tissue and fluid removed], the blood loss was
negligible." Although lidocaine is sometimes added when performing wet
or superwet liposuction, patients will also receive general or
In the tumescent technique, doctors inject up to five times as much
fluid as aspirate. Because the injected fluid also contains large
amounts of lidocaine, tumescent liposuction is generally performed
with only a local anesthetic.
Many doctors are offering a modified version of the procedure that
calls for using ultrasound in addition to the injected solution and
the suctioning. Rhodes and others at the FDA are especially concerned
about this practice, which calls for using devices not approved for
liposuction--that is, special cannulas that vibrate at high rates and
emulsify fat tissue before its removal. The wand generates a great
deal of heat, and if doctors don't move it constantly, it can cause
severe burns. As Roxolana Horbowyj, M.D., senior medical officer in
CDRH, points out, a temperature increase of 20 degrees Celsius (about
36 degrees Fahrenheit) may encourage cell death. And, as FDA
epidemiologist Brown notes, "We don't really know the long-term
effects of ultrasound on tissues."
Understanding the Benefits vs. the Risks - In a society in which
beauty is often measured by slender bodies and youth, it is no wonder
that thousands of Americans chase the "perfect" look by means of
liposuction. Portrayed in upbeat tones and associated with Hollywood
glamour, liposuction seems to offer instant help for unsightly bulges.
Consumers checking out liposuction Web sites on the Internet are
further assured by the positive information they find.
"There are probably hundreds of thousands of patients who have had
body sculpting without complications," says Ann Graham, senior nurse
consultant in CDRH's Office of Surveillance and Biometrics. "But we
are concerned about the published reports of patients who have not had
a good outcome. They have undergone liposuction for weight reduction,
not just body sculpting. Liposuction, in general, is a purely elective
procedure. As such, our tolerance for an unsafe or harmful outcome is
Although many consumers think of liposuction as a quick and permanent
fix, it's likely that few understand its risks and frequently
temporary results. There is no national group of consumers, nor one
group representative of all clinicians, that is organized to oversee
liposuction procedures and results. Although FDA is aware of problems
published in medical literature and described by other sources, "very
few adverse event reports are coming into the agency through its
formal reporting channels" according to Anita Kedas, a nurse
consultant in CDRH's Office of Surveillance and Biometrics. But the
small number of reports may simply mean that negative outcomes aren't
Office-based procedures may present the greatest reporting problem.
There's no requirement that adverse events from office procedures be
reported, and most procedures are done in offices, according to
Graham. Even if offices are well equipped, she adds, patients often
need days of continuous support such as rehydration, pressure
dressings, and good nursing care, while others actually need
resuscitation and hospitalization to recover. And if a patient goes to
the emergency room for care, FDA doesn't hear about it, adds Graham.
Whether reported or not, liposuction problems are real enough--though
some, such as wavy or uneven skin after fat removal, are not medically
But others are. Overworking the heart can be a serious side effect of
the tumescent technique. "Let's say they plan to remove 5,000 cc's of
aspirate," says plastic surgeon Fodor, "so they inject a dangerously
large amount of fluid. The patient would be practically 'drowning' in
fluids. The heart can't handle this fluid overload."
Another potential complication is infection, says Brown. Infections
can occur after any surgery. Sometimes, infections may be serious or
life threatening such as in cases of necrotizing fasciitis (when
bacteria eat away at tissue) or toxic shock syndrome, a serious
infection which has been associated with tampon use but may also be
associated with surgery, says Brown.
Other possible problems Brown lists are burns, embolisms, cardiac
arrhythmia, edema, and nerve compression, which are all reported in
the medical literature. Often, too, Graham notes, cannulas are
inserted in several different locations, resulting in puncture wounds
that need to heal.
A condition called seroma, or an oozing or pooling of serum, or body
fluid, may be a problem after the more aggressive ultrasound
techniques during which some skin is detached from underlying tissue
and fluid accumulates in a subcutaneous pocket.
Deaths and Liposuction - According to a survey conducted by the
American Society of Plastic Surgeons (ASPS) 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 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
ASPS. 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
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." 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.
After Surgery - Patients should expect discomfort post-surgery, says
Graham. "Patients are bloated, have wounds all over, and are feeling
Surgeons, says Bruner, should discuss such conditions with their
patients beforehand. "We talk about excessive bruising and chronic and
prolonged swelling," he says. 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
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.
Is Liposuction for Everyone? - Many people develop stubborn fatty
deposits--like in the buttocks or upper thighs, or the so-called "love
handles"--that are resistant to dieting and exercise. And although
most people would admit to wanting to reshape their body in some way,
not everyone makes an ideal liposuction candidate, says Daniel
Morello, M.D., president of the American Society for Aesthetic Plastic
Surgery. Morello stresses that liposuction is for body contouring, not
weight reduction. "It is designed for removing localized areas of
fatty tissues--not as a substitute for proper dietary management and
But what happens to the mildly to seriously overweight people who want
and get liposuction? Sometimes after the surgery, these people may
face yet another unwanted--and possibly unexpected--complication: the
return of fatty deposits, but probably in other areas of the body,
says C. Wayne Callaway, M.D., an associate clinical professor of
medicine at George Washington University. Callaway, who is also an
internist, endocrinologist, and obesity specialist in Washington,
D.C., sees post-liposuction patients complaining of renewed
accumulations of fat.
Animal studies have shown that if you remove significant amounts of
fat from one area, body fat increases elsewhere, according to
Callaway. "The signal is leptin, a hormone made in fat cells," he
says. "The more fat you have, the more leptin is made ... and if a
large amount of fat is removed, there is a drop in leptin levels." In
animal studies, this drop in leptin levels results in an increase in
food intake and a decrease in activity until the leptin levels are up
again, according to Callaway.
Callaway says that the people who have the most trouble after a
liposuction procedure are the really obese who have had large amounts
of fat removed. "They have a compensatory increase in new fat cells,"
Callaway says. "And fat goes to areas where there are still a lot of
fat cells. So that means to the neck, above collar bones, and the
upper abdomen." Besides, he adds, abdominal obesity is controlled by a
whole other set of signals, so that even after liposuction, the
underlying causes for obesity remain. "Those causes are not addressed
by taking out fat cells." He points out that, contrary to recent
theories, "One can keep making new fat cells throughout life, so
little can be gained by liposuction."
Liposuction for obese patients is "a prescription for disaster,"
according to Gerald Imber, M.D., a plastic surgeon in New York City
and clinical assistant professor of plastic surgery at Cornell-Weill
Medical College. The greater the volume of fat and tissue fluids,
including plasma, that are sucked out, the greater the chance of
severe dehydration and electrolyte imbalances. "When you remove six,
eight, or ten liters of mixed fat and water, you are courting
disaster," he says. "Liposuction is not meant to change a size 16 to a
According to a consensus of the experts, the ideal liposuction
candidate is a mature adult between the ages of 30 and 50 years old,
male or female, in good health, who has dieted and exercised to lose
unwanted pounds, with good skin tone, with a set of realistic
expectations, and who wants a limited procedure for body contouring.
Fighting fat may be the number one battle for many Americans, but
liposuction may not be the best weapon to win that slimmer, trimmer
Alexandra Greeley is a writer in Reston, Va.
Buyer Beware - Anyone considering liposuction should consider all the
options, and consumers need to be very careful when selecting a
doctor. The saying "caveat emptor" (buyer beware) has never been
truer, says Morello. Liposuction sounds so deceptively simple, but in
the hands of unskilled doctors, it poses a real threat to people's
health, he adds. To complicate matters, anyone with a medical degree
can perform liposuction, even with only the briefest weekend training