DOCTOR'S VIEW ARCHIVE

One Danger of Liposuction -- Death

Liposuction is now the most common cosmetic surgery in the U. S. with over 400,000 of these procedures done annually. Liposuction involves the surgical suctioning of fat deposits from specific parts of the body. The most common target areas are the abdomen, buttocks, hips, thighs, knees, chin, upper arms, back, and calves.

Liposuction breaks up and "sucks" fat out of the body through a hollow instrument (a cannula) inserted under the skin (subdermally). A strong vacuum is applied to the cannula.

In ultrasonic-assisted liposuction (UAL), the cannula is energized with ultrasonic energy which causes the fat to melt away on contact. This method offers an advantage in treating scar tissue in areas 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, the 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. This procedure involves pumping several quarts/liters of a solution below the skin (subcutaneously) in the area to be suctioned. The solution consists of salt water (saline) to which is added the local anesthetic lidocaine to numb the surgical site and the vessel-constrictor epinephrine (adrenaline) to help minimize bleeding. The fat is then suctioned out through small tubes. Tumescent liposuction is now the most common 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 ages 33 to 54. Four of the 5 patients were women. All 5 had received lidocaine. Three died because their heart rate became too slow (bradycardia) and their blood pressure dropped dangerously (hypotension). It is well known that lidocaine lowers the heart rate. In fact, lidocaine is sometimes used as an emergency measure to slow dangerously rapid heart rates.

One patient died of a 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. During a tumescent liposuction procedure of the legs, the patient developed a clot (thrombosis) in her calf veins, which 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 unfavorable interactions of lidocaine with other medications the patient may be taking.

No matter which technique is used, liposuction is considered completely cosmetic and therefore entirely optional (elective). 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.)


Last Editorial Review: 7/25/2002