The introduction of liposuction in the United States in 1982 provided a new method for removing localized pockets of excess fat that did not respond to diet and exercise. The creation of the tumescent technique by dermatologic surgeon Jeffrey Klein, MD, in 1987, significantly increased the procedure's clinical efficacy and safety with decreased major side effects, such as bleeding during the procedure. Currently, tumescent liposuction is the standard of care for patients and carries a rate of serious complications that is approximately one tenth to one percent.

A study published in the scientific journal Dermatologic Surgery shows that office-based liposuction may be significantly safer than hospital-based liposuction. Moreover, no deaths were reported by dermatologists performing approximately 300,000 procedures from 1995 to date. This sharply contrasts a recently published survey in the Journal of American Society of Plastic and Reconstructive Surgeons that found that for every 5,000 liposuction procedures performed by plastic surgeons from 1994 to 1998, one patient died-a total of 95 in all.

A review of malpractice claims from the Physicians Association of America (PIAA) from January 1, 1995 through December 31, 1997 showed that of the 257 claims filed during that time, less than one percent were against dermatologists - even though dermatologists perform more than one-third of the liposuction procedures in the United States. In addition, patients undergoing liposuction in a hospital setting accounted for 71 percent of malpractice claims.

According to statistics from their respective professional organizations, dermatologic surgeons currently perform about 100,00 liposuctions annually, with plastic surgeons accounting for more than 170,000 fat removal procedures per year. "Our study found that liposuction is safest when it is performed as a solo procedure under local (tumescent) anesthesia in an outpatient setting by a board certified dermatologic surgeon," said William P. Coleman, III, MD, Clinical Professor of Dermatology at Tulane Medical School in New Orleans and co-author of the study.

"In fact, our data shows that there have been no deaths from liposuction by dermatologic surgeons, probably because the proper procedures are followed," added Dr. Coleman, President of the American Society for Dermatologic Surgery, which is credited with developing stringent guidelines of care for liposuction surgery.

The tumescent technique injects large volumes of salt water, containing a local anesthetic into the targeted fat before it is suctioned out. The patient typically receives local anesthesia alone, rather than general anesthesia. Dermatologists receive advanced training in this procedure with an emphasis on using local anesthesia and limiting the extraction of large volumes of fat during a single procedure.

While all surgical procedures carry some risk, experts say the risks associated with liposuction can almost always be traced back to a physician adopting an overly aggressive approach to the procedure. The PIAA study confirmed this finding and demonstrated that the primary predictor of complications after liposuction was the use of general anesthesia. Patients who had liposuction performed under local anesthesia using the tumescent technique had no fatalities and fewer complications.

According to Dr. Coleman, some of the aggressive approaches which patients should be aware of when considering treatment and selecting a physician include:

• Extracting large amounts of fat
• Using general anesthesia in a hospital setting
• Performing multiple procedures during the same surgery

"The favorable safety record of dermatologic liposuction reflects a conservative approach to the procedure," concluded Dr. Coleman.

(Dr. Robert Gordon performs liposuction strictly with the tumescent technique using local anesthesia in his in-office surgical suite.)

Source: William P. Coleman, III, MD, Clinical Professor of Dermatology at Tulane Medical School and co-author of the study.