Lowdown On Liposuction

Cherie Ferraris is no slacker. The 51-year-old flight attendant eats reasonably, exercises regularly and carries just 128 pounds on a 5-foot-4-inch frame. But fat has always collected on her belly. "No matter how much I worked out, this lump was still there," she says. "My stomach was bigger than my butt." Then Ferraris discovered liposuction. Last fall, in a two-hour, $6,000 procedure, Dr. Anthony Geroulis of Northfield, Ill., vacuumed about three pounds of fat from her midsection through a thin metal straw. She felt some pain for a few days--"like I'd done too many sit-ups"--and had to wear a compression garment for five weeks. But she has no complaints. Though her weight is virtually unchanged, she's finally able to wear fitted clothing. "I wouldn't hesitate to do it again," she says.

Plastic surgeons, dermatologists and other physicians performed roughly 400,000 liposuctions last year, making it the nation's leading cosmetic procedure. The elective operation is a gold mine for physicians, who can select patients and set fees without scuffling with health insurers. And the great majority of recipients come away happy and unharmed. But liposuction is still serious surgery--and as a study from last week's New England Journal of Medicine reminds us, surgery can have serious consequences. By scouring New York City death records, researchers identified five patients who died after liposuction from 1993 to 1998. The blunt conclusion: this routine procedure can "kill otherwise healthy persons."

The deaths reviewed in the new study all involved variations on "tumescent" liposuction, a popular technique developed by dermatologists in the late 1980s. Unlike earlier techniques, which required hospitalization and general anesthesia and often involved blood transfusions, tumescent liposuction can be performed in a doctor's office with the patient under conscious sedation. The physician injects the unwanted fatty tissue with several quarts of fluid, which is spiked with lidocaine (to block pain) and epinephrine (to constrict blood vessels and minimize bleeding). The water-logged fat cells are then sucked out with the fluid through keyhole incisions. The procedure saves time, blood and money--unless something goes awry.

Two of the five deaths described in last week's study had obvious causes. A 225-pound woman died 18 hours after surgery, when blood clots that formed in her legs traveled to her lungs. Another woman died when the excessive fluids administered during a four-hour procedure filled her lungs. The other patients all experienced mysterious drops in blood pressure and heart rate--followed by cardiac arrest--and the researchers suspect that lidocaine is somehow to blame. People undergoing tumescent liposuction receive up to eight times the doses normally used as local anesthesia. Experts have long assumed that when lidocaine is pumped into fatty tissue, it enters the bloodstream too slowly to cause harm. But blood levels can rise rapidly once the liver becomes saturated. And the sedatives given during liposuction may hasten that event by competing with lidocaine for access to liver enzymes.

The authors of the new study conclude that tumescent liposuction may pose unpredictable hazards. But advocates of the procedure insist it's safe when performed as intended. Though people often think of it as a weight-loss technique, experts agree that it shouldn't be used as a treatment for obesity (three of the New York patients weighed more than 200 pounds). People should diet and exercise first, says Dr. Jeffrey Klein, the California dermatologist who pioneered the technique, and use liposuction to trim any small, stubborn deposits that persist. Though tumescent liposuction was conceived as a gentle alternative to hospital surgery, Klein says, some surgeons are now using it to perform aggressive, whole-body makeovers. At least three of the New York patients required general anesthesia. "It's often said that the riskier cases should be done in a hospital," he says. "In truth, they shouldn't be done at all."

What lessons can patients draw? First, choose your doctor carefully. Any M.D. can perform liposuction, but many lack the proper training. Pick one who is board certified in surgery or dermatology, and ask about his experience with the technique. Above all, don't chase miracles. The come-ons "make it sound easy," says Ruben Fernandez of La Habra, Calif., whose 47-year-old wife, Judy, died during a tumescent procedure two years ago. The physician in charge had excellent credentials--and a grossly inflated sense of what the technique could accomplish. His license was later revoked. With liposuction, less really is more.