Does the location of the surgery or the specialty of the physician affect malpractice claims in liposuction?

Litigation Arising From Minimally Invasive Cosmetic Procedures: A Review of the Literature

BACKGROUND

Minimally invasive cosmetic procedures are on the rise. To meet this rising demand, increasing numbers of physicians and nonphysicians are performing these procedures. Understanding malpractice trends and reasons for litigation in cosmetic medicine is important to establish safeguards for patient care and minimize liability.

OBJECTIVE

Perform a comprehensive review of the literature on litigation associated with minimally invasive cosmetic procedures and discuss strategies to avoid facing a lawsuit.

MATERIALS AND METHODS

The authors searched PubMed databases using a variety of keywords to identify studies of lawsuits arising from minimally invasive cosmetic procedures through December 2020.

RESULTS

A total of 12 studies of litigation meeting inclusion criteria were identified: botulinum toxin (1), soft tissue fillers (3), lasers (5), body contouring/liposuction (1), chemical peels/dermabrasion (1), and sclerotherapy (1). Principle factors associated with litigation included negligence, lack of informed consent, vicarious liability for action of delegates, lack of communication, poor cosmetic result, failure to inform of risks, inappropriate treatment or dose, and failure to recognize or treat injury.

CONCLUSION

Understanding malpractice trends and reasons for litigation in minimally invasive cosmetic procedures can strengthen the patient-provider relationship, establish safeguards for patient care, and may minimize future risk of a lawsuit.

Safety of Tumescent Liposuction Under Local Anesthesia in 9,002 Consecutive Patients

BACKGROUND

Liposuction has become one of the most popular aesthetic procedures today. Among the different anesthesia methods, tumescent local anesthesia (TLA) has been shown to be the safest. Liposuction is typically performed as an outpatient procedure under minimal oral sedation and without the need for any intravenous (IV) fluid administration.

OBJECTIVE

To record complications in a larger series of patients undergoing liposuction in TLA.

MATERIALS AND METHODS

Between 2003 and 2020, 9,002 consecutive patients underwent liposuction in TLA with the same team of surgeons. The occurrence of complications was recorded in detail.

RESULTS

There were neither fatal complications nor damage to deeper structures such as nerves, blood vessels, muscles, lungs, abdominal organs, nor permanent lymphedema. A total of 19 of the following side effects, mainly minor, required closer follow-up or intervention: allergic drug reaction to doxycycline (0.06%), seroma (0.04%), large hematoma (0.03%), erysipelas (0.02%), transient acrocyanosis (0.02%), deep vein thrombosis (0.01%), skin necrosis (0.01%), and generalized edema (0.01%).

CONCLUSION

Liposuction in TLA is a reliable and safe procedure if it is performed by an experienced surgeon and the guidelines of care are strictly followed.

Evidence-Based Medicine: Liposuction

LEARNING OBJECTIVES

After studying this article, the participant should be able to: 1. Review the appropriate indications and techniques for suction-assisted lipectomy body contouring surgery. 2. Accurately calculate the patient limits of lidocaine for safe dosing during the tumescent infiltration phase of liposuction. 3. Determine preoperatively possible "red flags" or symptoms and signs in the patient history and physical examination that may indicate a heightened risk profile for a liposuction procedure. 4. Provide an introduction to adjunctive techniques to liposuction such as energy-assisted liposuction and to determine whether or not the reader may decide to add them to his or her practice.

SUMMARY

With increased focus on one's aesthetic appearance, liposuction has become the most popular cosmetic procedure in the world since its introduction in the 1980s. As it has become more refined with experience, safety, patient selection, preoperative assessment, fluid management, proper technique, and overall care of the patient have been emphasized and improved. For the present article, a systematic review of the relevant literature regarding patient workup, tumescent fluid techniques, medication overview, and operative technique was conducted with a practical approach that the reader will possibly find clinically applicable. Recent trends regarding energy-assisted liposuction and body contouring local anesthesia use are addressed. Deep venous thromboembolism prophylaxis is mentioned, as are other common and less common possible complications. The article provides a literature-supported overview on liposuction techniques with an emphasis on preoperative assessment, medicines used, operative technique, and outcomes.

Analysis of medical litigation among patients with medical disputes in cosmetic surgery in Taiwan

BACKGROUND

This study aimed to investigate the key factors in medical disputes (arguments) among female patients after cosmetic surgery in Taiwan and to explore the correlates of medical litigation.

METHODS

A total of 6,888 patients (3,210 patients from two hospitals and 3,678 patients from two clinics) received cosmetic surgery from January 2001 to December 2009. The inclusion criteria specified female patients with a medical dispute. Chi-square testing and multiple logistic regression analysis were used to analyze the data.

RESULTS

Of the 43 patients who had a medical dispute (hospitals, 0.53%; clinics, 0.73%), 9 plaintiffs eventually filed suit against their plastic surgeons. Such an outcome exhibited a decreasing annual trend. The hospitals and clinics did not differ significantly in terms of patient profiles. The Chi-square test showed that most patients with a medical dispute (p < 0.05) were older than 30 years, were divorced or married, had received operations under general anesthesia, had no economic stress, had a history of medical litigation, and eventually did not sue the surgeons. The test results also showed that the surgeon's seniority and experience significantly influenced the possibility of medical dispute and nonlitigation. Multiple logistical regression analysis further showed that the patients who did decide to enter into litigation had two main related factors: marital stress (odds ratio [OR], 10.67; 95% confidence interval [CI], 1.20-94.73) and an education level below junior college (OR, 9.33; 95% CI, 1.01-86.36).

CONCLUSION

The study findings suggest that the key characteristics of patients and surgeons should be taken into consideration not only in the search for ways to enhance pre- and postoperative communication but also as useful information for expert testimony in the inquisitorial law system.

Prospective evaluation of dermatologic surgery complications including patients on multiple antiplatelet and anticoagulant medications

BACKGROUND

Few prospective studies have evaluated the safety of dermatologic surgery.

OBJECTIVE

We sought to determine rates of bleeding, infection, flap and graft necrosis, and dehiscence in outpatient dermatologic surgery, and to examine their relationship to type of repair, anatomic location of repair, antibiotic use, antiplatelet use, or anticoagulant use.

METHODS

Patients presenting to University of Massachusetts Medical School Dermatology Clinic for surgery during a 15-month period were prospectively entered. Medications, procedures, and complications were recorded.

RESULTS

Of the 1911 patients, 38% were on one anticoagulant or antiplatelet medication, and 8.0% were on two or more. Risk of hemorrhage was 0.89%. Complex repair (odds ratio [OR] = 5.80), graft repair (OR = 7.58), flap repair (OR = 11.93), and partial repair (OR = 43.13) were more likely to result in bleeding than intermediate repair. Patients on both clopidogrel and warfarin were 40 times more likely to have bleeding complications than all others (P = .03). Risk of infection was 1.3%, but was greater than 3% on the genitalia, scalp, back, and leg. Partial flap necrosis occurred in 1.7% of flaps, and partial graft necrosis occurred in 8.6% of grafts. Partial graft necrosis occurred in 20% of grafts on the scalp and 10% of grafts on the nose. All complications resolved without sequelae.

LIMITATIONS

The study was limited to one academic dermatology practice.

CONCLUSION

The rate of complications in dermatologic surgery is low, even when multiple oral anticoagulant and antiplatelet medications are continued, and prophylactic antibiotics are not used. Closure type and use of warfarin or clopidogrel increase bleeding risk. However, these medications should be continued to avoid adverse thrombotic events.

Tumescent liposuction: a review

Liposuction is a cosmetic procedure to remove fat. Liposuction may be performed either under general anaesthesia or under local anaesthesia. The procedure has been reported to be associated with significant morbidity and risk of mortality under general anaesthesia. Since the first description by Jeffrey Klein, dermatologic surgeons have made significant contributions in this field, and tumescent liposuction using microcannuale under local anaesthesia, is regarded as safe and effective. The author has performed over 200 liposuctions in the last four years in India and this article describes the procedure of microcannular tumescent liposuction in the light of her experience.

Safety of tumescent liposuction under local anesthesia in a series of 4,380 patients

BACKGROUND

Liposuction is increasingly performed under local anesthesia and in an outpatient setting. The term 'tumescent liposuction' has been used in the literature in patients receiving other forms of anesthesia as well, hence the confusion regarding the safety profile of liposuction performed under local anesthesia alone.

OBJECTIVE

To analyze the safety of tumescent liposuction performed under local anesthesia in a larger group of patients.

METHODS

Between 2003 and 2010, 4,380 consecutive patients underwent tumescent liposuction by the same surgeon. The occurrence of complications was recorded in detail.

RESULTS

There were no serious complications requiring hospitalization. There were no injuries, no nerve damage or permanent lymphedema, no deep venous thrombosis or seroma. Seven patients needed closer follow-up due to large hematoma (n = 3; no drainage needed), allergic drug reaction to doxycycline (n = 2), erysipelas (n = 1) and generalized edema (n = 1).

CONCLUSIONS

Tumescent liposuction under local anesthesia is a safe method, providing it is performed by an experienced surgeon and the guidelines of care for liposuction are strictly followed.

Development of a patient safety culture measurement tool for ambulatory health care settings: analysis of content validity

The development of patient safety culture in health care organizations is a necessary precursor to patient safety improvement. However, existing tools to measure patient safety culture are intended for implementation in hospitals. A new, abbreviated patient safety culture survey was developed for use in ambulatory health care settings. This survey was tested for content validity utilizing a panel of six experts. It had a clarity interrater agreement (IR) of 0.75, a clarity content validity index (CVI) of 0.95, a representativeness IR of 0.75 and a representativeness CVI of 0.95. The content validity analysis served as a useful tool for assessing the relevance and comprehensiveness of this survey of patient safety culture in ambulatory care organizations.

Dermatology's malpractice experience: Clinical settings for risk management

BACKGROUND

Dermatologists need objective information that will help them make rational risk management decisions.

OBJECTIVE

We asked, "What can be learned from the limited sources available regarding the clinical situations associated with malpractice litigation against dermatologists?"

METHODS

We searched 2 legal databases, one jury verdict and settlement reporter, and reviewed and analyzed a major report from an association of physician insurers.

RESULTS

A wide variety of clinical circumstances give rise to malpractice claims. Melanoma is still associated with high risk, and common conditions are associated with relative claim frequency. The clinical details currently available do not encourage optimal responses to reports of malpractice cases.

CONCLUSION

Information that clinicians can use in their own risk management efforts can be derived from available sources, but more reliable objective data is needed.

The cutaneous surgery experience of multiple specialties in the Medicare population

BACKGROUND

There has been tremendous growth in the performance of ambulatory surgical procedures. Traditional forms of peer review, commonplace for hospital-based procedures, are not typically performed in the office-based setting. Hospital credentialing of physicians has been suggested to be a means of assuring patient safety. Credentialing committees may be unaware of the level of experience of typical office-based physicians who perform cutaneous surgery.

PURPOSE

To compare the levels of cutaneous surgery experience of dermatologists and other surgical specialists.

METHODS

Medicare claims data on number of cutaneous surgery procedures performed by various medical disciplines, including dermatologists, plastic surgeons, general surgeons, and others, were obtained from the 1998-1999 Medicare Current Beneficiary Survey (MCBS) and analyzed. The number of physicians in each specialty was used to normalize the data to a per physician basis.

RESULTS

Dermatologists performed half (50%) of the complex repairs and most of the excisions (58%) and intermediate repairs (62%). Dermatologists performed more flaps (40% of all flaps) than any other specialty, while plastic surgeons performed more total grafts (38%) than any other specialty. Dermatologists and plastic surgeons performed similar numbers of full-thickness skin grafts, while plastic surgeons performed more split-thickness skin grafts.

CONCLUSION

As dermatologists seek hospital credentials for performing cutaneous surgery procedures, these data should help surgical colleagues understand the typical level of experience of their dermatologist colleagues.

Tumescent liposuction report performance measurement initiative: national survey results

BACKGROUND

This study was created by the Accreditation Association for Ambulatory Health Care Institute for Quality Improvement to measure clinical performance and improvement opportunities for physicians and ambulatory health-care organizations. Data were collected prospectively between February 2001 and August 2002. Thirty-nine study centers participated, and 688 patients who had tumescent liposuction were surveyed and followed for 6 months.

OBJECTIVE

The objective was to determine patient satisfaction with tumescent liposuction and examine current liposuction practice and the safety of tumescent liposuction in a representative cohort of patients.

METHODS

The Accreditation Association for Ambulatory Health Care Institute for Quality Improvement collected prospective data from February 2001 to August 2002 from 68 organizations registered for this study. Ultimately 39 organizations submitted 688 useable cases performed totally with local anesthesia, "tumescent technique."

RESULTS

The overall clinical complication rate found in the Accreditation Association for Ambulatory Health Care Institute for Quality Improvement study was 0.7% (5 of 702). There was a minor complication rate of 0.57%. The major complication rate was 0.14% with one patient requiring hospitalization. Seventy-five percent of the patients reported no discomfort during their procedures. Of the 59% of patients who responded to a 6-month postoperative survey, 91% were positive about their decision to have liposuction (rating of 4 or 5 on a scale of 1-5) and 84% had high levels (4 or 5 on a scale of 1-5) of overall satisfaction with the procedure.

CONCLUSIONS

Our findings are consistent with others in that tumescent liposuction is a safe procedure with a low complication rate and high patient satisfaction.

Surgical treatment of nonmelanoma skin cancer in the Medicare population

BACKGROUND

Nonmelanoma skin cancer (NMSC) is the most common malignancy of white populations. Different surgical treatment options can be used to treat these tumors, depending on the tumor characteristics and setting.

OBJECTIVE

To determine how frequently different specialists use the different types of surgical options available for the treatment of NMSC using a 1998-1999 sample of Medicare claims data.

METHODS

Episodes of care of NMSC were identified by pathology claims with a diagnosis of NMSC. The surgical interventions performed within 7 days before the pathologic diagnosis of NMSC were then analyzed. The numbers of patients and the variety of surgical treatments were categorized by specialty to include dermatology, general surgery, and plastic surgery.

RESULTS

Dermatologists managed 82% of the NMSC episodes. Dermatologists used a wider range of different treatment options than other specialists and performed 90% of the biopsies, 56% of the excisions, 95% of the destructions, and 100% of the Mohs micrographic surgeries for NMSC.

CONCLUSIONS

Dermatologists identify and manage most of the NMSC in the United States and offer patients a broad range of surgical options. The use by dermatologists of office-based surgical methods not commonly used by other specialists may partially explain previous findings of better NMSC outcome by dermatologists. The low level of use of specific surgical options by some specialists may indicate the need for greater training/exposure to these methods.

No smoking gun: findings from a national survey of office-based cosmetic surgery adverse event reporting

BACKGROUND

Because of recent press reports of adverse outcomes, office-based cosmetic surgery has come under intense scrutiny and associated legislative regulatory action.

OBJECTIVE

To assess the safety of office-based cosmetic surgery through a national survey of state agencies that collect information on adverse patient outcomes.

METHODS

Medical boards or other responsible authorities were contacted in 48 states to obtain records on adverse outcomes from cosmetic surgery procedures performed in an office-based setting.

RESULTS

Five states were able to provide complete information regarding 13 cases of adverse outcomes that resulted from office-based cosmetic surgery procedures. Thirteen states had incomplete information or were unable to provide information. The remaining states reported no adverse outcomes. Information collected by state agencies varies greatly and is inadequate to define the safety of office-based cosmetic surgery practice.

CONCLUSIONS

The need to regulate physician office surgery on the basis of hospital privileges and office certification is not supported by current data. Mandatory reporting of adverse outcomes from office-based surgery is warranted to identify modifiable risk factors and to reduce the risk of adverse outcomes.

Estudo retrospectivo de 288 lipoaspirações realizadas no serviço de dermatologia do Hospital do Servidor Público Municipal de São Paulo

RESUMO FUNDAMENTOS: A lipoaspiração ou lipossucção consiste na remoção cirúrgica de gordura subcutânea. Inicialmente foram realizadas pelo método "seco", sem nenhuma infiltração local de solução anestésica com sérias complicações pós-operatórias. Após a introdução da técnica "tumescente" com a utilização da solução de Klein tornou-se possível realizar cirurgias de lipoaspiração de forma segura. OBJETIVO: Analisar as cirurgias de lipoaspiração pela técnica tumescente quanto a sexo, idade, localização, volume aspirado, quantidade de gordura retirada, volume de solução anestésica de Klein utilizado e possíveis complicações. MATERIAL E MÉTODOS:Trata-se de estudo retrospectivo, desenvolvido no período de 1994 a 2000, de 288 cirurgias de lipoaspiração realizadas em 266 pacientes, no ambulatório na Clínica de Dermatologia do Hospital do Servidor Público Municipal de São Paulo. RESULTADOS: Houve nítido predomínio do sexo feminino em relação ao sexo masculino, sendo a faixa etária mais freqüente a de 30-50 anos de idade. As regiões mais freqüentemente lipoaspiradas foram: abdômen, região trocantérica e flancos. A quantidade de gordura aspirada e o volume da solução de Klein injetado variaram conforme a região operada. Não foram observadas complicações no trans e pós-operatório. CONCLUSÃO: A cirurgia é segura, podendo ser realizada em ambulatório. A solução de Klein permite realizar a cirurgia com anestesia local oferecendo suficiente analgesia intra e pós-operatória, com rápida recuperação. Quando a lipoaspiração é realizada com anestesia tumescente, obedecendo a uma seleção criteriosa dos pacientes, os riscos cirúrgicos são extremamente raros.

Skin cancer is among the most costly of all cancers to treat for the Medicare population

BACKGROUND

Compared with other malignancies, nonmelanoma skin cancer (NMSC) is associated with much less morbidity and mortality. NMSC is, however, far more common than other malignancies. The cost of managing NMSC has not been assessed.

OBJECTIVE

The purpose of our study was to determine where the cost of NMSC management ranks among other cancers in the Medicare population.

DESIGN

Representative Medicare part A and B claims data were obtained from the Medicare current beneficiary survey, 1992 to 1995. Claims associated with cancer costs were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification codes. Weights were applied to obtain nationally representative estimates.

RESULTS

Average Medicare expenditure on cancer management was $13 billion per year. The 5 most costly cancers to Medicare were lung and bronchus, prostate, colon and rectum, breast, and NMSC. The mean annual cost per patient using Medicare for all cancers was $17,094. Malignancies of lung and bronchus, colon and rectum, breast, and prostate were 11 to 19 times more costly per affected patient than NMSC.

CONCLUSION

In addition to classifying cancers by number of cases and number of deaths, the financial impact of treatment can also be used to prioritize different malignancies. Such a scheme ranks NMSC far higher than would death statistics. In light of its already high and rising incidence, the cost of NMSC care to Medicare is likely to increase. However, to maintain the cost-effective management of NMSC, it is essential to preserve the current low per-patient cost of its management.

Ambulatory patient safety. What we know and need to know

While safety risks are widespread in ambulatory settings, there has been insufficient attention directed at developing the evidence base that is needed to improve ambulatory safety. In this article, the current state of knowledge about ambulatory safety is reviewed. A research agenda in ambulatory safety is proposed, as well as a series of potential interventions that could be used to improve safety in the ambulatory setting.

The safety of liposuction: results of a national survey

BACKGROUND

Liposuction procedures are increasing in frequency and may be performed in hospitals, ambulatory surgery centers, or physician offices. Deaths associated with liposuction and previous surveys of liposuction safety have raised concern about the safety of office-based surgery.

OBJECTIVE

To determine the safety of office-based, tumescent liposuction among dermatologic surgeons.

METHODS

A survey mailed out to dermatologic surgeons in August 2001 requested retrospective information regarding the number of patients undergoing liposuction, the setting in which the procedures were performed, and the complications that occurred during the 7-year period from 1994 to 2000. A detailed complication record was requested for each serious adverse event or death reported. Surveys were mailed to 517 worldwide members of the American Society for Dermatologic Surgery (ASDS) listed as performing liposuction; 505 had adequate contact information. The main outcome mesure was the rate of serious adverse events (SAEs) or deaths per 1000 liposuction procedures for each service setting and for each level of conscious sedation.

RESULTS

The overall response rate was 89% (450/505), and of these, 78% (349/450) perform liposuction. A total of 267 dermatologic surgeons completed the survey; 261 provided data on 66,570 liposuction procedures. No deaths were reported. The overall serious adverse event rate was 0.68 per 1000 cases. The SAE rates were higher for hospitals and ambulatory surgery centers than for nonaccredited office settings. SAE rates were also higher for tumescent liposuction combined with intravenous or intramuscular sedation than combined with oral or no sedation.

CONCLUSION

Office-based tumescent liposuction performed by dermatologic surgeons is safe, with a lower complication rate than hospital-based procedures. Future legislation should recognize the proven safety of this procedure as performed by dermatologic surgeons in their offices.

Cost of nonmelanoma skin cancer treatment in the United States

BACKGROUND

Despite being the most prevalent form of cancer, the economic impact of nonmelanoma skin cancer (NMSC) in the United States has not been assessed.

OBJECTIVE

To determine the overall cost and to estimate the cost per episode of NMSC care in the United States in physicians' offices, outpatient surgery centers, and inpatient settings.

METHODS

Data from the Medicare Current Beneficiary Study 1992-1995 were analyzed to obtain the total cost of NMSC and the cost in different settings. To normalize these data on a per episode basis, the cost in each setting was divided by the number of procedures performed in each setting obtained from the National Hospital Discharge Survey (NHDS, 1992-1997), the National Survey of Ambulatory Surgery (NSAS, 1994-1996), and the National Ambulatory Medical Care Survey (NAMCS, 1995).

RESULTS

The total cost of NMSC care in the United States in the Medicare population is $426 million/year. Physician office-based procedures for NMSC accounted for the greatest percentage of money spent to treat NMSC and the greatest percentage of procedures. The average cost per episode of NMSC when performed in a physician's office setting was found to be $492. The cost per episode of care in inpatient and outpatient settings were $5537 and $1043, respectively.

CONCLUSION

Compared to other cancers, the relative magnitude of NMSC treatment costs is currently small because NMSC is managed efficiently and effectively, primarily in office-based settings. Legislative or regulatory measures that discourage office treatment of NMSC will lead to increased cost.

The benefits of powered liposuction versus traditional liposuction: a paired comparison analysis

BACKGROUND

There is much debate about the safety of liposuction as well as the efficacy and risk:benefit ratio of newer devices used in this procedure.

OBJECTIVE

To determine if there are any benefits in terms of safety and efficacy of power reciprocating cannulas compared to traditional manual liposuction cannulas.

METHODS

Patients served as their own controls in a paired comparison analysis of power liposuction cannulas and traditional liposuction cannulas.

RESULTS

Power cannulas significantly reduced procedure times, intraoperative pain, and surgeon fatigue, and increased the amount of fat aspirated per minute. Power cannulas also decreased postoperative pain, ecchymoses, and edema, as well as resulting in higher patient satisfaction scores.

CONCLUSION

Power liposuction cannulas produce significantly faster recovery times for patients, allow faster procedure times, and reduce surgeon fatigue, resulting in safer and more precise surgery. A lower incidence of touch-up procedures is likely due to these benefits.

Lipoplasty Claims Experience of U.S. Insurance Companies

An analysis of medical liability claims for lipoplasty (liposuction) from January of 1985 through June of 1998 compared the insurance industry experience of plastic surgeons with that of other physicians. The Data Sharing Project database of the Physician Insurers Association of America, a trade association of professional liability companies owned and operated by medical professionals that collectively insure approximately 60 percent of America's private practice physicians, was queried. Of the nearly 45,000 total entries in the database, 292 were claims for adverse events related to lipoplasty or liposuction. These raw data were stratified by physician specialty, severity of complication, practice location, patient gender, indemnity payment, and other insurance industry-relevant variables. To simplify interspecialty comparisons, we normalized the claims rate to incidents per 100 insured physicians. The indexed lipoplasty claims rate was 3.0 per 100 insured plastic surgeons and 4.1 for other surgeons; the indexed lipoplasty claims rate for nonsurgical specialists was 2.5 per 100 insured dermatologists and 2.3 for other nonsurgeons. The higher claims rate for surgeons most likely reflects the wider scope of full-service aesthetic surgery performed by surgical specialists. Nearly two-thirds of claims (65.4 percent) during the 13-year survey period were the result of hospital-based lipoplasty; 20.9 percent were office-based claims. The prevalence of hospital-based claims may be a consequence of both historical bias introduced by hospital-based specialty surgery in the early years and prudent patient safety considerations during performance of complex or prolonged procedures in more recent years.Two-thirds of the claims (67 percent) arose from informed-consent or breach-of-contract issues, far higher than the 26 percent aggregate claims norm. The mean indemnity payment was $94,534 per lipoplasty claim; claims paid against board-certified specialists averaged $83,350. Consistent with national lipoplasty demographics, 87 percent of claims were brought by women and 13 percent were brought by men. Seven fatalities (three women and four men) were noted; cause of death is not recorded in this type of database.

A history of dermatologic surgery in the United States

BACKGROUND

Dermatologic surgery has a long and distinguished history in the United States.

OBJECTIVE

To examine the specific contributions of American dermatologic surgeons.

METHOD

The medical literature on cutaneous reconstructive and cosmetic surgery for the last century and a half was researched.

RESULTS

Numerous American dermatologic surgeons have had a major impact on scientific and technological discoveries in cutaneous surgery. Dermatologic surgeons have been significantly involved in cutaneous surgery since the second half of the 19th century. Dermatologic surgeons have contributed many important advances to the fields of chemical peeling, cryosurgery, dermabrasion, electrosurgery, hair transplantation, soft tissue augmentation, tumescent liposuction, laser surgery, phlebology, Mohs chemosurgery, cutaneous reconstruction, wound healing, botulium toxin, blepharoplasty, and rhytidectomy.

CONCLUSION

Dermatologic surgeons in the United States have contributed significantly to the history of reconstructive and cosmetic surgery. Dermatologic surgeons have been leaders in advancing this field and are poised to continue in the future.

The history of liposuction and fat transplantation in America

Dermatologists have played an important role in the development of both liposuction and fat transplantation in the United States. Dermatologists were among the earliest physicians to embrace these new procedures and have been responsible for a number of breakthroughs and refinements in these techniques. Klein's development of the tumescent technique has profoundly altered the way liposuction and fat transplantation are performed. These procedures continue to be increasingly popular among dermatologic surgeons.

Morbidity and mortality related to liposuction. Questions and answers

Reports of fatalities following liposuction have lead to investigations by state medical boards. The risk of complications and fatalities is clearly different for liposuction under local anesthesia and intravenous sedation. Thousands of patients have been treated with true tumescent liposuction as described by dermatologist Dr. Jeffrey A. Klein, with no reports of fatalities. Patients should seek physicians who are experienced in this extremely safe method of liposuction.