Safety of liposuction: a review of 9478 cases performed by dermatologists

Laser Acupuncture versus Liraglutide in Treatment of Obesity: A Multi-Institutional Retrospective Cohort Study

BACKGROUND

Obesity is a global concern, driving the search for alternative treatments beyond lifestyle changes and medications. Laser acupuncture (LA) shows promise in obesity management, yet few studies compare it with FDA-approved medications. This study aimed to assess and compare LA's impact with liraglutide on weight reduction in obese individuals.

METHODS

Data from the Chang Gung Research Database (CGRD) (2013-2018) were analyzed. Primary outcomes included changes in body weight and BMI within 180 days, with secondary outcomes measuring the proportion achieving 5%, 10%, and 15% weight loss. Adverse events were also assessed.

RESULTS

Of 745 subjects (173 LA users, 572 liraglutide users), LA users lost more weight by day 180 (5.82 ± 4.39 vs. 2.38 ± 5.75 kg; p < 0.001) and had a greater BMI reduction (-2.27 ± 1.73 vs. -0.93 ± 2.25 kg/m2; p < 0.001). More LA users achieved 5% and 10% weight loss compared to liraglutide users (64.2% vs. 22.7%, 26.6% vs. 4.2%; all p < 0.001). After balancing baseline differences, LA's benefits remained significant. No adverse events were reported with LA.

CONCLUSIONS

LA may offer superior weight reduction compared to liraglutide. Future studies should explore LA alone or in combination with liraglutide for obesity management.

Breast Autologous Fat Transfer Entirely Under Tumescent Anesthesia: Safety and Efficacy

BACKGROUND/OBJECTIVES

The prior use of external expansion has been described in the literature as a tool to allow reliable grafting of more than 200 mLs of autologous fat under general anesthesia. The purpose of this study was to determine whether breast autologous fat transfer entirely under tumescent anesthesia (BAFTEUTA) is a safe and effective technique.

METHODS

After institutional board approval, 22 consecutive patients were enrolled in this single-cohort, prospective study. All patients underwent preoperative expansion using manually evacuated domes. All procedures were performed under tumescent anesthesia with oral sedation.

RESULTS

There was a median successful graft of 200 mLs. Complications were minimal and limited to occlusive folliculitis.

CONCLUSION

Although the author has not reported as large graft volumes as some other authors, BAFTEUTA is a safe procedure and can have good outcomes with high levels of patient satisfaction.

1997 Guidelines for Liposuction Surgery

A joint Ad Hoc Committee of the American Society of Liposuction Surgery (ASLS) and the American Academy of Cosmetic Surgery (AACS) was formed to create the following guidelines for liposuction surgery. The members of this committee include: Robert Alexander, M.D., D.M.D.; Guillermo Castillo, M.D.; Robert Jackson, M.D.; Jeffrey Klein, M.D.; Melvin Shiffman, M.D.; and Howard Tobin, M.D. These guidelines were presented to and passed by the ASLS and AACS Board of Trustees on October 16, 1997.

Guidelines for Liposuction

These guidelines for liposuction are approved by the Board of Directors of the American Academy of Cosmetic Surgery. The guidelines discuss the importance of adequate training for physicians, a thorough preoperative evaluation and medical history of the patient, the use of compression in postoperative care, the use of antibiotics, and the arrangement of hospital privileges. The relationship between the use of large amounts of dilute local anesthetic solution prior to surgery and decreased blood loss during liposuction is emphasized.

Guidelines for the use of local anesthesia in office-based dermatologic surgery

There are an increasing number and variety of dermatologic surgical procedures performed safely in the office setting. This evidence-based guideline addresses important clinical questions that arise regarding the use and safety of local anesthesia for dermatologic office-based procedures. In addition to recommendations for dermatologists, this guideline also takes into account patient preferences while optimizing their safety and quality of care. The clinical recommendations presented here are based on the best evidence available as well as expert opinion.

Complementary and alternative medicine for the treatment of obesity: a critical review

CONTEXT

Obesity and its associated morbidities pose a major health hazard to the public. Despite a multiplex of available diet and exercise programs for losing and maintaining weight, over the past years, interest in the use of complementary and alternative medicine (CAM) for obesity treatment has greatly increased.

EVIDENCE ACQUISITION

We searched PubMed, Google scholar and the Cochrane databases for systemic reviews, review articles, meta-analysis and randomized clinical trials up to December 2013.

RESULTS

In this review, the efficacy and safety of the more commonly used CAM methods for the treatment of obesity, namely herbal supplements, acupuncture, and non-invasive body-contouring, are briefly discussed. The evidence supporting the effectiveness and safety of these methods is either lacking or point to a negligible clinical benefit, barely surpassing that of the placebo. Furthermore, several limitations are observed in the available scientific literature. These shortcomings include, without being limited to, uncontrolled trial designs, non-random allocation of subjects to treatment arms, small number of patients enrolled, short durations of follow-up, and ambiguous clinical and laboratory endpoints.

CONCLUSIONS

Further investigations are necessary to accurately determine the efficacy, safety, standard dosage/procedure, and potential side effects of the various CAM methods currently in use.

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.

Ureteral tear at the ureteropelvic junction: a complication of liposuction

We report the case of a 47-year-old woman who presented to the emergency room with gross hematuria during liposuction of the abdomen. Computed tomography (CT) using hematuria protocol demonstrated extravasation of contrast at the right ureteropelvic junction and a small urinoma in the right perinephric space. The diagnosis of ureteral tear at the ureteropelvic junction (UPJ) was confirmed. A ureteral stent was placed at surgery. Visceral injuries and other complications associated with liposuction have been described. However, this is the first reported case of a ureteral tear related to liposuction.

Safety of ultrasound-assisted liposuction: a survey of 660 operations

BACKGROUND

Ultrasound-assisted liposuction (UAL), although providing some advantages over tumescent liposuction (TL) and traditional or suction-assisted liposuction (SAL), has been found to have some controversial complications. We performed this study to evaluate UAL's complications and to compare UAL with the previous routine techniques for liposuction.

METHODS

Six hundred sixty UALs were performed on 609 consecutive volunteers by one cosmetic surgeon. Demographic characteristics, local and systemic complications, and also severe adverse events (SAE) were registered intraoperatively and at 1, 4, and 12 weeks postoperatively.

RESULTS

No SAEs were identified and only nine complications, consisting of two systemic complications (two cases of hypotension) and seven local complications (3 seromas, 3 cases of contact dermatitis, and 1 case of hemorrhage), were registered. This yields a complication incidence of 1.36%. There was no association between the number of complications and the body region, age, gender, or body mass index (BMI).

CONCLUSION

Our findings are in line with others in that performing UAL using local tumescent anesthesia is a safe procedure with a very low complication rate and has remarkable advantages over other liposuction techniques (TL and SAL). In addition, there was no correlation between the incidence of complications and body region, age, gender, or BMI.

Major and lethal complications of liposuction: a review of 72 cases in Germany between 1998 and 2002

BACKGROUND

Liposuction is the most frequently performed cosmetic operation in Germany, with approximately 200,000 procedures performed in 2003. The public perception of liposuction as minor surgery fails to consider the potential of major complications or a possibly fatal outcome.

METHODS

A retrospective analysis of severe or lethal complications related to cosmetic liposuction is presented. To collect pertinent information, the authors sent 3500 questionnaires to departments of pathology and forensic medicine, intensive care units, and others. After the identification of cases with major complications, the second phase of the investigation consisted of interviews with the physicians performing the liposuction.

RESULTS

Two thousand two hundred seventy-five questionnaires (65 percent) were returned. The analyzed data showed 72 cases of severe complications, including 23 deaths following cosmetic liposuction in a 5-year period from 1998 to 2002. The most frequent complications were bacterial infections such as necrotizing fasciitis, gas gangrene, and different forms of sepsis. Further causes of lethal outcome were hemorrhages, perforation of abdominal viscera, and pulmonary embolism. Fifty-seven of 72 complications were clinically evident within the first 24 postoperative hours; 41 of these 72 liposuction procedures were performed using tumescent anesthesia and 17 of 72 were performed using true tumescent anesthesia, with four deaths.

CONCLUSIONS

Major risk factors for the development of severe complications are insufficient standards of hygiene, the infiltration of multiple liters of wetting solution, permissive postoperative discharge, and selection of unfit patients. The lack of surgical experience was a notorious contributing factor, particularly regarding the timely identification of developing complications. This is in fact the first study reporting deaths related to liposuction performed entirely under true tumescent anesthesia.

Fat injections for facial rejuvenation: 17 years experience in 1720 patients

BACKGROUND

Autologous adipose tissue has been proved to be an excellent filling material. Fat injections can correct cosmetic defects that are caused by loss of subcutaneous tissue, such as atrophy of the face due to significant weight loss, wrinkles and facial involution due to ageing.

OBJECTIVE

To evaluate the safety and long-term results of facial rejuvenation by autologous fat injections using the fine-needle technique to inject fat and frozen fat for repeating the implantation procedure.

METHOD

Patients were evaluated clinically and photographically. Extraction, processing and implantation of fat were performed using an anaerobic technique. The fat was harvested by tumescent liposuction, using syringes and small diameter blunt-tip cannulas (2-3 mm). After washing the collected fat in normal saline it was centrifuged, transferred to small syringes (1-2.5 mL diameter) and then injected subcutaneously using fine needles of 21-23 G. Hypercorrection was avoided, so one or two repetitions of the fat injections were usually necessary, at intervals of at least 1 month, in order to achieve the desired cosmetic result. Using frozen fat simplified repeat fat implantation.

RESULTS

The clinical long-term follow-up of 1720 patients up to 17 years is presented. Absorption of the injected fat was estimated at 40-60%. The absorption rate varied a lot in each case. Long-term follow-up proved that final correction after two or more repetitions of frozen fat injections, persisted for many years, the longest proved to be more than 12 years.

CONCLUSIONS

The advantages of the fine-needle technique for fat grafting were very important: more accurate and refined work, less painful injections, no scars at needle puncture points, early treatment of small defects, and the facility to treat multiple sites, even the entire face, in one session. There were no major complications. Oedema and sometimes echymoses at the donor site for 6-10 days and slight bruising at the injected areas for 3-5 days are the disadvantages of the procedure.

Special issues in plastic and reconstructive surgery

Intensivists frequently collaborate with plastic and reconstructive surgeons in treating patients with major wounds, following significant reconstructive procedures, and following free-tissue transfers. Pressure ulcers are a significant source of morbidity and mortality in the intensive care unit; prevention, early recognition, and multidisciplinary treatment are critical components for successful management. Necrotizing fasciitis is an aggressive, soft-tissue infection that requires rapid diagnosis, early surgical intervention frequent operative debridements, and soft-tissue reconstruction Catastrophic abdominal injuries and infections can be treated with an open abdominal approach and require the expertise of a plastic surgeon to reconstruct the abdominal wall. The success of free-tissue transfers and complex reconstructive procedures requires a thorough understanding of the factors that improve flap survival.

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.

Large-volume liposuction complicated by retroperitoneal hemorrhage: management principles and implications for the quality improvement process

Large-volume liposuction can be associated rarely with major medical complications and death. The case of exsanguinating retroperitoneal hemorrhage that led to cardiopulmonary arrest in an obese 47-year-old woman who underwent large-volume liposuction is described. Extensive liposuction is not a minor procedure. Performance in an ambulatory setting should be monitored carefully, if it is performed at all. Reporting of adverse events associated with outpatient procedures performed by plastic surgeons should be mandated. Hemodynamic instability in the early postoperative period in an otherwise healthy patient may be due to fluid overload, lidocaine toxicity, or to hemorrhagic shock and must be recognized and treated aggressively. Guidelines for the safe practice of large-volume liposuction need to be established.

Treatment of axillary hyperhidrosis: combination of the starch-iodine test with the tumescent liposuction technique

OBJECTIVE

To evaluate and permanently improve axillary hyperhidrosis.

BACKGROUND

Excessive sweating of the axillae is a common problem for which patients frequently seek dermatologic advice and therapy. Many treatments, including aluminum chloride, topical and systemic anticholinergic agents, tranquilizers, iontophoresis, direct surgical excision, botulinum toxin injection, and thoracic sympathectomy, have been employed to control this problem. All have drawbacks of one sort or another.

METHODS

The starch-iodine technique for delineation of preoperative and postoperative axillary sweating is described in detail. A method of sweat gland removal utilizing tumescent liposuction is discussed.

RESULTS AND CONCLUSION

The combination of the starch-iodine technique and tumescent liposuction is safe and effective for therapy of axillary hyperhidrosis.

Analysis of methods for reporting severe and mortal lipoplasty complications

During the past 2 years, media attention has focused on catastrophic outcomes associated with liposuction. A critical review of the lipoplasty literature was undertaken to determine the incidence of severe and mortal complications. Reported lipoplasty complications and patient outcome studies published in the English literature through January 1, 1999, were reviewed. From these and from ASPRS questionnaire surveys of experienced, board-certified plastic surgeons, it is apparent that (1) plastic surgeons do not often voluntarily report severe and mortal complications (either as case reports or in self-reported series), and (2) while survey studies provide the most accurate estimate of complications due to lipoplasty, they are subject to an underreporting bias because they exclude complications occurring in the hands of residents and junior attendings. The mortality from lipoplasty procedures is higher than the 0.003 to 0.02% reported in the literature and may be as high as 0.1%.

Deaths related to liposuction

BACKGROUND

The technique of tumescent liposuction involves the subcutaneous infusion of a solution containing lidocaine, followed by the aspiration of fat through microcannulas. Although the recommended doses of lidocaine are as high as 55 mg per kilogram of body weight, few safety data are available. Since reporting of adverse events associated with tumescent liposuction is not mandatory, the incidence of complications and deaths is unknown.

METHODS

We identified 5 deaths after tumescent liposuction among 48,527 deaths referred to the Office of Chief Medical Examiner of New York City between 1993 and 1998. The patients' records and postmortem examination results were reviewed to identify common contributory factors.

RESULTS

The five patients had received lidocaine in doses ranging from 10 to 40 mg per kilogram. Other drugs, such as midazolam, were also administered. Three patients died as a result of precipitous intraoperative hypotension and bradycardia with no definitively identified cause. Postmortem blood lidocaine concentrations in two of the patients were 5.2 and 2 mg per liter. One patient died of fluid overload, and one died of deep venous thrombosis of calf veins with pulmonary thromboembolism after tumescent liposuction of the legs.

CONCLUSIONS

Tumescent liposuction can be fatal, perhaps in part because of lidocaine toxicity or lidocaine-related drug interactions.

Tumescent liposuction complicated by pulmonary edema

In tumescent liposuction, large volumes of dilute lidocaine and epinephrine are infused subcutaneously to prepare fat for extraction. Reported cardiopulmonary complications of tumescent liposuction have been few, and the anesthetic and hemodynamic advantages are several. We report an instance of pulmonary edema in a healthy 55-year-old male body-builder who received 7900 cc subcutaneous and 2200 cc intravenous fluid. With normal cardiopulmonary and renal function, the patient responded promptly to intravenous diuretics without sequelae. Out of over 900 patients who have had tumescent liposuction with up to 15 liters infused parenterally, this is the first case of pulmonary edema.

Safety of tumescent liposuction in 15,336 patients. National survey results

BACKGROUND

Tumescent liposuction is a new method of liposuction under local anesthesia that has been developed by dermatologic surgeons.

OBJECTIVE

To determine the safety of tumescent liposuction in a large group of patients treated by dermatologic surgeons.

METHODS

A survey questionnaire was sent to 1,778 Fellows of the American Society for Dermatologic Surgery in February 1994. The comprehensive questionnaire requested information on numbers of patients treated with tumescent liposuction and complications that occurred.

RESULTS

Sixty-six dermatologic surgeons provided data on 15,336 patients. The complications that were reported were infrequent and minor. There were no serious complications such as death, embolism (pulmonary or fat), hypovolemic shock, perforation of peritoneum or thorax, or thrombophlebitis. Blood transfusions were not required in any of the 15,336 patients and there were no admissions to the hospital for treatment of complications.

CONCLUSIONS

Tumescent liposuction is an exceptionally safe method of liposuction under local anesthesia that eliminates the necessity of general anesthesia and blood transfusions. Tumescent liposuction is safer than liposuction under general anesthesia and results in fewer complications.

Liposuction surgery and autologous fat transplantation

Since the importation of liposuction surgery into the United States more than a decade ago, we have witnessed a number of major technique changes and practice trends occur. One of us (L.M.F.) was the first dermatologic surgeon to undergo the "lipsuction experience" (Paris, 1977) under the tutelage of Giorgio and Arpad Fisher and Pierre Fournier, and another (R.S.N.) the first to undergo training with Yves Illouz (also Paris). All three co-workers have served on teaching faculties of both the International and American Societies for Dermatologic Surgery, the American Society of Liposuction Surgery, and the American Academy of Cosmetic Surgery, have performed many hundreds of procedures, and have lectured/published on this subject on repeated occasions. We recognize certain vital changes and expansions have occurred during the past decade, and share our impressions of these with you.

Dermatologic cosmetic surgery

Many cosmetic surgery procedures performed today were either developed or refined by dermatologic surgeons. The role played by dermatologic surgeons in the development of dermabrasion, hair transplantation, liposuction, blepharoplasty, face-lift, cutaneous implants, fat transplantation, chemical peel, and sclerotherapy is described.