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Liposuction becomes most popular plastic surgery, but it is not without risks

Tuesday, December 29, 1998

By Mackenzie Carpenter, Post-Gazette Staff Writer

Dr. Bernard Cohen was sitting in his Allegheny Center office, talking about the history of liposuction, when the phone rang.

A medical supplies salesman was on the other end of the line. Had Cohen, one of Pittsburgh's most reputable plastic surgeons, decided to purchase the latest high-tech liposuction gadget from his company instead of another's?

Cohen, still dressed in his surgical scrubs from an operation performed that morning, was cordial but noncomittal. He hadn't decided yet, he told the persistent voice before hanging up.

"Where was I?" He asked a visitor, a smile creasing his weathered face. But Cohen had hardly gotten past liposuction's invention in France 18 years ago when the phone rang again. A former patient had stopped by to say hello. Cohen excused himself.

When he returned, the history lesson resumed: Under the old method of lipusuction, he explained patiently, fat was removed with cannulas, large suction devices resembling vacuum cleaners. Under new and improved liposuction, smaller, straw-like cannulas are used, and .....

The phone rang again. A patient was ready to be discharged, prompting Cohen's second disappearance, with profuse apologies.

Such is life on the crest of the wave - of liposuction procedures, that is. It's the fastest growing cosmetic procedure in North America, with the number done tripling in the past five years and 150,000 performed last year. And if you're a cosmetic surgeon who does liposuction - the surgical removal of fat deposits by a vacuum device inserted under the skin - the phone never stops ringing; indeed, it may be hard to complete a conversation with anyone other than your accountant.

The field is growing ever more crowded. As revenues under managed care continue to shrink, more and more doctors trained in reconstructive surgery turning to the cosmetic end of the spectrum, with liposuction the chief money-maker.

And while Pittsburgh may not be Los Angeles or Rio de Janeiro when it comes to body sculpting, liposuction is becoming increasingly popular here.

"It's the most common procedure we do, period. It has one of highest patient satisfaction indices," says Dr. Leo McCafferty, assistant clinical professor of plastic surgery at the University of Pittsburgh and spokesman for the American Society for Aesthetic Plastic Surgery.

"There's a quick recovery, and it's very safe, if the patients are selected properly."

There are risks, however, and there have been a growing number of deaths tied to liposuction across the country. Nationally, more and more doctors with no surgical background at all are opting to perform liposuction, with disastrous results, say some critics.

Lethal drug interactions, miscalculations by doctors on the amount of fluid to inject in the body during the process, infection and excessive bleeding are among the complications that have contributed to an estimated 60 to 100 deaths in the United States last year out of the more than 110,000 liposuction procedures studied.

It wasn't always this way, notes Cohen. During the first 15 years of liposuction, there were only a handful of deaths, but as more and more unqualified doctors perform the procedure, fatalities are increasing, he and other doctors believe.

Local surgeons stressed that patients must be careful to check the credentials of the doctor who will be performing liposuction.

While McCafferty and other doctors stress that the ideal liposuction patient is one who "is well-informed and not overweight with collections of fat that are diet and exercise-resistant," not all surgeons agree on what that means.

"I'll do it as long as it's a localized area of contour deformity," says another plastic surgeon, Dr. Raymond Capone. "Most of my patients are part of a formal diet program and belong to a gym."

Cohen also stresses that liposuction is "not a treatment for weight loss," but he will take people who are less than in perfect shape. Still, he says he strongly encourages them to diet and exercise.

"If they don't, they'll gain it all back," he warns.

Doctors also differ over how much fat should be removed at any one time. Too much can result in a dangerous shifting of body fluids. Capone limits himself to about 3,000 cubic centimeters, which, subtracting blood and other fluids, totals about three and a half pounds of fat; Cohen says he stops at between 6,000 and 7,000 cc's, and McCafferty prefers a limit of about 5,000 cc's.

"But it depends on the person. If he is really tall, you might take out more than you would otherwise," McCafferty says.

Whatever the case, the procedure is always evolving, he and others say. Surgeons are learning to "sculpt" fat more conservatively, avoiding that "scooped-out" look, for more natural results.

And while most surgeons perform "tumescent" or "superwet" liposuction, in which fluid containing anesthetic and an anti-bleeding agent is injected into tissue to serve as a sort of cushion against the trauma of the suction process, a new method, ultrasonic liposuction has also appeared on the scene - along with some controversy. The procedure uses sonic waves to liquefy the fat, making it easier to remove without injuring the tissues.

"It reduces bleeding and bruising. I've been very pleased with the results," says McCafferty.

Cohen is more wary of the ultrasonic method, citing reports of significant complications. But he's interested in yet another approach pitched to him by that salesman on the telephone: external ultrasonic liposuction, in which a piece of equipment emitting sonic waves is applied onto the skin, "loosening the fat cells" rather than melting them. McCafferty has scoffed at the procedure, but Cohen is intrigued. In these days of increasing competition, he wants to stay ahead of the curve.

"I definitely want one of those," he says with a grin.

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