Recently, I read an article about a practitioner in Toronto was defined as a “cosmetic” surgeon who performed a liposuction procedure on a patient that resulted in the patient’s death. He apparently was not a board-certified plastic surgeon.
This is an extremely tragic case, I would like to go over a few things that I think are extremely important when considering who your surgeon will be and where your surgery will be performed.
Liposuction, in my view, can be categorized from the surgeon’s perspective and two general ways. This is not the only way it can be categorized, of course, but for patient safety, I think it is a good pragmatic categorization.
Low volume liposuction refers specifically to liposuction of one or two anatomic areas such as the tummy, thighs, arms, flank. High-volume liposuction refers to liposuction of multiple areas that result in the removal of thousands of cc of fat rather than just of few hundred.
High-volume liposuction, though, is a serious operation with the possibility of extremely serious complications because removing that much fat can cause fluid shifts, bleeding, heart irregularities (because of the anesthetic that is administered in the skin to help reduce bleeding.)
Furthermore, a patient should know that liposuction, in any form, is absolutely not a weight loss procedure. It is a body contouring procedure. There are many surgical weight loss procedures available, and they do not include liposuction. I have a colleague, Fred Tiesenga, who is an expert practitioner in these surgeries.
High volume liposuction procedure, in my view, should always be done in a surgery center that has hospital access or a hospital surgery center (which is my preference) with an experienced and qualified surgeon–and an excellent anesthsiologist and nursing staff. Although it is generally a bit more expensive in the hospital, I think it is worth it.
A lot of times low volume liposuction can be done in the office. I personally do not have an office based surgery center, but I know many surgeons (some are plastic surgeon and some are not) that do perform office-based liposuction and they do an excellent job.
For a board-certified Plastic surgeon to perform this procedure in their office they must receive certification from JCAHO. This is a good thing, and I would recommend that you check that your surgeon has this certification in his office surgery suite. Many people argue that this is just another one of those government regulations that are stifling to business. This is a silly argument in my view. Regulatory standards are very important and some are essential. This is one.
Cosmetic surgeons, as some call themselves, do not necessarily need to oblige themselves to observe this regulation, as many are not plastic surgeons. Some in fact are general practitioners, some with very little experience in surgery of any kind, which is a disturbing trend in my view.
From a personal perspective, I have no problem with the general practitioner deciding to perform cosmetic surgery such as liposuction in their office. But I think that they should receive the appropriate training.
I trained in general surgery for four years. This means that I took care of all sorts of patients that were critically ill. I took care of burns in a burn unit, and I took care of severe traumas at Cook County Hospital under the tutelage of some very excellent teachers. They always focused on safety first, and first doing no harm. They always stressed the importance of having a level of safety over efficiency. I then proceeded to train two years in plastic surgery with the Fellowship in hand surgery.
That means I trained seven years and I observed thousands of operations. Some of my colleagues trained even more years than I did! I performed many operations under the direct supervision of board-certified surgeons. I was constantly tested through written examination an oral examination every year so I can pass to the next level of training. I was involved in teaching rounds and courses that were mandated every year. I still have to maintain my certification through learning and teaching.
I am not trying to make the point that complications can altogether be avoided or only a plastic surgeon can do certain surgeries. This is not the case at all. I feel there are many non-plastic surgeons who have great competency in aesthetic procedures.
The point is: it’s a rather silly for me at this point say that I’d like to learn how to do brain surgery, take a few courses can observe a few cases and then proceed to do brain surgery-even with the skill that I have.
Consider this when you evaluate your next surgeon because because there is an old anesthesia joke that I’ve heard many times working with my colleagues behind the curtain that goes like this, “I’m not paid to put people to sleep. I’m paid to wake them up!”
In the same sense, I believe most surgeons and many other doctors can perform cosmetic surgery, but I feel that only the most appropriately trained can really understand the nuances of surgery and anticipate, manage, and avoid the possible complications.
I hope that this information can help you, the patient, make an informed decision.