Monday, October 11, 2021

We have a serious liposuction problem, says cosmetic surgeon

‘We think it could be a done deal’ That’s the view of Dr Toby Hepworth, a plastic surgeon and professor of cardiovascular surgery at Kings College London, after the government last night announced it was abandoning any attempt to flatten the COVID curve – the result of liposuction, fat reduction and breast augmentation – when performed on operating-room floors.

Instead, the mortality rate of cosmetic surgery is to be slashed to just one in 70 operations.

For the last forty years there has been an alarmingly high body of evidence linking liposuction and fat reduction with increased risk of death. At least 43 people have died in UK hospitals as a result of “cosmetic surgery” since the 1990s.

And the issue of liposuction has been the focus of intense political attention since the death in 2004 of seven-year-old Esmee Jennings, who died just hours after having her liposuction operation at a hospital in Liverpool.

It is widely accepted that liposuction has the potential to be harmful, especially with patients under the age of eighteen, in combination with the use of excessive anaesthesia, and for women who have done multiple liposuction procedures in one go.

Due to repeated incidents of fatalities in UK hospitals, the Department of Health has had ongoing concerns about the safety of liposuction operations in UK hospitals since the mid-1990s. While liposuction is arguably safe when performed in specialist hospitals, increasingly it is being performed as part of routine operations in non-specialist hospitals.

At present there is little in the way of clinical evidence demonstrating that liposuction will be safe to perform in non-specialist settings. Trials to assess this are being undertaken, but the time to have definitive clinical evidence is too short for safe cosmetic surgery to be safely performed under normal hospital practice.

Women who have multiple operations will inevitably have their health compromised, particularly in cases where no post-operative follow-up is undertaken. The UK already has a significant minority of women with cancer suffering from mastectomy, hysterectomy and other reconstructive surgeries. But cosmetic surgery is potentially a very significant market for many women with cancer who are likely to be in post-menopausal syndrome.

In the event of any serious complication, existing evidence shows that women should be advised to urgently seek medical advice before undertaking liposuction, to ensure that minimally invasive treatment is not undertaken. This will also assist in mitigating the complications of liposuction should they occur. It is anticipated that most women who have had liposuction as part of a number of non-specialist procedures will also have minimal surgical complications, requiring only monitoring, as such cosmetic surgery is relatively low risk.

Women wishing to undertake operations for cosmetic reasons should consider that there is insufficient evidence currently to protect them from potentially unacceptable risk.

There are some suggested approaches to reduce the risk of operations. If an operation is to be undertaken, procedures to reduce the risk of complications are suggested to patients at a minimum.

For smaller procedures where risk of complication is less, the standard care package, which includes pre-operation checks and monitoring, should include no more than three or four procedures.

The association of liposuction and fat reduction with increased risk of death is acknowledged by the Academy of Medical Royal Colleges as well as a number of European organisations. For risk management to be effective for patients undergoing cosmetic surgery, advice is given to all patients with appointments on how to reduce or even eliminate risks such as those identified above.

In addition, the Department of Health has been proactively engaging with the plastic surgeon’s profession on the issue of fat reduction and liposuction and has set up a taskforce of plastic surgeons, nursing academics and physicians to review and inform decisions on whether surgery should be done.

In addition, Professor Stephen Cunningham, from the University of Liverpool, has been conducting research into the risks of liposuction and fat reduction since 2010.

Professor Cunningham and colleagues have drawn on datasets on thousands of patients. The results have demonstrated a correlation between the use of hormone therapy in patients undergoing liposuction and the increased risk of developing autoimmune or inflammatory diseases, often chronic pulmonary diseases, such as asthma, emphysema and osteoporosis. The increased risk also extends to women receiving surgical liposuction that is located on the chest or abdomen. This extends to in women under the age of 18 as well as those over the age of 80. Risk of hospital admission and death has also been shown to be higher in women who have had more than one liposuction procedure.

Professor Stephen Cunningham

Professor Stephen Cunningham

Prof Stephen Cunningham

Prof Stephen Cunningham

Prof Stephen Cunningham

Prof Stephen Cunningham

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