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One patient out of a hundred might be in for a long, bothersome hassle. She might have an infection, which would require going to the office for shots every day for a week or more. She might need a major revision procedure or transfusion, or have areas of skin death. There might have been some permanent cosmetic result that she didn't like. She might even be hospitalized, although this is a real rarity. These days, a serious medical problem due to a cosmetic procedure occurs for only one in several thousand patients. Rarely, people may even die, although this could involve other problems, such as the alleged drug abuse implicated in the death of a celebrity's wife after cosmetic surgery.

As of this writing, there have been a number of deaths due to liposuction in the U.S. My feeling is that liposuction procedures should be among the safest procedures in cosmetic surgery. I feel that modern liposuction training has been poor in some of the physicians who have experienced patient deaths. It is crucial to have your liposuction performed by a physician who is very familiar with the proper local anesthetic techniques. These were largely developed by dermatologists, and any doctor who performs liposuction should be familiar with dermatologic medical information.

Dr. Pat Lillis and others developed the safest standards for liposuction surgery. In my opinion, anyone doing a liposuction should understand tumescent anesthetic technique and fluid replacement, and know how to deal with emergency situations. The artful use of the tumescent fluid, which needs to be carefully spread out in all the areas to be liposuctioned, is a critical factor in patient safety. This is more than a matter of patient comfort; tumescent anesthetic makes possible a safer surgery and faster recovery. There is a lot of circumstantial evidence which implicates general anesthesia in liposuction problems. For more information, read my article on complications and another on general anesthesia, available in the Complications section on my website.

Asking a doctor about his tumescent technique may be a good index of how safe his technique is overall, but there are certainly no guarantees. Using the suggestions we offer in "How to Choose a Cosmetic Surgeon" can help you to make your decision in selecting the most competent physician.

Every doctor has his own profile of problems based both on the procedures he does and his overall experience. Hair transplants, for example, if done in the modern manner by the best practitioners, are very predictable. On the other hand, tummy tucks have a significantly higher problem rate no matter who does the surgery. Liposuction is somewhere in between. Breast implants, because a foreign substance is added to the body, have a chance of hardening and becoming unacceptable at any time during the rest of the patient's life (read the FDA Breast Implant Report).

Patients should understand the facts and plan for the best and the worst possibilities. Likewise, the doctor plans for his entire profile of patients, the good and the few poor results. Patients should be followed up at no charge until they are stable and happy with the process. I feel that touch-ups should also be free if the patient has a significant problem. Follow-up visits are the patient's responsibility. He or she must appear for follow-up appointments faithfully, so the doctor can spot any potential problems early.

If you can't accept the above — if you feel as though you couldn't possibly survive a long hassle with a difficult recovery — you should not have cosmetic surgery (or any elective surgery for that matter). Chances for complications are slim, but definite.

A Word about Multiple Procedures

Some medical literature is out now against the practice of performing multiple procedures simultaneously. (See my paper about anesthetic time in the Complications section of Because the surgeries are performed together, the time under anesthesia is longer and the physical toll on the patient's health is increased. This may result in a much greater risk of complication or death than with single procedures performed on different days. My advice: think twice about your "extreme makeover."

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