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A Review of Liposuction, Abdominoplasty and Facelift Mortality And Morbidity Risk Literature

In Summary

Careful and objective reanalysis of the literature data has been necessary in order to estimate the true mortality and morbidity risk rates from cosmetic surgeries. Discrepancies in the design, sizes, and biases (notably underreporting error of surveys) of these sparse reports defy definitive analysis. In particular, both surgeon and patient should be aware of the marked lack of literature for breast surgery and blepharoplasty risk. Until it is available, accurate and objective assessment of the risks associated with these procedures is impossible. We are highly suspicious that studies performed in the U.S. may be biased against revealing complications, and that only the studies showing the highest figures may be accurate. It is unfortunately in the interests of almost everyone involved in cosmetic surgery to conceal major complications in this litigious environment. We applaud Grazer and de Jong in particular for their courageous work despite these factors8.

Nevertheless, our critical analysis of the current data for liposuction and rhytidectomy shows that the morbidity and mortality rates associated with these procedures compares favorably with most general surgeries. In contrast, the disproportionately high risk rates associated with abdominoplasty, which are orders of magnitude higher than that for other plastic surgical procedures and nearly equivalent to the risk from major abdominal surgeries, remain unacceptable.

Finally, a number of other factors can greatly affect the risk of fatality or serious complications. First, surgical centers may be the safest venue in which cosmetic procedures are performed. Also, performance of multiple procedures - though this is as yet from sparse data - seems to have much more than an additive effect, and possibly an exponential effect, on mortality. Prolonged surgical duration clearly increases morbidity and mortality in other surgical fields, and this must occur for cosmetic plastic surgery as well. Lastly, general anesthesia carries an additional significant risk, a concept long denied in the anesthesia literature but now becoming clearly acknowledged.

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