When Liposuction Goes Wrong, the Result Can Be Deadly
Judy Fernandez, a 47-year-old businesswoman and mother of three from La Habra, Calif., trudged daily on her StairMaster, but like many women her age, she couldn't manage to lose the stubborn saddlebags and fat pouches on her legs and inner thighs. So when she saw a full-page ad in OrangeCoast magazine for "A New You" cosmetic surgery center, featuring a distinguished doctor surrounded by satisfied beauties, she was willing to try something new.
Fernandez underwent liposuction, a surgical procedure in which fat deposits are sucked out of the body from beneath the skin. She had intended to limit the procedure to her thighs and stomach, but she had the surgeon, William E. Matory Jr. of Irvine, Calif., perform liposuction on other areas, too, along with a fat transfer to her buttocks, a partial face lift, and laser resurfacing. Ten and a half hours later, after the doctor had removed 9 pounds of fat and fluids from her 5-foot, 2-inch, 150-pound body, she was lying on the operating table, unresponsive. Barely four hours later, she was dead of cardiac arrest.
Fernandez, whose case prompted the Medical Board of California to revoke Matory's license, was in an unfortunate minority among the hundreds of thousands of people who undergo this most popular of cosmetic procedures each year. Most patients find liposuction a relatively safe way to drop down a belt notch by trimming off what dieting and exercise can't. But Fernandez is part of a troubling statistic: A random survey of plastic surgeons released last month found that the death rate from liposuctions from 1994 to 1998 was 20 times higher--1 in 5,000--than elective surgery as a whole. And experts worry that the death rate is actually higher, because liposuction has moved out of hospitals and into doctors' offices and storefront clinics. These centers are not held to the same credentialing standards as hospitals and are under no obligation to report problems to state medical boards. "Liposuction is not trivial surgery," said plastic surgeon Frederick M. Grazer and anesthesiologist Rudolph H. de Jong, the study's authors. "Liposuction is not an altogether benign procedure."
Boomer bellies. Yet as Americans become older, richer, and fatter, they are flocking to "surgicenters" and "day spas" as never before, losing fat along with wrinkles and unwanted facial hair. The typical liposuction patient, once a socialite or actress, is now a 37-to-50-year-old career woman who just wants to look a little better in her jeans. These average Americans helped increase the number of liposuction procedures by 64 percent from 1994 to 1998, making it an estimated $700 million a year business.
It is a boom fed by unusually aggressive marketing. Doctors are luring patients with newspaper and magazine ads that compare "before" photographs of unsightly stomach rolls with "after" pictures of tight physiques that look fake because they often are. A recent issue of the LA Weekly newspaper featured ads for no fewer than 17 liposuctionists. And in Reno, Nev., a liposuction center has blocked views of the Sierra Nevada mountains with a lighted billboard that urges residents to dial 1-888-GO-4-LIPO. "Because of people's comfort level," says Harvey Zarem, former head of plastic surgery at the University of California-Los Angeles Medical Center, "liposuction is . . . pushed and fostered."
It is also extraordinarily lucrative. Because cosmetic surgery is rarely covered by insurance, doctors can set their own fees--anywhere from $3,000 to $8,000, depending on the length of the procedure. And anybody with a medical license can do it. Indeed, the 400 doctors who gathered to learn the latest liposuction and other techniques last month at the American Academy of Cosmetic Surgery in Orlando included oral surgeons, ear, nose, and throat doctors, and even osteopaths.
Melting the pounds. In a typical liposuction procedure, a doctor draws contour lines on the patient's skin, then places the patient under general anesthesia. Sometimes the doctor will run an ultrasound wand over the site to liquefy the fat. He or she then inserts a tube about the size of a ballpoint pen into the site and vacuums the fat into a beaker. With so-called tumescent liposuction, the doctor floods fat with fluids, making the suction easier and allowing more fat to be removed. One advantage of tumescent liposuction is that it can be performed with local anesthesia.
But as recent tragedies make clear, liposuction is not tooth extraction: It is invasive surgery, and particularly in the hands of an overly optimistic doctor or an anesthesiologist without emergency equipment nearby, things can go wrong. Rama B. Rao, a physician with New York University Medical Center, writing in the New England Journal of Medicine, linked five deaths in New York City from 1993 to 1998 to complications from tumescent liposuction, most of them caused by plummeting heart rates and dramatically reduced blood pressure. In Grazer and de Jong's study of 130 liposuction fatalities, the most common cause of death was a blood clot (which can occur after any surgery if a patient isn't carefully monitored), followed by perforations of organs or abdominal walls.
Lisa Marie Marinelli of Beachwood, N.J., was one of liposuction's unlucky victims. A 23-year-old secretary who stood 5 feet, 2 inches tall and weighed 115 pounds, Lisa went to a dermatologist because of a mild rash but made a liposuction appointment after reading a brochure in the waiting room. "I told her she was a nut to have this procedure done," says her mother, Kathleen. " 'You're beautiful; you don't need that.' " Yet the doctor, Rami Geffner of Toms River, N.J., gave Lisa a local anesthetic, removed a small amount of fat from her knees and thighs, and then wrapped her legs in Ace bandages. The next day, Lisa was dead from a blood clot in her lung that her family says was caused by too-tight bandages. The family sued the doctor, and a jury awarded them $558,600. Says Kathleen: "My daughter died for 2 tablespoons of fat." Geffner, who said he actually removed 10 ounces of fat, said he sympathized with the family and called Lisa's "an unfortunate case." But he denied responsibility for the incident and blamed emergency room personnel for not calling him until four hours after Lisa arrived.
The Marinelli case also highlights a challenge for prospective patients who want to check the credentials of doctors. Geffner, who has been a defendant in four other malpractice suits in 15 years--at least one of which he won--is listed as a doctor in good standing with the New Jersey State Board of Medical Examiners.
When a patient does narrow the choice of doctors, he is likely to get conflicting advice--even from the same doctor. A male U.S. News reporter, 5 feet, 10 inches, 170 pounds, in good shape but with small "love handles," consulted with one Miami Beach doctor, who told the 38-year-old he was wasting his money but nevertheless promised he would whittle his waist size from 34 to 31 inches. And within 90 minutes of the appointment, the clinic's marketing coordinator called to follow up. A doctor in another Miami clinic instantly labeled the reporter "overweight" but said he would remove only 4 pounds of fat on an initial visit. In Beverly Hills, a 43-year-old female reporter, 5 feet, 2 inches, 115 pounds, and very fit, visited one doctor who promised to "aggressively sculpt" her small saddlebags. Another said she was not a good candidate for the procedure.
Lax oversight. In response to growing concerns, at least three states are looking at ways to clamp down on outpatient surgery. In California, where as many as 70 percent of oral surgeons are now doing cosmetic surgery, a new law requires doctors to conspicuously post their board certification and use "after" pictures of real patients, not models. Florida recently issued new standards for office procedures, requiring better monitoring after surgery but still allowing in-office operations as long as eight hours. Still, state medical boards cannot regulate these centers unless they receive complaints. Yet policing isn't the only solution. "Part of the blame is with the patients, who expect a lot from this type of surgery," says de Jong. "I think the public needs to be aware that you can't expect too much."
[Photo captions]:
TAMMARIA COTTON,
Died at age 43
The Los Angeles woman leaked fluids after her liposuction, but the obstetrician who operated on her left his office. She had a fatal heart attack.
JUDY FERNANDEZ,
Died at age 47
Went in for liposuction and other cosmetic surgery, spending 10 hours on the table. The state medical board revoked the doctor's license for negligence.
LISA MARIE MARINELLI,
Died at age 23
The New Jersey woman had liposuction after seeing a brochure in her dermatologist's office. She died of a blood clot the day after surgery. The family sued and won.
With Doug S. Pasternak and Betsy Streisand
This story appears in the February 21, 2000 print edition of U.S. News & World Report.