Can Fat Removal Surgery Lead To Death?

On May 17, 21-year-old Kannada actor Chetana Raj passed away at a hospital in Bengaluru.

Post her death, her family alleged medical negligence over the ‘fat-free’ procedure she underwent at the hospital.

While it is not unknown for actors and celebrities to go under the knife for cosmetic reasons, the young actor’s unfortunate death has raised concerns about the possible risks and complications posed by such surgeries.‘s Divya Nair spoke to multiple experts from across India to understand the side effects of cosmetic surgery in general and liposuction, or fat removal surgery, in particular.

While most doctors she spoke to called it “unfortunate and rare” and refused to comment on Chetana’s case due to lack of adequate information, they did say that the possibility of death from cosmetic surgery was “one in a million”.

“Death could have been due to some rare surgical complication like pulmonary edema, pulmonary thromboembolism or fat embolism. But these fatal complications are very rare following liposuction surgery, says cosmetic and plastic surgeon Dr Kiran Mai Atla, Marengo Asia Network Hospital, Delhi.

“It (Complications or death) can happen to anyone with any kind of surgery. It doesn’t imply anything against the doctor or the procedure,” adds cosmetic dermatologist Dr Soma Sarkar, founder, Dr Soma’s Aesthetic Clinic, which has branches in Mumbai and Bengaluru.

“A patient goes through a series of investigations and tests before any surgery. This is a very unfortunate incident and it would be unfair to call it medical negligence,” Dr Sarkar says.

“Every human body is different. No matter how experienced a doctor or surgeon is, it is difficult to predict how a body will react to a surgery. And it’s not always the doctor’s fault,” she adds.

Dr Anup Dhir, senior consultant, Apollo Hospital and ex-president, Indian Association of Aesthetic Plastic Surgeons, says, “it is very rare for a fit and well patient to die after such routine procedures.”

What is liposuction?

In simple terms, liposuction is a surgical process in which fat deposits are removed from certain parts of the body under local or general anesthesia.

“The procedure was first introduced in the United States in 1982. Liposuction can remove localised collections of tiny fatty tissue in many areas of the body. By using a high vacuum device, the surgeon can suction fat from the legs, buttocks, hips, abdomen, back, arms, face and neck,” Dr Dhir explains.

While there are different procedures to remove fat, including invasive and non-invasive methods; in a surgical process, “a cannula is inserted into your body in the area where the fat has to be removed; it is sucked out and comes like a semi-fluid into the jar,” says Dr Sarkar.

In India, there are manual, power assisted, water jet and VASER liposuction processes available.

After the successful completion of the surgery, patients are given pressure dressings and sent home or, in certain cases, monitored in the hospital.

There is a possibility that, for a day or two, the residual liposuction fluid could leak through the small cuts that are made during the surgery.

Post-surgery, the patient has to follow certain lifestyle modifications that includes diet, exercise, possibly wearing a corset, following the prescribed routine and consulting with the doctor at regular intervals.

What is excessive fat?

According to Dr Sarkar, the human body has two types of fat — visceral (fat accumulated around the organs of the body) and subcutaneous (fat found under your skin). The latter helps maintain your body’s temperature and acts as a shock absorbent.

However, if there is an excessive amount of visceral or subcutaneous fat, it is bad for a person’s overall health as it can lead to diseases such as diabetes and obesity and cause cardiovascular problems.

“Every human body has a healthy ratio of fats that is essential for its regular functioning and balance,” says Dr Sarkar, adding, “When you visit a cosmetic surgeon, s/he will recommend certain tests to determine if the patient is medically fit and eligible for the procedure. Also, if the patient is obese, s/he may require fat removal surgery in multiple sessions.”

Who should go for liposuction?

Liposuction is a safe procedure and is recommended for all healthy individuals who seek improvement in their body contours, say doctors. Even patients who have co-morbid illness like diabetes and hypertension can consider this procedure if these pre-existing conditions are under control, they add.

Patients with comorbidities that are not under control, patients with heart problems or those who are on anticoagulants which cannot be stopped cannot undergo liposuction, they underline.

Doctors are also careful to point out that liposuction is not a weight reduction surgery.

“It is recommended for the reduction of fat deposits and to shape the body in patients who are moderately overweight,” says Dr Dhir.

Before the surgery, a series of tests are conducted on the patient to analyse various parameters that helps the doctor decide on the best form of surgery and treatment.

If you have metabolic disorders where medication is required, or any other health condition, this is taken into consideration by your doctor before a fat reduction surgery is recommended.

Potential risks and complications after the surgery

Cosmetic surgeries are normally conducted on patients who are “fit and well,” say doctors. The fatality rate in liposuction procedures is about one in two million, adds Dr Dhir.

Apart from anaesthetic and other routine complications, there is the risk of fat embolism which can happen in a few cases, say doctors.

As per Dr Mai Atla, the risks of cosmetic surgery are same as with any other major surgery. “There may be local complications at the site of the surgery — like bleeding, infection, fluid or blood collection or systemic complications like bowel perforation, fluid overload, deep vein thrombosis and fat embolism.”

“Sometimes, you can only remove 3-4 litres of fat in one session. So, if you are obese, you may require multiple surgeries. Post surgery, there can be complications with cardiac tissues,” adds Dr Sarkar.

A good doctor looks at the patient’s physiology and explains how s/he can realistically meet the patient’s requirement and expectations.

Cosmetic surgeries are not always about aesthetics, Dr Sarkar insists. Sometimes, in the case of obese patients, it is also about embracing a healthier lifestyle post-surgery.

Cost of surgery

A simple surgery can set you back by Rs 40,000 to Rs 200,000 in India, depending on the amount of fat that needs be removed and the areas involved.

In most cases, pricing also depends the method, technology and equipment used in the surgery, combined with the expertise of the doctor and/or surgeon/s.

Important pointers for patients

  • As they would with any surgery, it is important for patients to get all their health parameters thoroughly tested before a surgery.
  • The patient should go to a board-certified and hospital-accredited surgeon and get the procedure done in a hospital rather than risk doing it at a small centre.
  • The patient should ask the surgeon about his/her experience as far as liposuction is concerned, understand the risks and potential complications of the procedure and make an informed choice.
  • It’s important not to get overwhelmed by facts or data.
  • Do not go price hunting and make a decision based merely on the cost of surgery. Do also look at the doctor’s expertise and analyse previous case studies to understand the risks and success rate.
  • Always share your medical history with complete honesty. Do not hide or withhold any information from your surgeon.

Long term fix: An alternate healthy lifestyle?

If you don’t want to consider surgery, there are non-surgical, non-invasive procedures you can explore.

Nowadays, people are more aware about their bodies so the dependency on these procedures has reduced.

While biological ageing is a given, there is also pressure on people in certain professions to look flawless and presentable all the time.

But there are alternatives to surgery or other invasive treatments. The best option, always, is to take good care of your body.

“Why, for example, should you consider botox? Sometimes using a simple sunscreen or investing in a good skincare routine every day can be the secret to anti-ageing or premature ageing,” says Dr Sarkar.

“Though you invest so much in your clothes, your skin is the best representation of your personality. You have to follow certain routines to keep it healthy.

“If you ask me, flaunting your greys is absolutely okay. And if it is not impacting your personal or professional life, go ahead and do it.

“At the end of the day, it’s all about balance. Anything in excess is bad.”

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