No liposuction in overweight

Liposuction entails risks and can in the worst case lead to death

01/09/2013

Liposuction seems to be an alternative for sports and a healthy diet against unpleasant flab for more and more people. In very few cases there is a medical need. But the procedure entails considerable risks. Especially overweight should refrain from liposuction because it does not serve the weight reduction, experts advise. Those affected should first with exercise and a diet slim down the superfluous finds.

Liposuction in case of unwelcome flab
There are fat pads such as the so-called riding pants on the thighs or the „Love handles“ on the flanks that are not going to train with sports. Some people are so upset that they dare to go to the cosmetic surgeon. As a rule, the choice falls there on a so-called liposuction, liposuction. However, people with a strong overweight should definitely refrain from it.

„Liposuction is not for the overweight, it is not used for weight loss, "says Lutz Kleinschmidt of the German Society for Aesthetic Plastic Surgery (DGÄPC) .Only liposuction is to be considered when sport and diet no longer reduce weight. In the case of liposuction, a body mass index (BMI) should be between 19 and 25, Kleinschmidt explains: According to their own statements, the specialist would not carry out this treatment for very obese people.

Liposuction and skin tightening
Professor Günter Germann of the German Society of Plastic, Reconstructive and Aesthetic Surgeons (DGPRÄC) explains the connection between liposuction and skin tightening: „Liposuction is always an integral part of an upper arm, thigh or tummy tuck.“ Tightening is desired, for example, after heavy weight loss in some cases.

In a liposuction, according to Germann, fat is sucked off via a cannula and, in addition, a large wound is generated by the surgeon, which is intended to naturally tighten the skin during healing when contracting. However, an improvement of the body contour can not always be achieved. „In many situations, the sucking alone is enough, sometimes it is just a try, and the skin stays limp without retreating“, explains Germann, whose private clinic is part of reconstructive medicine at the University of Heidelberg. Then an operative skin tightening can be considered.

Liposuction rarely medically necessary
In most cases, liposuction is done for esthetic reasons only. However, there are also medical indications. „If there is too much volume in the reconstructive area in so-called flap plasty after tissue transplantation, ie if, for example, skin and adipose tissue were transferred from the upper to the lower leg, then suction is now a means of reducing this, "reports the physician.

In so-called lipoedema - these are pathological vascular changes with accumulations of water in the fatty tissue - liposuction may also be suitable from a medical point of view. The vascular expert Professor Etelka Földi of the German Society for Phlebology sees a wide range of applications for liposuction, to prevent discomfort of the bone structure threatening X-legs. Then fat is sucked off at knee height. „However, liposuction in lipedema does not replace the conservative treatment of sports, compression stockings and lymphatic drainage, "said Földi, who was involved in the preparation of the treatment guidelines for lipedema.

There are many risks in liposuction. This is no different than other operations, as the physician emphasized. The biggest danger is that at the points where the fat was sucked off, dents form. It could also lead to inflammation or embolism in the fat. But that rarely happens. "Normal complications include swelling and bruising, which affects all patients," reports Kleinschmidt. It is also possible that an asymmetric result results. Surgeons avoid this by accurately comparing the amount of fat millimeter, which is sucked right and left, for example, from the thighs. Despite numerous precautions, it can happen again and again that about three months later an intervention is necessary to make corrections.

Partly deadly consequences of an intervention
According to a survey of the University of Bochum as part of a doctoral thesis, there were 75 serious complications between 1998 and 2002 with a total of 2275 liposuctions in Germany, Austria and Switzerland. 23 patients died as a result of the procedure. For example, severe skin and subcutaneous dermal infections, sepsis, damaged gallbladder, gas gangrene and other damage occurred. Most adverse events occurred within the first 24 hours after surgery. Often, however, after 14 days after the operation follow-up visits are agreed. Therefore, the doctor advises in her dissertation, „Doctors should routinely check patients within the first 24 hours after surgery.“ In addition, liposuction should not take place simultaneously with further interventions. „The extracted amount should never exceed four liters“.

After liposuction, all those who are operated on must wear compression girdles and be physically fit for up to 14 days. This also means that sport and active movement may not be carried out for at least two weeks. A repetitive procedure on the same part of the body is, according to the experts „at the earliest six months of the previous OP possible“. If surgery is performed elsewhere, reoperation is possible after three months.

Health insurance companies do not pay any treatment costs
In principle, health insurance companies do not pay the costs for a liposuction. Each procedure must therefore be carried out of pocket. The treatment costs are based on the effort that has to be made. For the suction on the outer and inner sides of the thigh estimated for example Dr. Kleinschmidt between 4000 and 6000 euros. If you want to treat more parts of the body, you can quickly get 10,000 Euro together.

The health insurances do not pay even if the patients suffer from lipoedema or a genetic predisposition „columns leg“ to have. According to Földi, the study on liposuction in lipedema is very confusing“. However, funds only pay if there is clearly a disease and scientifically proven treatment. „In all other cases, the patients alone have to bear the costs. Only right, if the procedure is cosmetic, emphasizes Steffen Hausmann, insurance expert. (Sb)

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Picture: Martin Büdenbender