29 Sep 2011
By: JOAN CHEW
Every day in Singapore, about a dozen people undergo a procedure to suck fat out from parts of their bodies – just to look good.
Liposuction is the fastest way for one to lose stubborn and unwanted fat from the arms, abdomen, back, thighs and buttocks – areas which may not respond quickly enough to traditional weight-loss methods of diet and exercise.
Doctors say there is no medical need for liposuction nor does it confer any health benefits, because the type of fat it removes is not linked to health problems such as heart disease and stroke.
The quick fix is appealing but not without risks, so new ways to make it safer and more effective have emerged in the last 10 years.
Traditionally, doctors use a procedure called suction-assisted liposuction, which requires them to move a tube called a cannula around the area where fat is to be removed, to physically break up the fat before sucking it out.
Now, they can choose to break up and detach the fat using a vibrating cannula in power-assisted liposuction, or high pressure water jets in water jet-assisted liposuction.
Alternatively, they can melt the fat by using a laser in laser lipolysis, or high-frequency sound waves in ultrasonic-assisted liposuction.
These innovations have made the job easier and less tiring for doctors, in turn enhancing patient safety.
Nonetheless, anyone seeking liposuction should recognise that it still involves some risks, despite these improvements.
BOTCHED PROCEDURES
Last month, the safety of this fat-busting method was called into question again following reports of two botched procedures.
One woman suffered severe burns on her nose under the hands of a general practitioner (GP), who was found guilty by the medical watchdog, Singapore Medical Council, of using laser lipolysis inappropriately.
He was trying to dissolve fat from the client’s nose to make it slimmer and sharper. While he was trained to perform the procedure, it is not recommended for the nose.
Another woman, a diabetic, suffered traumatic injury to her intestines during liposuction by a senior surgeon at the Singapore General Hospital (SGH) and needed emergency surgery.
Botched liposuction even killed one man here in 2009. Property head honcho Franklin Heng, 44, died from punctures to his intestines sustained during liposuction.
Other than last month’s SGH case, no reports of major complications have been made since last November, when the Ministry of Health (MOH) ruled that doctors had to report these within 24 hours, said a ministry spokesman.
The ministry considers anything that requires the patient to undergo remedial treatment in a hospital as a major complication.
Citing confidentiality, the ministry declined to release other data on how patients fared after liposuction, which doctors have been required to submit since 2008 to be accredited.
A ministry spokesman said: “MOH does not track patient satisfaction or how well body contouring is achieved through liposuction.”
BETTER AND SAFER TECHNIQUES
Liposuction was introduced in the late 1970s. In the early days, improvements were linked to advances in the design of the surgical tools.
But there were still issues related to surgeon fatigue, blood loss, post-operative bruising and limited effectiveness in fibrous areas of the body, such as the upper back.
Dr Leslie Kuek, a past president of the Singapore Association of Plastic Surgeons, said that 25 years ago, liposuction to remove more than 2 litres of fat from a patient’s body would most likely require a blood transfusion.
Blood would comprise up to half of the volume of the substances removed.
Since a decade ago, all doctors have been infusing a solution into the area first before the fat is sucked out.
The solution contains epinephrine – a medication that shrinks blood vessels to decrease bleeding and bruising – and a local anaesthetic to minimise pain.
Because of this, blood now makes up between 10 and 15 per cent of the substances sucked out through liposuction, said Dr Andrew Khoo, a plastic surgeon at Mount Elizabeth Medical Centre.
To remove 5 litres of fat may require two or three procedures previously but this can now be achieved safely in one sitting, saving time and money, he added.
A study published in 2009 in the Aesthetic Surgery Journal also found that the proportion of patients who needed a repeat procedure dropped from 12 per cent to 2 per cent after this solution was introduced.
Then within the last 10 years, different types of technology have emerged to make the removal of fat less tiring for doctors.
This theoretically also reduces the risk of mistakes and complications during surgery, though none of the newer techniques have been proven to be safer and more effective than the traditional one.
Studies have shown that the complication rates are relatively low. For example, a study published in Aesthetic Plastic Surgery in 2009 showed that complications such as low blood pressure, skin irritation, fluid retention and bleeding occurred in only 1.4 per cent of 660 ultrasonic-assisted liposuction cases.
This procedure, which applies ultrasound waves that cause fat cells to vibrate and separate from one another, appears to be the most popular here.
Seven out of 10 doctors – eight plastic surgeons and two GPs – said they used an ultrasonic system for liposuction.
This emulsification process turns fat from “a solid chunk to milkshake” which can be easily sucked out, said Dr Kevin Teh, a GP of Singapore Medical Group, who is accredited to carry out liposuction.
Dr Andrew Tay, a plastic surgeon at Novena Medical Centre who uses this system, attributes its popularity to the heavy marketing by its distributor, which prompts some patients to ask for it too.
But because ultrasonic-assisted liposuction is costlier than other types of liposuction, some doctors use it only selectively, like Professor Walter Tan, a specialist in plastic surgery at Raffles Hospital.
He said the technique is useful for breaking down difficult areas of fat, but he would opt for traditional and power-assisted liposuction in most cases.
The traditional procedure at Raffles Hospital costs at least $8,000 while the water jet-assisted method will set one back by at least $10,000. The ultrasonic-assisted one costs at least $12,000.
At least one doctor is also looking for more precision in how much fat to take off.
Doctors typically do the “pinch” test, holding a chunk of skin and fat between the thumb and fingers to differentiate fat below the skin which can be sucked out safely, from fat surrounding the organs which is too risky to remove.
Dr Teh uses an ultrasound machine, which is more exact and can also pick up conditions like hernia, signalling a muscular weakness in the abdomen.
News of constant improvements in liposuction is welcome to women like a 29-year-old cosmetic counter sales assistant who did not want to be named.
She went to Dr Teh last year to get an imperfect liposuction fixed. That first procedure, done five years ago, left her with a bigger left thigh than the right.
She said: “I could see that both my thighs were slimmer than before, but why were they asymmetrical?”
The second time round, with ultrasonic-assisted liposuction, she had less post-operative pain and was happier with the results.
But in the end, technology may matter less than skill, say specialists.
An experienced surgeon using traditional liposuction may achieve as good a result as another using the latest tool, noted Dr Tay.
Another plastic surgeon at Novena, Dr Tan Ying Chien, said: “No matter how advanced the plane, it will still crash if it’s not driven by a competent pilot.”
A 39-year-old mother of two, who works in sales and underwent liposuction in April to rid herself of the “folds of fat” in her stomach, agreed.
She did her own research on the Internet and spoke to others who had undergone the procedure to pick her doctor.
She was so pleased with the results that she has since spent $12,000 on new figure-hugging clothes.
She said: “Choosing the correct doctor is the key."
Email: joanchew@sph.com.sg
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