The liposuction scandal

When Eda Watson steeled herself to undergo a liposuction operation it was with the aim, dear to many women, of banishing the fat from her hips and thighs. Instead, the General Medical Council (GMC) heard this week, she was subjected to what is perhaps any patient's worst nightmare: she came round during the operation.

The results of her surgery were "equally horrific". "I looked like a Michelin Man," she told the hearing into the conduct of Dr Thomas Norton, the GP who operated on her. "I was all bulges and lumps. The contour of my chest was distorted."

Lawyers for the GMC told the hearing that Norton, who treated her at the private Transform clinic in Sheffield, was a GP with no past registration, experience or training in surgery or anaesthesia. Watson, 56, claimed he neither asked for her medical history nor conducted a physical examination before operating. Yesterday Norton admitted treatment "fell short of what was required", although he denies serious professional misconduct (the hearing is expected to end tomorrow).

This horror story could have been far worse, however, given the catalogue of dangers and side effects inherent in what has fast become Britain's most popular form of cosmetic surgery.

The adverts in the back of women's glossy magazines may promise a perfectly smooth silhouette, but the result could be lumpy, uneven, saggy, or - if the doctor is overzealous - bear the grooves of the liposuction equipment.

The dangers are not merely aesthetic. "The perception is, 'It's very simple: you just suck the fat out' - but it can be potentially life-threatening," says Professor David Sharpe, former president of the British Association of Aesthetic Plastic Surgeons.

Dangers of the treatment - which in 99.9% of cases is purely cosmetic - include ruptured abdomens and bowels, perforated spleens, serious tissue infection, and death caused by the blood pressure plummeting and the body going into shock if too much fat and fluid is removed.

In Britain, where an estimated 20,000 liposuctions are performed each year, at least one patient is believed to have died as a direct result; in America, where nearly 110,000 operations take place annually, the mortality rate is one in just over 5,000 [19 per 100,000] . "It's a sensational statistic - but, in the States, your risk of dying from liposuction is higher than from a road traffic accident," says Norman Waterhouse, a consultant plastic surgeon at the Chelsea and Westminster hospital in London. (This means that if you are involved in a road accident, your chances of death are lower than if you had opted for surgery - and clearly many road accidents are extremely minor.)

Whatever the merits of Watson's case, the risks, according to Sharpe and Waterhouse, are highest when inadequately trained doctors perform the operation - a situation which occurs since there is no accreditation system, and any doctor can set themselves up as a cosmetic - as opposed to plastic - surgeon.

"The perception is it's an easy thing to do, so you get some GPs, and doctors who have failed their surgical training doing it," says Waterhouse. "There are an awful lot of people around wielding liposuction cannulas [the large hollow needle through which the fat is sucked] with no training and an inappropriate knowledge of anaesthetics."

While such ignorance means unsuitable patients are operated on, it also leads to results that are far from attractive. "Technically, it's very simple: it doesn't require a great deal of intelligence or skill and that's why it's done by people not properly trained in plastic surgery," adds Sharpe, a consultant plastic surgeon at Bradford Hospital. "But it does require a sense of aesthetics."

For those who, like Nicole Appleton, Geri Halliwell and the topless model Jordan are - reportedly - unswayed by such risks, the "technically simple" procedure only works well on some candidates.

"Liposuction's not a way of losing weight," says Waterhouse. "You can't take a fat person and make them thin through it. It's a surgery of the silhouette - and it can have startling results on the right patients."

The ideal patient - who must be willing to pay between £2,500 and £5,000, since liposuction is rarely available on the NHS - is a woman with perfect muscle tone who works out but can't shift stubborn weight from localised areas such as her inner thighs or knees or who doesn't want to because it will make her face look too scrawny.

She's unlikely to be over 50: consultants are wary of operating on older patients because their skin is more likely to sag. Ideally, she should not want more than one and a half litres of fat removed, since pumping vast quantities out can lead to the potentially fatal fluid imbalance.

Once her medical history has been assessed, the operation involves tiny slit incisions, just a few millimetres in length, in a specific area, such as the abdomen, hips or inner thighs. A solution of saline, local anaesthetic and adrenaline is then pumped into the fat cells to reduce blood loss and loosen and liquefy the fat.Then, with a powerful suction machine attached, the surgeon scrapes backwards and forwards in the fat layer, breaking the fat down so it can be sucked out.

After the operation, patients have to wear a fitting garment for at least three weeks to encourage the now loose skin to lie flat and to help reduce the swelling.

Reactions are mixed. "People who are sensibly selected are very happy with the results," says Sharpe. "But it's the one operation which also leads to the most dissatisfaction." Some 60% of those approaching him are turned away - and often told to diet instead.

For those determined to press on, however, there are some clear recommendations. "Make sure your surgeon is connected to a proper hospital and is on a specialist register of plastic surgery or has an accreditation in plastic surgery, which you can check through the GMC," Waterhouse says.

Above all, he adds, don't fall for claims that the procedure will leave you with perfect buttocks, say, or the ideal belly. "You wouldn't choose your brain surgeon or heart surgeon on this basis, so why choose your plastic surgeon like this?"

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