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Large Volume Liposuction - Nip/Tuck Gets It Very Wrong

By December 22, 2009

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I am not so silly as to miss seeing FX Network's plastic surgery-based drama Nip / Tuck for what it truly is: entertainment. I don't expect pinpoint scientific accuracy. However, when doing any sort of medical-based drama, doing it well requires that you must at least attempt to be somewhere in the realm of reality where the medical facts are concerned.

Last week's episode broke that rule ten times over when it portrayed a large volume liposuction case in which 150 lbs of the patient's body weight were removed during a lipo/tummy tuck combo surgery. We won't even get into the ethical considerations of sucking the fat out of a prisoner so he can be legally slim enough to receive his scheduled lethal injection. That's a blog for another day.

According to Laurence Glickman, MD, the maximum amount of body fat, skin, and fluid that can be safely removed in any one surgery varies greatly, depending on a number of factors including the patient's health and whether the procedure is performed on and in-patient (with an overnight hospital stay) or outpatient basis.

Another post-bariatric body contouring specialist, New York-based surgeon, Thomas Sterry, MD, states that it impossible to give an absolute maximum volume of fat, skin, and fluid that can be removed under the most optimum circumstances during a combination liposuction/tummy tuck procedure, because of all the variables involved. Typically, larger amounts of fat and skin can be removed through a body lift procedure. However, Dr. Sterry agrees (along with every other "real world" doctor I've talked to) that the surgical removal of 150 lbs is quite obviously an exercise in fantasy with no basis in reality.

Dr. Sterry points out that accepted conventional liposuction guidelines are to take out no more than 5 liters (about 10 1/2 lbs) of total volume. However, only about half of that amount is typically fat. The rest is the tumescent solution (fluid introduced into the area to assist with the surgery). Anything above this 5 liter volume is considered large volume liposuction, and requires an overnight hospital stay and careful monitoring of the patient. 

If I've said it once I've said it a thousand times: As much as we might wish otherwise, liposuction is mean to be a body contouring procedure, not a substitute for conventional means of weight loss such as diet modification and exercise. According to a study published in The New England Journal of Medicine, fat loss resulting from liposuction does not provide any of the metabolic or other health benefits of weight loss achieved through diet and exercise. In fact, fat removed from women's hips and thighs may actually cause a decline in optimal metabolic function in some women, due to the metabolically protective nature of the types of fat cells located in these areas.

If you do opt for undergoing large volume liposuction, heed these words from American Society for Aesthetic Plastic Surgery(ASAPS) President, Peter B. Fodor, MD:

"Large volume lipoplasty, in particular, requires extensive experience in lipoplasty procedures. The surgeon and assisting medical personnel must have broad knowledge and experience in anesthesia and fluid management. Postoperative monitoring of the patients must be vigilant. Patients must be thoroughly informed of the possibility of increased risk associated with large volume fat removal."

I still love you, Nip / Tuck...but...tsk, tsk, tsk.

Something to think about: Can Liposuction Cause Weight Gain?

See plastic surgery before and after photos.

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discussion in the plastic surgery forum.

December 30, 2009 at 11:48 am
(1) ChasCaliforniaSurgicalInstitute says:

I wouldn’t get your panties into too much of a wad about Nip/Tuck and its black humor. I’ve only tuned it in once, when an alleged plastic surgeon was giving a patient a rhinoplasty. When the surgeon picked up a bone saw to start the procedure, it became pretty clear that most of the programming is a bleak satire on surgical rejuvenation.

December 30, 2009 at 12:07 pm
(2) plasticsurgery says:

The fact that Nip/Tuck is satire is not lost on me. However, I thought this particular episode was over-the-top in its absurdity. The real issue for me is that I fear there are some viewers who will actually believe that sucking out 150 lbs of fat is a possibility. And those same viewers may be getting their hopes up, not to mention wasting a lot of plastic surgeons’ time with consultations, only to be told it’s not going to happen. Or worse yet, they find some fake “doctor”who leads them to believe it CAN be done, only to butcher (or kill) them trying.

December 30, 2009 at 1:38 pm
(3) Charles Downey says:

My point exactly. How many other procedures and practices do you suppose the program misrepresents? I daresay it does not stop with large volume liposuction or rhinoplasty. At one time, there was a website dedicated to the flubs, mistakes, purposeful errors and downright silly surgeries shown on Nip/Tuck. Perhaps a better question would be why you, an otherwise well informed opinion leader, profess to love the program, probably leading even more viewers into the wasteland you so nicely describe.

December 30, 2009 at 1:59 pm
(4) plasticsurgery says:

I do get your point, and appreciate your input. I also understand that in many ways, it makes the practice of cosmetic surgery (and the patients who seek it) look like nothing but ridiculously insecure caricatures of every possible stereotype. Of course, I know this is not usually the reality (although in some cases it can be). This doesn’t mean I can’t still love the show. I love it for the interpersonal drama and in-your-face style of the show as a whole. Most of the time, I enjoy the irony and satire. I also love that it stirs up some conversation/controversy, and gives me some fun fodder for my blog (and a chance to point out whatever may have been wrong with what was portrayed). I have in fact written previously about some of its more glaring misrepresentations, although sometimes, I don’t feel the inaccuracies merit a mention. This time, I just happened to feel it was needed.

January 4, 2010 at 7:04 pm
(5) Michael C. Pickart, M.D., F.A.C.S. says:

I’m going to defend Ms. Kita on this topic. In our entertainment, many of us love bombast and hyperbole. Nip/Tuck is so much fun because it is so ridiculous.

The show has certainly misinformed many patients, but it has generated a lot of interest. We plastic surgeons should be thanking F/X! Many patients finally get the nerve up to show up to my office because of televeision programs. Certainly, I have had to readjust a lot of expectations, but most patients understand that Nip/Tuck is “just TV” and they have much more realistic goals.

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