Brain-dead from Laser Lipo Under Local Anesthesia?

Question

This question is for doctors who perform Smart Lipo or liposuction using local anesthesia: I read about a 37-year-old woman who went brain-dead after receiving laser lipo at a Medspa in the East Coast. How is it possible for a woman to go brain-dead and die from laser lipo, or do you think msybe something else transpired with her for such a drastic outcome of her surgery?

Armando Soto, MD, FACS · Answer

Hi there-
Without knowing more details about the patient and surgery you refer to, it is very difficult to know exactly what might have happened... I can tell you that there was recently a patient death here in Florida during Smart Lipo under local anesthesia (possible we're talking about the same case)....
This patient died as a result of Lidocaine toxicity- a situation in which she was administered excessive amounts of numbing medicine during the procedure in an attempt to make her comfortable. Complicating the situation (and in my opinion contributing heavily to the risk) was the fact that she was having the procedure performed by a physician whose primary training (his residency training) had been in rehabilitation medicine (the type of doctor that might help you recovery from hip replacement or a stroke... these doctors most certainly do not receive liposuction training in residency), and was being done in his office, not an accredited OR...
There are several issues here.... First of all, it is imperative to understand the difference between saying that something "can" be done, and whether or not it is actually in the best interests of the patient.... If you asked me, "Can liposuction be done on an awake patient with local anesthesia?", I would answer yes, but unless it is the SMALLEST of areas, you are exceptionally tough, and you don't mind possibly compromising the outcome a bit, you should not have it awake...
Regardless of technology, the truth is that liposuction (again, unless it is the smallest of areas) hurts. Period.
Sculpting a lovely outcome for a patient is very difficult when they are in pain (even if they are a bit sedated and might not remember it) because I (being a nice guy) worry about their pain and the trauma they are experiencing, and become a bit distracted from the job they paid me to do- to give them the best outcome possible. The possible scenario here is that you end up having a terrible, painful experience, and don't even get the desired outcome because instead of focusing on doing their best work for you, your surgeon is preoccupied with your pain.
I suspect that this is what got the doctor in the situation above into trouble and led to the unfortunate death of his patient- she experienced pain, and he treated the pain with the only option available to him (since he was not doing it in an OR with an anesthesiologist available)... and ended up giving her so much numbing medicine that it caused her death.
So in my opinion, just because in some cases liposuction CAN be done with only local anesthesia doesn't mean that it is in the best interests of the average patient. 
The second big issue is that the symptoms of lidocaine toxicity usually are not manifested for many hours after the drug is administered (up to 16 hours later!). This means that by the time you begin to have a problem from receiving so much lidocaine, you are probably no longer at the doctor's office, but at home, where you may not realize you have a problem until it is a big one....
Finally, it cannot be emphasized enough that liposuction (ANY liposuction, whether it is with Smartlipo, the VASER, or any other machine) IS SURGERY. No surgery should be entered into lightly. You should absolutely research the surgeon's credentials, but also those of the facility and the anesthesia provider. Be sure your surgeon is certified by The American Board of Plastic Surgery.... You would never let a doctor perform heart surgery on your mother if you knew his residency training had been in pediatrics, would you? Letting a doctor who did not receive training in plastic surgery as a resident do liposuction on you is not much different.
Be careful- safe and effective liposuction exists- but you have to do your homework.

John K. Wakelin III, MD, FACS · Answer

For any surgical procedure it is important that your Plastic Surgeon has your safety as priority #1. Make sure that your surgeon is Board Certified and practices at an accredited facility. Fortunately liposuction and Smartlipo done by a reputable and safe surgeon on an appropriate patient is a very safe procedure.

Sonia Badreshia-Bansal, MD · Answer

Without knowing all of the details, there is no way to speculate about what transpired. More detailed information is needed to begin to understand what happened.

Richard Baxter, MD · Answer

Liposuction has been around for a long time and there have been several improvements in technique and technology. In the mid-1990's, there were several reports of death and serious complications, and the procedure started to get a bad reputation. As a result, a task force of experts was put together and it was determined that there should be limits on how much could be done at one time, and that it should be done in properly accredited surgical facilities. It then became a safe and increasingly popular procedure.
Laser lipo has been touted as a safer and less invasive "alternative" even though the laser adds additional risk and by definiton it is not less invasive. In a competetive market, larger and larger volumes are being removed and the procedure is being done in medispas as though it isn't a surgical procedure at all! In doing these larger volumes, more anesthetic and fluid has to be injected, and the risk increases. Buyer beware.

John LoMonaco, MD, FACS · Answer

It is possible for "lightning to strike" any one of us at any time, including during a plastic surgery case. 
Sadly, almost all of the bad outcomes that you will hear about in the media are have one or more of the following in common:

A practitioner  with inadequate training or questionable credentials
A facility that is not properly staffed or equipped

My advice to all patients is to seek only board-certified plastic surgeons who perform their procedures in fully accredited facilities. 
Your doctor should also have hospital privileges for whatever procedure he is performing, even if it is in an outpatient facility.

David A. Bray, Sr., MD · Answer

There are multiple risks that should be minimal. The medication for sedation may have been too much, The xylocaine infusion could have been incorrectly calculated. The beauty of smart lipo is that it should be done sedated mot a general anesthesia. My patients talk to me alll through the procedure but, are perfectly comfortable

Steven Wallach, MD · Answer

Surgery is surgery, and liposcution whether done with laser as in Smartlipo or more traditional means can have complications. While it is extremely rare, death can happen with almost any surgery. The key to minimizing your risks, are to go with a top qualified surgeon in a fully accredited facility or hospital, and have a full medical work-up as deemed appropriate for your age and general health statu.

Marcus L. Peterson, MD · Answer

All of the advice you have been given is very good.  I want to add a bit of information that could possibly save a life.  Many states, my state included, do not control the spectrum of medical practice of licensed physicians.  Once a physician has a license to practice medicine in that state they can call themselves any thing they want no matter what specialty of training they have had.  I know OB-GYN doctors that are suddenly marketing themselves as cosmetic surgeons and soliciting patients for liposuction and face lifts.  The state licensing board is not bothered by this.  Once a physician is given a license they can do any thing they want as long as do not kill any one, this is the mind set of the bureaucrats.
Buyer beware.  You have to do you own home work and not depend on the government to make medicine safe for you.  Find a surgeon that has real credentials and beware of the marketing.
Best Wishes
Dr. Peterson

Peter A. Aldea, MD · Answer

Dear Flawed,
REGARDING -"How is it possible for a woman to go brain-dead and die from laser lipo, or do you think maybe something else transpired with... "
This case has been in the news repeatedly and exemplifies why you should ALWAYS insist on a Plastic surgeon going Plastic surgery rather than the current state where due to corrupt state officials ANY doctor can PRACTICE any field of Medicine. 
In this case as in most such disasters implicating "plastic surgeons", the Doctor was NOT a member of the American Society of Plastic Surgeons (as are ALL of us on this panel). Instead, the "plastic surgeon" here was Dr. Omar J. Brito, MD who went to medical school in Venezuela and trained here in Occupational Medicine (Occupational medicine is the branch of medicine that deals with the health of workers. An occupational medicine physician treats work-related injuries that include lung disease, breathing disorders, allergic reactions to chemicals, or chemical burns. This specialist also works with business owners and workplace safety organizations to protect the health of workers and to prevent work-related injuries, accidents and diseases. ) / Family Medicine / Adult Medicine actually practiced Plastic Surgery, also happened to have a disciplinary action against him by the state of Florida.
"Weston, Florida&mdash;last Friday, Rohie Kah-Orukaton went to her favorite spa to have a routine liposuction procedure performed. However, the procedure, described as minimally invasive, went terribly awry. After suffering a seizure, the nurse and mother of three is brain dead and on life support at the Cleveland Clinic in Weston, Florida.
Mrs. Kah-Orukaton was a patron of the Weston spa for approximately five years prior to receiving the liposuction procedure. Apparently, the facility was not licensed to perform liposuction. However, Doctor Omar J. Brito, the doctor who performed the procedure, is licensed. Furthermore, he alleges that he was unaware that Weston Medspa was unlicensed to perform liposuction procedures. Nevertheless, Michael Freedland, the Kah-Orukaton family&rsquo;s attorney, believes that Rohie suffered a seizure as a result of an anesthetic called lidocaine. He has since requested a medical report from the spa, but has yet to receive it.
Dr. Brito maintains that he did not experience any difficulties during the procedure until the very end and then called 911 immediately. In spite of that statement, Dr. Brito&rsquo;s profile on the spa&rsquo;s website does not list any training or residency with cosmetic surgery. His attorney, Brian Bieber, however, maintains that the doctor has performed liposuction procedures for 4 years. Nonetheless, it is against Florida state law to perform liposuction in an unlicensed facility. Rohie&rsquo;s husband declined to comment on the matter, as he and his family make a decision whether or not to take her off of life support. She will leave behind three children&mdash;ages 4, 5, and 7."
From reading the hundreds of E mail on REALSELF.COM asking "where is the cheapest XXXX plastic surgery procedure?" it is painfully obvious that our message is NOT getting through. I am sure this poor woman's procedure was a real bargain. Sadly, it was not the bargain she expected. Now the lawyers, as they always have, will be the real winners of this tragedy.
GET A MEMBER OF THE AMERICAN SOCIETY OF PLASTIC SURGEONS TO DO YOUR PLASTIC SURGERY. You ARE Worth it!

John P. Stratis, MD · Answer

First, liposuctioning is a very common and very safe procedure if done correctly by a board certified plastic surgeon. Even under the best conditions complications can occur.
If you read the news reports on the internet about this case several red flags come up immediately:
1. This was done at a Medispa
2. This was done by a occupational therapy doctor, and NOT by a Board Certified Plastic Surgeon
People need to do their homework and choose wisely when considering cosmetic procedures.

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