Welcome to our March email Update.


The past few weeks have been rather busy. Late last month, I traveled to Adelaide, Australia. I was invited to be a featured guest speaker and instructed at a liposuction surgery course sponsored by the Australian Society of Liposuction Surgery. It was my first trip to Australia, and my only regret was that I only got to spend three days there. It was a long flight for a short trip, but still proved quite enjoyable.


My talks covered a broad range of topics on liposuction, but the keynote presentation was on liposuction safety related to large volume procedures.   Modern techniques have certainly improved the safety of liposuction, but it is still always important to remember that in removing larger amounts of fat, we must never let or goals interfere with our primary focus on safety. Certainly, risk can never be entirely eliminated, but fortunately it is quite low when surgery is properly performed.

Proper performance of surgery goes beyond surgical skills, although they are also quite important. Safety actually starts with proper patient selection. The amount of surgery that a patient can safely undergo varies in accordance with patient health and age. In patients with coexisting medical problems, the amount of surgery may have to be scaled down or perhaps delayed or not even considered. In some cases, this may be a temporary measure, but in others, a permanent consideration.


Surgical and anesthetic risk increase with operating time, and so again, this must be considered in planning an operation. Another factor that is often ignored is the surface area of the body that is being treated. Patients often request treatment of multiple areas of the body without realizing that the more areas that are treated, the more trauma the body sustains. This does not present a problem when relatively conservative amounts of fat are to be removed, but in large volume cases, can significantly increase risk. Therefore, in larger volume procedures, we recommend confining surgery to fewer areas.


We just read about a case where a patient sustained a massive infection resulting in the loss of most of the skin of the abdomen. What made this case even more shocking was the fact that the surgery was done in the patient’s kitchen under anesthesia. Hard to believe but true! While an extreme example, it points out the fact that much cosmetic surgery is still performed in totally unregulated or accredited facilities. We always stress to our patients that they should not only check out their surgeon, but also the facility where the surgery will be performed.


One of the activities that I most enjoy is serving as a volunteer surveyor of the Accreditation Association for Ambulatory Healthcare (AAAHC). Having served on the Board of that organization for 12 years, I well appreciated the importance of accreditation. As a surveyor, I just returned from Seattle, Washington, where I carried out an accreditation surveyor in another cosmetic surgeon’s practice.   The evaluation is quite comprehensive covering all aspects of the practice including policies, the facility, medical records as well as the surgery and recovery environment. Of course, the primary focus is on safety.

Accreditation is a two way street, and we are now due for our own inspection which will be carried out the end of March. It has been three years since our last inspection, and the staff has been busy checking to be sure we are ready for this evaluation. Having recently passed our state licensure evaluation with flying colors, we feel that we are well prepared, but the accreditation inspection helps to keep us on our toes. This is our sixth or seventh inspection and we are hoping and expecting a full three-year accreditation. We’ll let you know when we get our report!

That’s it for this month. As always, we appreciate your interest and welcome your suggestions.


Howard A. Tobin, M.D., F. A. C. S.

For general information: askdena@newlook.org or n41gt@newlook.org