Patients should expect discomfort after a surgery like liposuction, says Ann Graham, senior nurse consultant in CDRH's Office of Surveillance and Biometrics. "Patients are bloated, have wounds all over, and are feeling distended."

Surgeons should discuss such conditions with their patients beforehand, says Jack Bruner, M.D., associate clinical professor of plastic surgery at the University of California, Davis, and chairman of the task force on liposuction for American Society of Plastic Surgeons (ASPS).

"We talk about excessive bruising and chronic and prolonged swelling," he says, adding, anytime there's an injury—and liposuction surgery is really a controlled injury—body fluid rushes to the site and the injured tissue becomes like a sponge, he explains. With liposuction, doctors have gone under the carpet of skin and have taken away the fat undercoating, so the raw surface oozes serum on the inside.

To control the swelling, Bruner has his patients wear a garment with elastic pressure, reaching from below the breast area to mid-thigh. "This gives good compression, and if we don't do that, the body swells up like the Michelin man," he says.

The skin sticks to the undersurface, and as it starts to heal the fluid stops oozing and the swelling goes away. "At the end of three weeks, 90 percent of the swelling and bruising are gone," he says, although patients may wear the elastic garment for up to six weeks.

Deaths and Liposuction
According to a survey conducted by the American Society of Plastic Surgeons of more than 1,500 plastic and reconstructive surgeons in January, 1999, the death rate of one in every 5,000 (or 20 out of 100,000) liposuction patients between 1994 and 1998 was much higher than anyone anticipated—higher even than death rates from traffic accidents.

And higher than acceptable death rates from other kinds of surgeries, admits Bruner. Although the survey data are not considered scientific information, they are useful when establishing practice guidelines, and they led ASPS to recommend some practice changes when performing liposuction.