By Doris Obinna
Dr. Ogbe Omoruyi is retired Army Chief Consultant Plastic Surgeon. He is a fellow of the West African College of surgeons, member of the Nigerian Association of Plastic, Reconstructive and Aesthetic Surgeons, a member of the American Society of Plastic Surgeons.
He is Medical Director/Chief Executive Officer, Consultant Plastic Surgeon, Cynosure Aesthetic Plastic Surgery, Lagos. In this interview, he spoke on challenges, risks and other issues affecting the profession. Excerpts:
Tell us more about plastic surgery especially liposuction
Liposuction is a procedure, which involves the use of a special suction device to suck out fat from under the skin, essentially for the purpose of contouring the body. The harvested fat can also be processed and injected into certain parts of the body to improve the shape and volume of the area amongst other reasons.
There was a rumour that five deaths were recorded in your facility within a year.
The insinuation of deaths on our facility is malicious. I heard a blog said five deaths were recorded in this facility within a year. I want to reject that. That is not us and definitely not this facility. The risk of complications is almost there in every hospital all around the world. We are specialists we have consultants. We’re members of very high professional bodies and we hold our practice in high esteem, and we love to save lives. We love to give high quality care to people.
Unfortunately, death happens and all I can say is that we have not recorded more than three deaths attributable to this facility. The three deaths recorded in our facility spread across the years.
The most recent that sparked the rumour was a 23-year-old lady. We had the surgery done for a young lady. The surgery was a liposuction and factors for the body contouring procedure. It was successfully done and the patient was fine.
We were hoping to discharge her. But on the fourth day of admission, she developed a sudden onset of difficulty with breathing. We recalled it immediately. We started doing what was required and she started getting better and her breathing improved.
However, we saw the need to refer her to the ICU centre for more critical care monitoring, as she eventually was refreshed. But sadly, after she had gone outside of our facility where they did the CT pulmonary angiogram to check for any embolism, we are aware that it is reasonable to speculate that fat embolism was the most likely cause of her sudden onset of breathlessness.
A CT Pulmonary Angiogram (CTPA) was conducted the same day the client arrived at the ICU. The result showed there was no pulmonary embolism. A CPA is the gold standard for diagnosing pulmonary embolism (whether for fat, blood clot or air embolism).
The specialty centre is 10 minutes away from our facility. However, we have never really seen patients who need it beyond three patients that were referred there. The first two referred in a different year were successful.
After her demise, samples were sent for COVID-19 testing on account of her recent travel history, as well as some features seen on the CTPA.
However, the report did not get to us. We did not request for it. It was requested for by the specialist where we referred her. But then when we got privy to the findings, we got to know that the result suggested COVID-19.
Why do ladies feel the need to go for this surgery?
Plastic surgery is done by both men and women of different ages although more commonly done by women. Some boys or men have abnormally enlarged breasts, a condition known as gynaecomastia for instance. Liposuction can very easily correct that condition with minimal downtime since it is minimally invasive.
However, young ladies desire it more to suck out fat from stubborn areas of their bodies. Rather than throw away the fat, it is used by the surgeon to skilfully enhance their curves especially around their hips and buttocks to improve their shape and become more confident about themselves.
It will amaze you to know that quite a number of women are born with unequally developed hips and buttocks. One side may be bigger or smaller than the other side. Fat grafting, also known as fat transfer, helps to correct this asymmetry quite easily.
This is aside from the fact that some ladies just want to have bigger buttocks and wider hips to become more self-confident and probably become more attractive.
How long does it last, or is it a life long procedure?
The result is life long. However, it could change as you gain or lose weight. Clients are advised to maintain a healthy weight after their procedure by eating healthy and exercising.
What are the challenges encountered?
When it comes to liposuction, there is a lot of ignorance, scepticism and negativity as regards plastic surgery. There are different misconceptions and interpretations from people about it. People think those who come for plastic surgery are for vanity and that’s not true.
Again, there is the issue of acceptance. Plastic surgery is still trying to gain acceptance in this part of our clime.
Also, there’s the challenge of client keeping to the rules and that is post-up care. It is an issue because you need to be able to recover very well. There are rules you need to keep and follow to the later once you’re done with the procedures.
Most times, patients do not follow these rules. They are always in a hurry to do things outside the rules. In the process, they have issues/complications and will keep you in the dark of whatever it is they did outside the rules.
Having said that, electricity is a major challenge in this part of the world. We cannot function well without power. When there is no power to power your facility, you are forced to invest a whole lot in fuel. You need to power your facility 24 hours.
Another challenge is brain drain. A lot of our colleagues are leaving the country for greener pastures. This is putting a lot of pressure on hospitals both government and private. Doctors and nurses are leaving in droves.
However, our retainer ship is commendable. Our ability to hold down our doctors and nurses has been high compared to other centres.
What are the risk implications?
Generally, the risk to life is extremely low. People will find it unbelievable to know that a liposuction and even a tummy tuck is by far safer than a caesarean section (CS) for pregnant women.
This is particularly more so if the procedure is done under awake-anaesthesia without the use of general anaesthesia. General anaesthesia carries its own specific risks, which includes cardiac arrest.
Probably the most serious complication of liposuction and fat transfer is fat embolism. It is a situation in which fat is either injected directly into a vein or gets sucked up by an injured vein. But this does not happen when a well-trained surgeon avoids the locations of the veins. This is why a good knowledge of anatomy is important.
Apart from this, the risks are generally not life threatening. They include irregularities of the area, asymmetry of the areas, fat necrosis, skin necrosis, infection of the area and discolouration of the skin.
Certain risk factors on the part of the patient can predispose them to having complications such as smoking, use of skin bleaching products, alcohol consumption and certain underlying health conditions.
During consultations, these possible risk factors are pointed out so that the clients are told to stop before the surgery. More so, the pre-operative laboratory investigations are tailored to identifying as many risk factors as possible based on the needs of each client.
Can someone with an underlying health condition consider liposuction?
You have to be healthy with no underlying health condition. Most people who come for plastic surgery are healthy people. When a patient comes to have a surgery, apart from the fact that they are healthy, they still undergo some tests.
Someone with kidney failure for instance will not be coming for it. However, we still go ahead to check all the vital information of the person to be sure they do not have any underlying health condition.
For instance, if someone has any particular health condition, say if the person seems to be hypertensive. We go as far as doing an echocardiogram (ECG). You have to be fit and healthy before you can go for liposuction, even though investigation must be carried out to ascertain the level of your fitness.