Liposuction in Maryland set for tighter regulation

Maryland is moving to strengthen laws on the fast-growing medspa industry — a shift developed to narrow a “loophole” and stop fatalities including one last year following a liposuction treatment at a Timonium, Md facility.

Laws being discussed by state officials might bar plastic surgeons from performing liposuction and other procedures in medspas and health-related offices unless the services are inspected by the authorities or third – party accrediting bodies, Maryland Secretary of Health Joshua Sharfstein stated.

Greater scrutiny would be brought by the changes to an industry where liposuction clients generally pay out of pocket for procedures – – – making the customer the primary oversight authority, instead of private or government insurers who demand safeguards, Sharfstein said.

“The objective would be to be sure the riskier procedures are happening in the safer places,” he said.

Maryland is among a growing number of states wanting to regulate where liposuction and other procedures can be performed. Twenty-seven states have passed regulations or added guidelines regarding where liposuction operations can take place, based on the American Association for Accreditation of Ambulatory Surgery Facilities

A law was passed by Florida, for example, last year requiring yearly review of any center that eliminates more than 1000 cubic centimeters of fat during liposuction. In New York, certification is required for any office-based surgery that eliminates more than 500 cubic centimeters of fat during liposuction or uses anything more than minimal anesthesia.

“A lot of states are working out these problems with medspas,” said Dr. Doug Forman, a cosmetic surgeon in North Bethesda who serves on the American Society of Plastic Surgeons’ government affairs board. “Nationally, medspas are slipping in to this grey area.”

There are almost 5, 000 now listed using the International Medical Spa Association, while there were about 800 medspas across the US five years ago, said director Allan Share.

But there is no classification for what qualifies as a medspa, and they include facilities that offer a variety of solutions from Botox to complex surgeries, Share said. The industry continues to grow as centres seek to benefit from the demand from demand from cash paying customers, he said.

“Minimally invasive” processes such as laser skin treatments and Botox injections have increased by 6 percent since 2000, according to the plastic surgeons society. Surgical procedures, meanwhile, have dropped 16 per cent on the same period. Health authorities encourage individuals to verify that licensed physicians are conducting their cosmetic surgery procedures and that the procedures are taking place in certified facilities that are either equipped to manage problems or have associations with neighborhood hospitals.

Physicians and other health care workers have been charged with a range of infractions in the past few years, occasionally with serious results, Md Board of Physicians records show. Maryland lawmakers were pressed into motion a year ago after a Lochearn woman died of an illness developed during liposuction at Monarch Medspa in Timonium.

But similar risks are shown by earlier cases. A doctor at another Timonium plastic surgery center lost his medical licence in 2011 after two of his patients died of complications associated with complex aesthetic surgeries. Officials reprimanded that doctor for executing procedures in improper settings.

Others have been disciplined for offering services including laser hair removal without a medical licence at all. Their state Dept of Health and Mental Hygiene elevated plastic surgery regulation to a best legislative priority in the days after regulators close down Monarch Medspa in Sept over “likely deviations from common infection control methods.” Three aggressive infections were contracted by patients after undergoing liposuction; one of them, 59 – year – old Eula Witherspoon, died less than a week after the process. Monarch officials had pledged to assist authorities and extended their sympathies when the infections came to light. They could not be reached for further comment.

At the time, Sharfstein noted “an unevenness” in regulation over liposuction and additional aesthetic procedures.

The 2013 Basic Assemblage approved a bill permitting the health department to create laws that tackle the loophole. Health authorities anticipate Gov. Martin O’Malley to sign the bill next month, though Raquel Guillory, a spokeswoman for the governor, stated it is not clear when that will be.

Regulators intend to begin by seeking community input on processes which should be protected by the requirements, Sharfstein said. That can include liposuction and other surgical procedures that require anesthesia, he said.

Cosmetic surgeons who run out of workplaces which are currently accredited welcomed the new regulations as a godsend to patient security. For example, Dr. Adam Summers of the Maryland Cosmetic Surgery Center in Glen Burnie mentioned that service would not be affected by the regulations because, even though the center bills itself as a “medical spa,” it is already certified by the state as an ambulatory surgical center.

Health officials and plastic surgeons informed that any aesthetic procedure involving a scalpel or a laser involves danger, though. Board of Doctors records show a variety of disciplinary steps in recent years involving plastic surgeons and aesthetic procedures.

Study shows that Liposuction doesn’t negate health risks of obesity

Obesity is related to most of the risk factors for diabetes and coronary heart disease. And losing weight can improve the results of tests for these risk factors (blood sugar, blood pressure, and etc). So one might anticipate that removing body fat by liposuction would also help in this respect. This possibility has been examined by a study reported in the New England Journal of Medicine. The objective of the research was to quantify the consequences of liposuction on the metabolic risk factors for coronary heart disease in overweight females. Here’s a summation of the results.

Fifteen women with abdominal obesity (waist size more than 39 ins, or 100 cm) were enrolled in the research. Their typical body mass index (BMI) was 37.7. Ten of them had normal sugar threshold (i.e. they were not diabetic) and 7 of them had type II diabetes, treated with oral medication.

Before their surgery, each subject had a test to demonstrate the effectiveness of insulin on the blood glucose levels in their liver, muscle, and fatty cells after intravenous glucose administration followed by an infusion of insulin; it was a measure of insulin sensitivity, which can be reduced in diabetes.

Other assessments measured markers of chronic inflammation in the blood (C-reactive protein or CRP, interleukin-6, and tumor necrosis factor), blood fats, and blood pressure.

Each week thereafter, the women had ‘large-volume’ liposuction (removal of over 4 liters of fluid, which is 60% fat); in fact, on average, 16-17 liters were removed. Five to 12 months after the tests the operations were repeated.

The non-diabetics had their body fat decreased by 18%, and the diabetic by 19%, 10 weeks after liposuction. Average BMI levels was reduced by 2.3 points in non-diabetics and by 3.9 points in diabetics.

What was notable was that liposuction had no substantial effect on insulin sensitivity of the liver, muscle, or fat tissue; it didn’t modify the inflammatory blood markers predictive of coronary artery disease; and other cardiac risk factors — blood pressure, blood sugar, blood lipids — were also unaffected.

Clearly, abdominal liposuction had no significant beneficial effects on the problems often categorized as the metabolic symptoms, and which are associated with an increased risk of coronary and diabetes heart disease. Why was this so? An associated editorial in exactly the same medical journal tries to offer a reason.

Dr Kelley points out that losing weight by dieting and exercise does enhance metabolic and cardiovascular risk factors. So what is the distinction when losing weight by liposuction? It appears that these outcomes are produced by the ‘negative energy balance’ activated by eating fewer calories and burning more calories in exercise. A negative balance isn’t generated by liposuction in this sense.

The article points out that before writing off liposuction as a sort of therapy for obesity, we should remember that it can help considerably with people’s appearance, and reducing weight quickly in this manner can reduce the chance of heart failure and improve knee arthritis. Nonetheless, liposuction is not the panacea that some had hoped, for health improvement. The article instead recommends following a suitable calorie-controlled diet combined with lots of exercise.