LIPOSUCTION BOARD CERTIFIED

Evolution of Plastic Surgery

Plastic surgery is a speciality that evokes a response of familiarity today, which uses surgical techniques to change the appearance and function of a person's body. "Sushruta Samhita" described the reconstruction of the nose by cheek flap, repair of cut earlobe, piercing of earlobe, repair of cut lip, skin grafting, classification of burns, wound care and wound healing in 600 B.C. The modern and better known history of plastic surgery begins in the 1960s and 1970s, wherein Plastic Surgery in modern India owes a great deal to Sir Harold Gillies, Eric Peet and B.K. Rank . The most popular performed plastic surgery procedures were Rhinoplasty and Liposuction. Rhinoplasty originated as a reconstructive procedure, which, in essence, was a form of nasal augmentation. A long rhinoplasty history has made this procedure a safe and effective way to drastically improve the physical facial form.

Liposuction is a cosmetic procedure in which a special instrument called a cannula is used to break up and suck out fatty tissue from beneath the skin. In 1974 Dr Giorgio Fischer, a gynecologist from Rome invented liposuction using cannula. American Physicians had no interest in the technique until 1982 when dermatologist, cosmetic surgeons and plastic surgeons began to visit France to learn liposuction. The tenchnique of liposuction advanced from wet , superwet, tumescent liposuction to ultrasound assisted liposuction and laserlipolisis which is a newer procedure invented in Italy. This procedure is not found in the United States as of yet.

Epidemology of Obesity

Obesity has reached epidemic proportions in the United States. More than 20% of adults are clinically obese as defined by a body mass index of 30 kg/m2 or higher, and an additional 30% are overweight. In a given population, some people are genetically predisposed to develop obesity, but that genotype may be expressed only under certain adverse environmental conditions, such as high-fat diets and sedentary lifestyles. 30% to 40% of the variance in BMI can be attributed to genetics and 60% to 70% to environment.

Diet, Inactivity, Quitting Smoking, Pregnancy , Medications like corticosteroids, TCAs usually working in combination can contribute to weight gain and obesity. Hypertension, Heart Disease, Hypercholestrolemia, Diabetes, Stroke, Cancer, Gout, Sleep Apnoea, Osteoarthritis are few of the problems faced by obese population. Diet , Exercise, Medical and Surgical treatment options are available depending on the choice of the physican and the patient. But as is rightly said, Prevention is better than cure.

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Psychology of Beauty

There are 72,000,000 baby-boomers who are approaching their 40s and associate looking good with success. What do they want to achieve with cosmetic surgery, and are their expectations realistic? A plastic surgeon must be a keen psychologist and understand why a person decides to change some aspect of his or her appearance. One's emotional and psychological well-being should be a concern even after the procedure. A plain-Jane who is convinced that a facelift automatically will bestow ravishing good looks needs to be told a plastic surgeon can not create a Venus, if the basic elements for beauty are not already there. The usual treatment process consists of a consultation, operation, and discharge, with a follow-up visit in a week.

Throughout the world there have been only three personalities who reached the top even after their complete downfall. They were ---Winston Churchill (Prime Minister of England), President Digal of France and India's Prime Minister Indira Gandhi. There are yet others whose essence would be lost if they had undergone plastic surgery. Imagine if Barbra Streisand chose to have a rhinoplasty. Her voice would remain intact, but a surgically transformed proboscis would change forever her essence in the minds of others. Her nose is linked inextricably with her voice. It is part of her identity. Scientists have also found that the body's proportions play an important role in perceptions of beauty as well. In general, men have a preference for women with low waist-to-hip ratios (WHRs) . Whatever the reason, the notion that attractiveness correlates with success still rings true. Yet beauty is not always advantageous, for beautiful people, particularly attractive women, tend to be perceived as more materialistic, snobbish, and vain. Thus, striving to appear attractive may not be such a vain endeavor after all. This isn't to say plastic surgery is necessarily the answer. Instead, lead a healthy lifestyle that will in turn make you a happier person

Breast are specialised accesory glands of the skin that are capable of secreting milk. Each Breast consists of 15-20 lobes, which radiate out from the nipple. The main duct from each lobe opens seperately on the summit of the nipple and possess a dilated ampulla just prior to its termination. Breast is supplied by perforating branches of the internal thoracic artery and the intercostal arteries. The Lymph Drainage of the mammary gland is of considerable clinical importance because of the frequent development of the cancer in the gland and the subsequent dissemination of the malignant cells along the lymph vessels to the lymph nodes. The nerves are derived from the anterior and lateral cutaneous branches of the fourth, fifth, and sixth thoracic nerves.

Abdominal Muscles consist of three broad thin sheet that are aponeurotic in front: they are external oblique, internal oblique , transverses. Blood Supply comprises mainly of Superior Epigastric Artery ,Inferior Epigastric Artery, Deep Circumflex iliac Artery-Lower lateral part of the abdominal wall, Posterior intercostal Arteries-Lateral part of the abdominal wall. The cutaneous lymph drainage above the level of umbilicus drain upward into the anterior axillary lymph nodes. The vessels below this level drain downward into superficial inguinal nodes.

Buttocks region is largely made up of gluteal muscles and and a thick layer of superficial fascia. The superior and inferior gluteal arteries supply the gluteal muscle. The lymphatic vessels of the lower extremity consist of two sets, superficial and deep, and in their distribution correspond closely with the veins.

Thigh is divided into three compartments, each having muscles, nerves and arteries. The compartments are front , inner and lateral thigh. Profunda femoris artery is a large artery that arises from the lateral side of the femoral artery in the femoral triangle. Obturator nerve arises from the Lumbar Plexus (L2,3,4) and arises in the medial border of the psoas muscle within the abdomen. Lymph from the skin and superficial fascia on the back of the thigh drains upward and forward into the vertical group of superficial inguinal lymph nodes.

Physiology

Adipose tissue is a type of connective tissue that synthesize and store fat, releasing it for metabolism in fasting. Two types are present: white adipose tissue which has a structural, cushioning function and found in a wide variety of locations in the mammalian body. And the metabolically more active brown adipose tissue, which is involved in heat production to maintain body temperature and mainly found in subscapular, interscapular, and mediastinal areas. Much of the body fat reserve is subcutaneous; in addition there is adipose tissue around the organs, which serves to protect them from physical damage.

In lean people, 15-25% of body weight is adipose tissue, increasing with age; the proportion is greater in people who are overweight or obese. Adipose tissue contains 82-88% fat, 2-2.6% protein, and 10-14% water. The energy yield of adipose tissue is 8000-9000 kcal (34-38 MJ) per kg or 3600-4000 kcal (15.1-16.8 MJ) per pound.Free fatty acid is "liberated" from lipoproteins by lipoprotein lipase (LPL) and enters the adipocyte, where it is reassembled into triglycerides by esterising it onto glycerol. In humans, lipolysis is controlled though the balanced control of lipolytic B-adrenergic receptors and a2A-andronergic receptor mediated antilipolysis.

Microbiology

Microbiology is the study of organisms that are too small to be clearly seen by the unaided eye. It includes five major groups of microorganisms: the subdivisions of virology, bacteriology, mycology, phycology and protozoology. The cell wall determines the shape of the bacteria. Some bacteria can survive without a cell wall. The mycoplasma is the smallest known bacteria to survive outside living cells, and they do not have a constant shape, i.e. they are pleomorphic.

The cell membrane of the bacteria is differentially permeable, and is also the site where enzymes occur, sited on the mesosomes. Endospores are round or oval bodies, formed inside the bacterial cell in adverse conditions to help the bacteria survive. Endospores may remain viable for many years through adverse conditions, but as conditions improve the endospore will germinate and produce a new bacterial cell. Sterilisation is the process of destroying all forms of microbial life, including spores. It is absolute, and there are no degrees of sterilisation. Disinfection is the process of destroying vegetative pathogens, but not necessarily endospores or viruses. Disinfectants tend to reduce or inhibit microbial growth, but normally do not sterilise. Gram positive organisms are more susceptible to disinfectants and antiseptics than Gram negative organisms. Pseudomonas are resistant to chemical agents, and will actively grow in some disinfectants and antiseptics.

Many organisms inhabit the body without causing us any harm, and in some cases are positively beneficial and essential for health. Mutuals are bacteria which actually aid some process in the body, such as vitamin K-producing bacteria in the gut. Commensals benefit from living on the body, but we gain no benefit directly from their presence. There are certain conditions in which normal flora may cause infection such as taking broad spectrum antibiotics, reduced immunity , debility, stress. There are three common types of skin infections: Cellulitis, Erysipelas, and Impetigo (Pyoderma).

Cellulitis is usually an easily treated, but potentially dangerous skin infection. Cellulitis sometimes results when a cut, scrape, insect bite, splinter, or other break in the skin allows bacteria to enter underlying tissues. Often, lymph nodes close to the affected skin will be enlarged, and there may be red streaks running through the skin away from the infection.

Erysipelas is a form of cellulitis that affects only the top layers of the skin. It is more common among children and the elderly. Erysipelas differs from cellulitis in that the inflamed area is distinct from surrounding skin-it is raised, firm, and the redness is sharply marked off.

Impetigo (pyoderma) is the most common bacterial infection of the skin. It is contagious and can happen at any age, but is most common in young children. Impetigo appears in the form of reddish sores that blister to produce a yellow-brown fluid.

Pharmacology

Pharmacology is the science of drugs. It is derived from Greek word pharmacon meaning drug and logos meaning discourse in. Two integral part of pharmacology are :

Pharmacodynamics(physiological and biochemical effects of drugs and their mechanism of action)-mechanism of action, combined effect of drugs, drug dosage, factor modifying drug action.

Pharmacokinetics(is the quantitative study of drug movement)- absorption, distribution, binding/ localization/ storage, biotransformation and excretion of the drug.

Drugs can be administered by Local routes(topical, deeper tissues i.e intraarticular, intrathecal , retrobulbar and arterial supply). Systemic routes (oral, sublingual, rectal, cutaneous, inhalation, nasal and parenteral i.e intramuscular, intravenous or intradermal. Patients should be carefully screened for clinical evidence of hemodynamic and cardiac pathology before larger-volume liposuction is undertaken, as it may result in unnecessary high risk for patients who have preexisting cardiovascular disorders..

Tumescent liposuction totally by local anesthesia has proven to be extremely safe despite the use of unprecedented large doses of lidocaine and epinephrine. The explanation for this remarkable safety is the extreme dilution of the tumescent local anesthetic solution.. Various studies have suggested that tumescent anesthesia with a total lidocaine dose of up to 55 mg/kg is safe for use in liposuction.

Anesthesia

The word "Anesthesia" was first used by Greek philoposopher Dioscoides to describe the narcotic effect of plant mandragora. The sine qua non of Anaesthetized state is unconsciousness. General anesthesia is a state of reversible loss of all sensation and consciousness. An ideal anesthetic drug should include anesthesia smoothly and rapidly and permit rapid recovery as soon as administration ceased. It should also posess a wide margin of safety and be devoid of adverse affects. The modern practice most commonly involves the use of combination of drugs, taking advantage of their individual favorable properties while attempting to minimize their potential for harmful actions. American society of Anesthesiology (ASA) has prescribed standards for basic anesthetic monitoring. The patient's oxygenation, ventilation, circulation, and temperature shall be continually evaluated. Some important anesthetic agent and techniques used today are

Ketamine is a phencyclidine derivative that produces dissociative anesthesia that resembles a cataleptic state in which the patient's eyes remain open with a slow nystagamic gaze. Patient is non communicative, amnesia is present and analgesia is intense. Ketamine has been used extensively for burn dressings, debridement, and skin grafting procedures.
Benzodiazepines commonly used in perioperative period include diazepam, midazolam, and lorazepam.
Tumescent local anesthesia (TLA) is a technique for regional anesthesia of skin and subcutaneous fatty tissues by means of direct infiltration of large volumes of dilute local anesthetic. TLA technique revolutionized the liposuction technique in 1980's. TLA technique uses small cannulas and involves infiltration of localized adiposities with large amounts of tumescent fluid containing lidocaine, 0.05%-0.125% and epinephrine 1:1000,000 to 1:2000,000 to obtain regional anesthesia and vasoconstriction.

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Patient Assesment and Pre-operative
Assessment of pain is the essential prerequisite for successful pain management. First step in pain assessment is to ask the patient about the pain intensity and believe them. Lack of a diagnosis should not preclude administration of adequate analgesia while a diagnosis is sought.

Acute and chronic pain is often separated by the artificial time limit of 3 months. In reality, they are part of a continuum. Chronic pain is better defined as pain from continuing disease or pain that continues beyond the time expected for normal healing. Acute pain is usually short lived and of known origin.

In most situations, the simple model of 'assessment, treatment, reassessment' in combination with diagnosis and treatment of the underlying condition will resolve the problem. The most common multidimensional pain scales are the McGill Pain Questionnaire, and the Brief Pain Inventory, but many others are available.

Fear of prescribing to opioid abusers often leads to inadequately treated pain. However, the nature of the lifestyle of abusers means that they are more likely to suffer chronic painful conditions than the general population.

Preanaesthetic check up is ideally done few days prior to surgery in a PAC and usually a day prior to surgery. A system-based enquiry is generally used to identify the disease processes that may influence anaesthesia. Most hospitals provide a pre-assessment questionnaire for patients to fill in before the anaesthetist's visit. A Patient's stomach must be empty to reduce any risk of aspiration-ward staff must be aware to keep the patient nil by mouth (no food or drink).

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Equipments and Sterilization

Sterilization refers to any process that effectively kills or eliminates transmissible agents (such as fungi, bacteria, spores, viruses and prions) from a surface, equipment, foods, medications, or biological culture medium. Heat sterilization of medical instruments is known to have been used in Ancient Rome, but it mostly disappeared throughout the Middle Ages resulting in significant increases in disability and death following surgical procedures. The various agents used in sterilization are divided into 2 categories :-

Physical agents- like sunlight, drying, dry heat(flaming, incineration, hot air), moist heat(pasteurization, boiling, tyndallization, steam, and steam under pressure), filtration(candles, asbestos pads, membranes), radiation, ultrasonic and sonic vibrations.

Chemical agents-like alcohols (ethyl, isopropyl, trichlorobutanol), aldehydes (formaldehyde, glutaraldehyde), dyes, halogens, phenols, surface active agents, metallic salts..

Heat is the most reliable method of sterlization and should be the method of choice unless contraindicated. Commercial plants use gamma radiation(cold sterlization)for mass sterilizing products like plastics, syringes, swabs, catheters, animal feeds, cardboards, oils, grease, fabrics and metal foils. Chemical agents are mostly used as antiseptics and disinfectants. Irradiation is used by the United States Postal Service to sterilize mail in the Washington, DC area.

Surgical Procedures and techniques

Liposuction is reserved for patients who are healthy and without significant illnesses. Although difficult to determine absolute contraindications, significant medical history should necessitate discussion with the patient's primary physician and/or anesthesiologist prior to approval of any procedure. The abdomen is the most common area of the body to be treated by liposuction among both men and women. Important factors that affect the success of abdominal liposuction include: the amount and location of abdominal fat, history of weight gain and weight loss, history of pregnancy, and the age and the sex of the patient. An extensive number of liposuction cannulas are available to the surgeon that can be used depending on the area, volume, and type of tissue to be treated. . Liposuction totally by Local Anesthesia performed by an expert is safer and usually associated with less pain overall than general anesthesia. On the other hand, for patients who are terrified by the prospect of needles and surgery, General Anesthesia might be more easily tolerated. Historically, 4 types of wetting solutions have been used for liposuction: Dry, Wet, Superwet, and Tumescent. The essential difference between these techniques focuses on the amount of infusate into the tissues and the resultant blood loss as a percentage of aspirated fluid. The Superwet Technique involves instillation of fluid with epinephrine in equal volume to the amount to be removed, eg, 1:1 ratio (supranatant fat and infranatant fluid) ultrasonic-assisted liposuction or UAL, is an advanced procedure used in removing body fats more efficiently and effectively. By using this tool to assist in breaking up the fat cells the surgeon can remove more fat, more easily. The most traditional liposuction treatment involves removal of the deeper layers of fat. However, superficial liposuction is performed in an attempt to improve skin contour in individuals with flaccid skin or cellulite in specific areas. Liposuction has been under especially close scrutiny recently due to tragic circumstances surrounding several large-volume procedures. These issues revolve around fluid delivery and lidocaine /epinephrine dosing. With large-volume liposuction, defined by the American Society of Plastic Surgeons as greater than 5 L, significantly greater fluid shifts occur as a result of tumescent fluid infusion and fat removal.

Complications and Treatment

Liposuction can be fatal and a number of serious complications are known to occur, but the frequency is unknown. The physician should discuss these possible consequences with the patient before the intervention, and adequate after care if complications occur must be provided. Significant irregularities and depressions of the skin are frequently the result of the surgeon's inattention to detail . Skin Necrosis is a rare complication in which the skin falls off in the necrotic area. Full Thickness Skin Necrosis (death of the affected skin) can result from excessive superficial liposuction that injures the vascular supply of the overlying skin. Erythema Ab Liporaspiration is a permanent blotchy (net-like pattern) pink-brown discoloration of the skin resulting from rasping the undersurface of the skin during superficial liposuction . Excessive amounts of surgical trauma can be regarded as toxic to patients. Increasing doses of liposuction-induced surgical trauma produce increasing risks of toxicity in the form of surgical complications. Staying in bed increases the risk of clot formation, but not getting enough rest can result in increased swelling of the surgical area. The incisions involved in this procedure are tiny, but the surgeon may close them with stitches or staples. These will be removed the day after surgery. However, three out of eight doctors use no sutures. Minor bleeding or seepage through the incision site is common after this procedure. Vascular Injury and Excessive Bleeding Vascular injury and excessive bleeding are rarely caused by liposuction with the use of microcannulas . Post-Liposuction Panniculitis is a manifestation of postoperative inflammation due to incomplete drainage of blood-tinged tumescent anesthetic solution and the formation of small seromas. It is more common when incisions are closed with sutures thus preventing complete drainage and entrapping the inflammatory blood-tinged anesthetic solution beneath the skin.

Liposuction can damage superficial nerves. Some patients lose sensation in the area that has been suctioned, but feeling usually returns with time. It is far more common with the use of ultrasonic assisted liposuction (UAL).
Rapid heart rate can occur during or after liposuction as a result of the epinephrine (adrenaline) that is an essential ingredient of the tumescent local anesthetic solution . In a more recent survey of surgeons who only do liposuction by local anesthesia, there were no deaths in 65,000 cases of tumescent liposuction . Performing lipoplasty in any facility should be required to have surgical privileges/ accreditation to perform this procedure in an acute care hospital and Physician should be qualified for examination or certified by an ABMS-recognized surgical board

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Pain Management
Pain is a sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. Pain perception involves multiple interacting central and peripheral mechanisms. In addition, pain is multifactorial and involves physical, psychological and environmental aspects in every individual. Pain fibres are carried in spinothalamic tracts which transmit sensations of pain and temperature of the contralateral side. Effective pain management is fundamental to the quality of care.A multidisciplinary approach to the management of acute pain, particularly in a formal acute pain service, leads to improved pain relief and better patient outcomes . Opioid analgesics are the cornerstone of the management of moderate to severe pain. Opioids should be administered by the safest and most effective route available. The patient's need for pain relief should be seen as more important than strict adherence to a dose interval. 'Patient-controlled analgesia' overcomes the wide variation in patients' analgesic requirements and allows patients to adjust the level of analgesia to their own level of comfort and tolerance of side effects. While PCA is usually associated with intravenous administration, it may be used to deliver opioids subcutaneously or epidurally . The advantage of tramadol is that it is analgesic with minimal sedation, respiratory depression, gastro-intestinal stasis, or abuse potential. Tramadol is a weak mu opioid agonist but also has important non-opioid spinal and central nervous system effects via noradrenergic and serotoninergic pathways. Tolerance may develop during chronic administration of drugs, and it may be due to both pharmacokinetic and pharmacodynamic changes. Tolerance to opioids can develop rapidly, especially under experimental conditions. Physical and psychological dependence can also develop.

NSAIDs can be very useful for managing mild to moderate pain. When NSAIDs alone cannot control pain, they have a significant opioid dose-sparing effect and can be useful in reducing opioid side effects . Recently, the roles of the N-methyl-D-aspartate (NMDA) receptor and nitric oxide in the production of 'wind-up' and morphine tolerance have been investigated.

Non Medical interventions are appropriate for patients who wish to use them, who may benefit from reducing drug therapy, or who are likely to experience a prolonged interval of pain. Cognitive-behavioural approaches include preparatory information, simple relaxation, imagery, hypnosis and biofeedback The advent and increasing use of laparoscopic surgery, liposuction and other day care surgeries has had a marked impact on the length of hospital stay of surgical patients and on their postoperative management, including pain management

Wound Healing

Wound healing, or wound repair, is the body's natural process of regenerating dermal and epidermal tissue. When an individual is wounded, a set of events takes place in a predictable fashion to repair the damage. These events overlap in time and must be artificially categorized into separate steps: the inflammatory, proliferative, and remodeling phases . The wound healing process can be applied to both acute and chronic wounds
For a chronic wound to heal as quickly as possible, it must be recognized at onset or soon thereafter and be treated appropriately. Four stages of chronic wounds have been identified, with Stage I as initial onset and Stage IV as the most advanced stage. If a chronic wound progresses to Stage IV, there is a high likelihood that the patient will suffer complications including amputation, sepsis, and other serious consequences of an improperly treated chronic wound. To provide the best chance for chronic wounds to heal, the surgeon should attempt to identify any factors that may be acting to impede success, and then correct the problem through optimization of the cellular and molecular wound environment.

The basis for correct treatment of chronic wounds is a standard protocol that is administered in a systematic manner. The Wound Healing Center has established standard protocols that have achieved significant improvements in the time to substantial improvement of wounds and wound closure-regardless of the wound type. It is critical that clinicians utilize all available methods of wound treatment, including relatively new therapies like skin cell matrices/human skin equivalents. Diabetic foot ulcers can occur in any person with diabetes who has a break in the skin. Pressure ulcers can occur in any bed- or wheelchair-bound patient. Pressure ulcers may remain unnoticed for a substantial period of time. Sickle cell ulcers are a complication associated with sickle cell disease, an inherited hemoglobinopathy most common among s. Following significant weight loss due to a bariatric surgery (also known as gastric bypass surgery), diet, or exercise, women and men often elect to have various cosmetic procedures to help them achieve the body shape that they seek. Following significant weight loss, a person can be left with a tremendous amount of excess, hanging skin throughout many areas of the body that cannot shrink back to the person's new body shape. Since Liposuction does not reduce the amount of skin present the best results are obtained in those patients with good skin tone/elasticity because their skin readily contracts to the newly contoured frame. Once all of the necessary cosmetic procedures are done, the cosmetic results can be extremely rewarding to the patient in physical, emotional, lifestyle, and functional respects.

Nutrition

Food is an enjoyable part of our everyday lives. Food helps us breathe, move and think . Food keeps us alive and well. Carbohydrates are the body's main source of energy and should be the major part of total daily intake. Complex carbohydrates are preferred because these foods are more nutritious yet have fewer calories per gram compared to fat and cause fewer problems with overeating than fat or sugar. Protein supplies amino acids to build and maintain healthy body tissue. There are 20 amino acids considered essential because the body must have all of them in the right amounts to function properly. Fat supplies energy and transports nutrients. There are two families of fatty acids considered essential for the body: the omega-3 and omega-6 fatty acids. Vitamins are organic substances present in food and required by the body in small amounts for regulation of metabolism and maintenance of normal growth and functioning. The most commonly known vitamins are A, B1 (thiamine), B2 (riboflavin), B3 (niacin), B5 (pantothenic acid), B6 (pyridoxine), B7 (biotin), B9 (folic acid), B12 (cobalamin), C (ascorbic acid), D, E, and K. Fiber is the material that gives plant texture and support. Although it is primarily made up of carbohydrates, it does not have a lot of calories and usually is not broken down by the body for energy. Water helps to regulate body temperature, transports nutrients to cells, and rids the body of waste materials. Government issued the Fifth edition of the Dietary Guidelines for Americans. The Document carries three basic messages referred to as the " ABCs for good health "

A- Aim for Fitness
B- Build a Healthy Base
C- Choose Sensibly

Vegetarians eat plenty of fruits, vegetables, grains and legumes , so they get lots of fiber, Magnesium, Vitamins A, C , E . Also , plant based diets generally have less saturated fat and cholesterol than diet based on meat . That's why its no surprise that vegetarian diets are linked to a lower risk of many chronic diseases including colorectal cancer, coronary heart disease, diabetes, diverticular disease, hypertension , obesity, and renal disease.

Legal and Malpractice

Medical malpractice is an act or omission by a health care provider which deviates from accepted standards of practice in the medical community and which causes injury to the patient.

The plaintiff is or was the patient, or a legally designated party acting on behalf of the patient, or in the case of a wrongful-death suit , the executor or administrator of a deceased patient's estate. The defendant is the health care provider. Relying on vicarious liability or direct corporate negligence, claims may also be brought against hospitals, clinics, managed care organizations or medical corporations for the mistakes of their employees. Like all other tort cases, the plaintiff (or the plaintiff's attorney) files a lawsuit in a court with appropriate jurisdiction. Between the filing of suit and the trial, the parties (or their attorneys) are required to 'share information' through a process known as discovery. If both parties agree, the case may be settled early on negotiated terms. At trial, both parties will usually present experts to testify as to the standard of care required, and other technical issues during trial. The fact-finder (judge or jury) must then weigh all the evidence and determine which is the most credible. The plaintiff's damages may include compensatory and punitive damages. Compensatory damages are both economic and non-economic. Liposuction risk, or the risk involved in any form of medical treatment is an extremely important issue for the physicians, their staff, and the patient. Sometimes, news reports make it seem as though physicians must not even realize that there are risks in any treatment. However, the concept of risk:benefit ratio is the foundation of all medical decision making. This depends upon many factors. I mean, yes - it is safe if the below factors are in your favor and the guidelines followed. But it Can be disastrous if they are not.