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Cardiovascular considerations: Screen overweight patients for comorbidities before cosmetic procedures

Article-Cardiovascular considerations: Screen overweight patients for comorbidities before cosmetic procedures

Key iconKey Points

  • Peripheral obesity can be treated with liposuction techniques, but cosmetic surgeons can do little for central obesity
  • Current studies haven't shown that liposuction will improve metabolic syndrome
  • CV disease a central issue for cosmetic surgeons, particularly in female patients

Editor's note: Fat-reducing procedures in cosmetic surgery have become very common. Overweight patients undergoing such procedures may have associated comorbidities, including cardiovascular (CV) disease, which, according to experts, needs to be thoroughly investigated prior to any cosmetic surgery procedure. In this three-part series, we will look at the potential comorbidities that overweight patients may have, many of which may preclude cosmetic surgery, and how failure to investigate the CV status of these patients may have catastrophic consequences. In future installments, we will explore the potential adverse events that overweight patients may experience after cosmetic surgery, as well as the possible impact of the medications that CV patients take on the outcome of cosmetic surgery.

Like the Cardiometabolic Disorders and Weight series that ran in the September 2009, October 2009 and November/December 2009 issues of Cosmetic Surgery Times, this series is part of Advanstar Communications' Action for Outcomes interdisciplinary healthcare initiative. See for more information on this effort and to access Cardiometabolic Disorders and Weight articles.

Dr. Bailey
As patients seek to achieve their ideal body shape, abdominoplasty and various liposuction techniques have become extremely popular procedures in cosmetic surgery. However, a large majority of overweight patients often have numerous associated comorbidities, including cardiovascular (CV) issues. Therefore, a thorough investigation of the CV status of these cosmetic surgery patients should be performed prior to procedure, as neglecting to do so may have potentially catastrophic implications.

Dr. Obagi
"There is a clear association between overweight and obese individuals with heart and CV disease. Further, patients undergoing larger liposuction and abdominoplasty procedures commonly have a gamut of intertwining health issues, such as components of the metabolic syndrome. These risk factors need to be carefully screened in order to ensure a high standard of care in this patient population," says Colin E. Bailey, M.D., F.A.C.S., Bailey Vein and Aesthetic Centre, Osage Beach, Mo.

Seen in about 35 percent of American adults, metabolic syndrome consists of a cluster of risk factors that are associated with each other and, according to Dr. Bailey, can increase the likelihood for coronary heart disease and stroke. Components of the syndrome include hypertension, insulin resistance and glucose intolerance, diabetes, dyslipidemia and obesity. These patients are prothrombotic, meaning their risk for developing deep venous thrombosis and pulmonary edema is increased.

CATEGORIZING OBESITY Obesity is divided into central (submuscular) obesity and peripheral (subcutaneous) obesity, and two basic body forms are recognized — the android type and the gynoid type. The android, or apple-shaped, body is more the barrel-chested male patient with deep visceral, centralized fat, and the gynoid is more the pear-shaped body of the female, where the fat is located more on the hips and the outer thighs.

"Men from their mid-thirties and peri-menopausal women will gain what we call central obesity. I consider central obesity to be one of the last frontiers of cosmetic surgery, as effective treatment strategies by and large still evade us," says Alan Matarasso, M.D., clinical professor, department of surgery, Albert Einstein College of Medicine, New York.

Peripheral obesity can be effectively treated using various liposuction techniques. According to Dr. Matarasso, however, there isn't much that cosmetic surgeons can do about central obesity. The most effective approach in treating central obesity is with weight loss medication and lifestyle changes, including a healthy diet and regular exercise.

As well as improving the aesthetic image, Dr. Matarasso says the reduction of central obesity is crucial in reducing cardiac and CV risks in cosmetic patients. In central obesity, patients carry their fat deep around the visceral organs, and these patients have a much higher degree of CV disease and diabetes. This possibly may be due to the type of fat that localizes centrally.

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