Surgeon shares rationale for lip on 12-year-old

Editor's NOTE: The following excerpt, written by Robert A. Ersek, M.D., F.A.C.S., will appear in its entirety in Dermatology Times' sister publication, Cosmetic Surgery Times, next month. Dr. Ersek performed liposuction and abdominoplasty on a morbidly obese 12-year-old Austin girl who, at 5 feet 5 inches tall, weighed 225 pounds and could not lose weight through conventional methods. We believe the excerpt to be particularly appropriate for our readers in light of the questions brought up in this month's On Call about performing liposuction on a 12-year-old patient.

Some of the criticism has been to the fact that surgery is risky, and even riskier in a young person. I am unaware of any studies showing that young people heal more slowly than old people or that young people are less resistant to complications of surgery than old people. In fact, recent studies have been performed with surgery in utero because the very youngest seem to heal the very best.

In this particular case, there were extenuating circumstances. The patient was 12 years old when we first met. Her dad called and asked if I would consider liposuction for his 12-year-old-daughter. I said, "No, she should consider diet and exercise."

Well, her dad has been a patient of mine for about 25 years. He said, "We know that you have been doing quite a bit of liposuction, and this girl weighs 225 pounds and she is at her wits' end."

He said she had been dieting and exercising since age 3 and her life is miserable. "She suggested liposuction might help her, since we have tried everything we can think of. Please, just talk to her."

She came in with her parents and explained that she has been dieting and exercising her entire life. Her mother was very insistent that she had tried everything: Deal-A-Meal, Weight Watchers, liquid protein diets, starvation diets, exercise to the point of exhaustion. She would lose a few pounds and then a few weeks later, she would gain it back plus a little more. I explained that often children are chubby.

The child's mother said the child's doctor said she was prediabetic and she just had to lose the weight, and they did not know of a way this could be done with the usual behavior modification methods.

I suggested gastric bypass or a lap band. One of their neighbors had recently died from a gastric bypass, so that option was out of the question. I explained that we could remove a safe amount of fat (5 to 10 liters); wait six weeks and take another 5 to 10 liters; wait six weeks and then do another 5 to10 liters. We could do this as an outpatient, a little bit at a time. They were very anxious to get started on that program.

Ulterior motive

During one visit, the patient and mother explained that they would like to do this more quickly than the one-or two-or three-year program I had outlined for her, because her father had metastatic bladder cancer.

She said, "I would like my dad to see me in a dress before he dies."

Her panus was very large and redundant, and therefore no amount of liposuction would cure that. Because of their temporal considerations, I agreed to remove a max amount of fat by liposuction in one session by having her donate two units of blood to herself ahead of time. Then, a minimum of six weeks later - assuming she had fully recovered, with no complications - we would perform an abdominoplasty. Because she had such a large panus, I did not perform any liposuction in that area.