THE RISKS IN LIPOSUCTION AREN'T SLIM; THREE DEATHS IN CALIFORNIA RAISE ALARM.

Byline: Jane E. Allen Associated Press

Judy Fernandez wanted the looks she had before she gave birth to three sons, and it seemed like an acceptable trade-off: 12 hours of surgery - at a cost of $20,000 - for a renewed face and body.

She was 47 and in good health, and her sister-in-law, Marilyn Larsen, says her motives were obvious: ``As a society, we really are encouraged to stay young, to look 40 at 60.''

But Fernandez never woke up from the liposuction and cosmetic procedures at A New You Plastic Surgery Medical Group in Irvine. She died March 17 from what the Medical Board of California called an overdose of anesthesia, fluid overload and a fatal dilution of the blood.

The case is one of three liposuction deaths currently under investigation in California - just the tip of the iceberg, experts say, in a burgeoning, unmonitored field driven by a quest for perpetual youth.

The risks of cosmetic surgery are increasing as it becomes more accessible to the middle class, experts say. With more doctors in a variety of specialties offering the procedures, some are pushing the margins of safety - often in private, outpatient surgical suites hidden from scrutiny.

It was in just such a setting that Rosemarie Mondeck, 39, of San Diego, died June 21, 1994, from cardiac arrest after tummy liposuction at a La Jolla dermatologist's office.

Deputy Attorney General Steven Zeigen said Dr. Nina Su, working without an anesthesiologist, administered too much epinephrine, a drug used to control local bleeding.

``Once Mondeck started to crash, (Su) didn't know what she was doing,'' Zeigen said. The board temporarily suspended Su's license on April 24 pending results of a disciplinary hearing.

Says her attorney, Richard K. Turner of Sacramento: ``I don't think she did anything wrong.''

Tammaria Cotton, a 43-year-old municipal court clerk from Los Angeles, suffered massive blood loss and died of cardiac arrest June 22, 1996, hours after obstetrician-gynecologist Dr. Patrick Chavis removed fat from her stomach, bottom and thighs.

At one point, he left her to recover at his Lynwood office with only a nurse and a worried husband nearby.

At the state board's request, a judge on June 19 temporarily suspended Chavis' license pending a disciplinary hearing. Chavis' attorney Robert D. Walker contends the state's case is based on incomplete records.

Seems simple at first

On its face, tumescent liposuction is simple: a doctor injects a combination of saline solution, a local anesthetic like lidocaine, and epinephrine to reduce bleeding, until the area becomes taut. Then, the surgeon makes a small incision and inserts a tubelike device called a cannula to suction out fat.

The procedure seemed so routine to Cotton, who'd heard about it from her beautician and church friends, that she didn't even tell her husband until the night before her surgery.

``It was just liposuction!'' cried Jimmy Cotton, a police officer, as his wife died in a hospital emergency room.

No organizations track such incidents. But Dr. Richard Ruffalo, past chairman of the department of anesthesia at Hoag Memorial Hospital in Newport Beach, says, ``For every case in which a death occurs, there's at least 15 to 20 cases where severe injury has occurred.''

Dr. Frederick M. Grazer, a Newport Beach plastic surgeon, says money is the root problem, especially as doctors' fees are limited by managed care.

``Many doctors who were never interested in plastic surgery ... take a weekend course and become interested in things they can bill upfront without insurance,'' Grazer said. ``They have increased the envelope to see how much they can inject in a patient and how much they can take without killing them.''

Under the proper conditions, liposuction - now the No. 1 cosmetic operation in the country - is safe, says Grazer, past president of both the California Society of Plastic Surgeons and American Society for Aesthetic Plastic Surgery. By various estimates, anywhere from 100,000 to 300,000 procedures are performed annually in the United States.

Grazer is waging a campaign to alert colleagues to potential overdoses from too much lidocaine injected into patients also receiving intravenous anesthesia. Overloading these patients with fluids can create pulmonary edema, a flooding of the lungs.

Grazer related the story of an East Coast doctor whose patient died at home hours after liposuction. Grazer explained that the lidocaine overdose was delayed because levels in the blood peak eight to 10 hours after surgery.

Revoked licenses

In response to Fernandez's death, the state has at least temporarily revoked the medical licenses of Dr. William Earle Matory Jr., an experienced plastic surgeon, and Dr. Robert Ken Hoo, an anesthesiologist nine months out of residency.

The state says Matory injected 14 to 15 liters of anesthetic-laced fluids and suctioned nearly 10 liters of fat. Meanwhile, Hoo administered nearly 19 liters of intravenous fluids. The 5-foot-3 woman walked in at 150 pounds. She died at 183, swollen from forehead to toes.

Her surgery - done by a surgeon whose lawyers cite a flawless 21-year record and an anesthesiologist whose lawyers say was taking his cues from the surgeon - has shaken the community of cosmetic surgeons.

The irony is that Fernandez, of La Habra, did everything right.

She found a reputable, board-certified plastic surgeon. She used an accredited outpatient surgical center. She discussed the procedures with the surgeon for a year and saw good results with her mother's facial surgery.

So what went wrong?

Some doctors say removing 10 liters of fat was excessive.

Dr. Ronald Iverson of Pleasanton, president of the American Society of Plastic and Reconstructive Surgeons, says he never removes more than 8 liters.

``There really isn't any paper, any book or any set of guidelines ... out there that tell you what is proper,'' said Dr. Guillermo Castillo of Champaign, Ill., president of the American Academy of Cosmetic Surgery.

Although Iverson and other plastic surgeons keep blood replacement nearby to counter blood loss, there was none in the Fernandez case, the Medical Board found.

And Matory performed very complex surgery outside a hospital, which Grazer and several colleagues found to be ``showing very poor judgment.''

But it should be noted that no surgery is risk-free. Matory performed an ambitious combination of full-body liposuction, a mini-facelift, brow-lift and laser skin resurfacing of the face, neck and chest.

``The public can't expect absolute protection and perfection because when you operate on the human body, whether you're doing a gallbladder or a facelift, you're injuring the body's tissue,'' Grazer warned.

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2 Photos

Photo: (1--Cover--Color) SUDDEN LOSS

Recent deaths point out risks of liposuction

David Sprague/Daily News

(2) An undated photo of Tammaria Cotton, who died after liposuction surgery in Los Angeles in 1996.

Associated Press photo