FAQ: Complications and Risks
1. What Factors Increase the Risks of Liposuction Complications?
The most dangerous aspect of liposuction is an attitude that ignores the risk of doing too much liposuction on a single day, or disregards the risks of doing multiple unrelated surgical procedures on the same day that liposuction surgery is performed.
- It is dangerous to attempt too much liposuction on the same day. There is a limit to the amount of surgical trauma that the human body can safely withstand. If the patient desires a large amount of liposuction, is it far safer to divide the procedure into two or more separate surgeries spaced 3 to 4 weeks apart, rather than to do one excessively large surgery on a single day.
- It is dangerous to combine liposuction with other unrelated surgeries, such as facelift, breast surgery, or laser surgery, on the same day as liposuction. It is especially dangerous to do abdominal liposuction on the same day as a gynecologic surgical procedure.
- The use of general anesthesia or IV sedation for liposuction may tempt a patient or a surgeon to do too much liposuction. Both the patient and the surgeon must be aware that too much surgery in a single day can be dangerous.
2. What are the risks of liposuction surgery?
As judged by current worldwide experience, liposuction is amazingly safe. Rare problems that can potentially occur with any surgical procedure include infections, bleeding, skin ulcerations, and nerve injury. The tumescent technique minimizes these risks. To the best of our knowledge, there have been no reported deaths using the tumescent technique for liposuction totally by local anesthesia. As with any surgical procedure, liposuction is associated with certain common side effects such as bruising, swelling and temporary numbness. Although irregularities of the skin are possible following liposuction, this side effect is minimized by tumescent liposuction using microcannulas. When larger cannulas are used there is an increased risk of occasional irregularities of the skin. When microcannulas are used, noticeable irregularities are uncommon.
3. What major complications have been associated with liposuction?
Major complications associated with liposuction are rare 1) when the patient is not excessively obese, 2) when the patient does not have too much liposuction on a single day, and 3) the patient does not have another unrelated surgical procedure (breast surgery, facelift, hysterectomy, etc.) on the same day. Nevertheless, liposuction does have some risks.
The following is a list of the most serious risks, which fortunately are rare.
Pulmonary thromboembolism (a blood clot in the lung)
This type of complication is a known risk of using general anesthesia, excessive surgical trauma, and obesity.
Liposuction infections are very rare. Inadequate sterilization of the surgical instruments, the application of Reston foam to reduce bruising, and ultrasonic assisted liposuction may increase the risk of infections.
Intra-Abdominal Perforation with Visceral Injury
With prompt diagnosis, an injury to an organ within the abdominal cavity can usually be repaired without long-term serious problems. However, if a liposuction cannula punctures the intestine, and the diagnosis is delayed until an infection has spread throughout the abdominal cavity, the consequences can be fatal. When liposuction is done totally by local anesthesia, any intestinal injury will immediately cause severe pain which should lead to a prompt diagnosis. However if the liposuction is done under general anesthesia, then both the patient and the surgeon may be unaware of the injury until it is too late.
Hematoma or Seroma
Bleeding into a closed space under the skin (hematoma), or the leakage of serum into closed space under the skin (seroma) can occur after liposuction. There is an increased risk of these types of complications associated with obesity, excessive liposuction with a large cannula, and with ultrasonic assisted liposuction (UAL).
Permanent nerve damage is very rare with tumescent liposuction. It is far more common with the use of ultrasonic assisted liposuction (UAL). Nevertheless, nerve injury is a known risk of any surgery.
Swelling or Edema
Temporary swelling of areas treated by liposuction is part of the natural healing process, and usually resolves within 4 to 12 weeks. By allowing incision sites to remain open (not closed with stitches), post-operative drainage of the residual blood-tinged local anesthetic solution can occur. By encouraging this drainage of inflammatory fluid, the degree and intensity of postoperative swelling and edema is minimized. When the surgeon closes incision sites with stitches, a considerable amount of inflammatory material is trapped under the skin, and this augments the swelling process.
Skin necrosis, or the death of skin cells within a circumscribed area, can result from thermal injury (burn or freezing), infection, or injury to the blood vessels that supply oxygen to the skin. Skin necrosis can occur with liposuction if the surgeon uses the liposuction cannula to intentionally injure the skin (some surgeons erroneously believe that injuring the skin will encourage contraction of the skin). It is not unusual for ultrasonic assisted liposuction (UAL) to cause skin necrosis as a result of ultrasonic energy burning the skin or burning blood vessels that supply the skin. Finally, a rare type of severe bacterial infection can cause necrotizing fasciitis of the skin. This type of infection is associated with UAL and with the use of Reston foam applied to the skin after liposuction in an effort to reduce bruising.
Excessive doses of intravenous fluids during and after liposuction have been known to cause excessive accumulation of fluid in the lungs. Severe cases of pulmonary edema can cause death. Intravenous fluids are not necessary, and in fact are contraindicated, with tumescent liposuction because the large volume of dilute tumescent local anesthetic fluid that is injected under the skin. The tumescent local anesthetic fluid is sufficient to replace any fluid that is lost by liposuction. Any additional fluid given through an IV is unnecessary and could be excessive.
Adverse Drug Reactions (Toxicity or Allergic Reactions)
This can occur with any medication. Both local anesthesia and general anesthesia can cause complications during or after liposuction.
In the year 2000, a survey of liposuction surgeons who traditionally do liposuction under general anesthesia found that these surgeons encountered one death in every 5000 cases of liposuction. 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.
4. What are the leading causes of death associated with liposuction?
The most common causes of death associated with liposuction are 1) Pulmonary Embolus (blood clot in the lung), 2) Infections, 3) Injury to Abdominal Organs (liver, intestines) or Lungs, and 4) Drug Reactions and Side Effects of Anesthesia. An article published in 2000 found 95 deaths among 475,000 liposuction patients who had liposuction by surgeons using general anesthesia or heavy IV sedation. In contrast, a 2002 study of surgeons who do liposuction by local anesthesia found no deaths among 65,000 liposuction patients.
5. Does the type of anesthesia affect the safety of liposuction surgery?
The type of anesthesia used for the liposuction surgery can influence the risk associated with liposuction. There have been no deaths reported with liposuction that is accomplished using the tumescent technique totally by local anesthesia. Virtually all deaths associated with liposuction are associated with the use of either general anesthesia or the use of intravenous (IV) sedation. A recent publication in the journal, Plastic and Reconstructive Surgery, reported 95 deaths associated with liposuction from 1994 to mid-1998, all of which occurred in the hands of surgeons who typically use general or systemic anesthesia. In the same period of time there were no reported deaths associated with liposuction when performed by surgeons who do tumescent liposuction totally by local anesthesia. (Reference: Grazer FM, de Jong RH. Fatal outcomes from liposuction: census survey of cosmetic surgeons. Plastic and Reconstructive Surgery 105:436-446, 2000).
6. What is the risk of infection with tumescent liposuction?
Although there have been reports in the medical literature of patients who have had serious infections following liposuction surgery, infections after tumescent liposuction are extremely rare. Lidocaine, the local anesthetic that is used for the Tumescent Technique has been shown to be bactericidal, that is, it kills bacteria. To the best of our knowledge, there has never been any patient who has had a serious infection following liposuction totally by local anesthesia using the tumescent technique.
7. How much blood loss occurs with liposuction?
There is virtually no significant blood loss associated with tumescent liposuction. This amazing fact is the result of the profound vasoconstriction produced by the epinephrine contained in the tumescent local anesthetic solution. With tumescent liposuction totally by local anesthesia approximately one percent (1%) of the material that is removed by liposuction is blood. With tumescent liposuction under general anesthesia approximately 4 to 8 percent of the aspirated material is blood.
8. Is a blood transfusion a common requirement after liposuction?
Blood transfusions are extremely rare with tumescent liposuction. However, excessive blood loss may occur 1) if the patient has taken aspirin or a nonsteroidal anti-inflammatory drug (NSAID) within a few days before surgery, 2) if the surgery involves excessively large amount of liposuction such as total body liposuction or liposuction removes more than 5 liters of tissue.