Rare and Severe Liposuction Complications

Anesthesia can be Dangerous

Complications due to anesthesia are rare. Both local anesthesia and systemic anesthesia, which includes general anesthesia and heavy intravenous (IV) sedation, can be dangerous if used by physicians who are not familiar with the pharmacology of tumescent local anesthesia or who are not adequately trained in the use of general anesthesia or intravenous sedation.

Local Anesthesia can be Dangerous

Local anesthesia can be dangerous if the surgeon exceeds well-recognized maximum recommended dosages of the local anesthetic lidocaine. Although lidocaine toxicity is rare, it is most likely to occur if the patient is also taking a drug that interacts with lidocaine by blocking the liver enzyme CYP3A4 that metabolizes lidocaine. See lidocaine metabolism for a list of drugs that can interact with lidocaine. All liposuction surgeons should be aware of the list drugs that can increase the toxicity of lidocaine. Lidocaine is the safest of all local anesthetic drugs. Other local anesthetic drugs such as bupivocaine (Marcaine) are too dangerous to be used for liposuction.

Systemic Anesthesia can be More Dangerous

Systemic anesthesia can be more dangerous than local anesthesia. Any exposure of patients to drugs that suppress breathing or interfere with protective airway reflexes will increase the risk of complications. The safe use of dangerous systemic anesthesia requires a trained anesthesiologist. Nevertheless, the presence of an anesthesiologist is not a guarantee for safety if general anesthesia is used in order to permit excessive amounts of liposuction. Other anesthesia-related issues include unexpected drug reactions, incorrect dosages, and injury form malfunctioning anesthesia equipment.

Blood Clots

Blood clots in the legs are associated with prolonged surgery and excessive surgical trauma. A blood clot in the legs can be fatal if it travels from the legs to the lungs. The occurrence of blood clots in the legs or in the lungs after liposuction is far more common with general anesthesia than with local anesthesia.

Injury of Abdominal Organs

Injury of abdominal organs following penetration of the abdominal cavity by a liposuction cannula can be life-threatening if the injury is not promptly diagnosed and treated. Under local anesthesia, this type of injury is rare because liposuction is done with finesse and gentleness. Under general anesthesia, surgeons tend to use larger cannulas and attempt to do liposuction with the greatest possible speed rather than the greatest possible finesse, and as a consequence, intrabdominal injury is more common under general anesthesia. Under local anesthesia, such a liposuction injury would be so painful that it would be diagnosed immediately, however, under general anesthesia, this type of injury is often missed until after infection and bleeding has progressed for many hours. It is very dangerous to combine gynecologic surgery and abdominal liposuction which would create an increased risk of intra-abdominal injury.

Excessive IV Fluids

Excessive IV Fluids can cause total body fluid overload. Pulmonary edema occurs when too much fluid collects. Extreme pulmonary edema has occurred in patients who were given excessive amounts of intravenous (IV) fluids following overly aggressive liposuction.

Excessive Blood Loss

Excessive blood loss has been associated with old-fashioned liposuction techniques that were used before the invention of the tumescent technique. Hypovolemia (an inadequate volume of fluid in the body's blood vessels) is a common consequence of excessively large volumes of liposuction. A hematoma is a collection of blood that occurs as a result of internal bleeding. Hematomas are more likely to occur in patients who take medications such as aspirin or ibuprofen which impair normal clotting mechanisms.

Hypothermia

Hypothermia, which occurs when there is a dangerous fall in the body's temperature, can cause fatal cardiac problems. Hypothermia can result from the use of systemic anesthesia. It can also occur if the surgeon uses a chilled solution of tumescent local anesthesia, instead of the recommended use of a solution that is warmed to body temperature.

Infections

Infections related to liposuction are quite rare but can occur with either local anesthesia or general anesthesia. There is an infection by an organism known as "rapid growing atypical mycobacteria" that has been associated with attempts to sterilize surgical instruments by soaking them in bacteriocidal chemical solutions. Because rapid growing atypical mycobacteria are resistant to bacteriocidal chemical solutions, all liposuction instruments should either be sterilized in a steam-autoclave, or be single-use disposable items. Another type of potentially fatal infection is known as necrotizing fascitis which has been associated with 1) a penetration wound to the intestines with a delayed diagnosis due to the use of general anesthesia, or 2) the use of Reston foam applied to the skin after liposuction to reduce bruising. The manufacturer of Reston foam has warned against its use with liposuction.

Infections associated with liposuction are extremely rare. This patient was infected by atypical mycrobacteria as a result of inadequately sterilized instruments.

Other Complications

Other potentially catastrophic complications, although extremely rare, include: Allergic drug reactions, aspiration pneumonia (most likely under general anesthesia), cardiac arrest and potentially fatal cardiac arrhythmias, permanent nerve damage, brain damage due to lack of oxygen under general anesthesia, and seizures.

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