Contour deformity was the most common complication of liposuction, with a prevalence of 2.35%, in a meta-analysis of 39 studies covering 29,368 patients[1]. Body contouring surgeries often necessitate revisions or secondary procedures, and autologous fat grafting, in which a person's own fat is harvested and injected, is used to correct contour abnormalities[2][3]. Published evidence on correcting liposuction deformities includes a case report in which a severe infragluteal fold deformity was very difficult to correct, with only a limited effect from fat transplantation despite multiple operations[4]. Even for fat grafting in general, a review found no evidence that any fat processing method is superior, owing to a lack of well-defined prospective studies[3].
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Contour deformity was the single most common complication in a large meta-analysis of liposuction, with a prevalence of 2.35% (95% confidence interval 1.05% to 5.16%)[1]. That meta-analysis selected 39 studies from 2957 articles and included 29,368 patients with a mean age of 40.62 years[1].
The same meta-analysis reported lower prevalences for other problems, including hyperpigmentation at 1.49%, seroma at 0.65% and hematoma at 0.27%[1]. The authors concluded that liposuction is a safe procedure with low complications, of which contour deformity is the most common[1].
The authors of that meta-analysis also wrote that raising awareness of specific risks can enhance surgical outcomes and improve understanding between patients and physicians[1].
One documented cause is overaggressive liposuction: a case report described how overaggressive liposuction of the infragluteal region can lead to an infragluteal fold deformity[4]. The same report said this kind of deformity creates esthetic defects in the contour of the buttocks[4].
The authors of that case report concluded that the infragluteal region should be preserved during liposuction to avoid deformity[4].
A review of secondary body contouring noted that body contouring surgeries often necessitate revisions or secondary procedures[2]. That review stated that balancing patient expectations and surgical limitations while methodically addressing shortcomings is crucial[2].
In secondary abdominoplasty, a repeat tummy tuck after an earlier one, the authors wrote that a precise diagnosis of the abdominal deformities is essential for planning[5].
A review of neck rejuvenation reached a similar view, saying that a thorough understanding of the anatomic basis of a neck deformity allows the surgeon to choose the appropriate treatment[6]. A review of arm contouring said that assessing fat excess, skin excess and the location of the deformity helps determine whether liposuction alone, skin removal or a combination is the best approach[7]. For arm contouring, that review also noted that no studies have shown the superiority of any technique[7].
Fat grafting moves a person's own fat from one area to another: the fat is harvested, processed and injected into the soft tissues to correct contour and other abnormalities[3]. A review of fat processing described fat graft as an ideal soft tissue filler because of its biocompatibility, lack of immunogenicity and availability[3].
The way the fat is handled affects the result, because the whole process of harvesting, processing and transferring the graft affects how well the fat takes[3]. Common processing methods include centrifugation, cotton gauze rolling, sedimentation and filtration or washing[3].
The review found no evidence that one processing method is superior to another, owing to a lack of well-defined prospective studies[3]. The review explained that careful processing matters because harvested fat cells are fragile and blood and cell fragments need to be removed[3].
In the case report of a severe post-liposuction infragluteal fold deformity, the patient experienced fat graft overabsorption, fat graft translocation (movement of the graft) and worsening of gluteal ptosis, a drooping of the buttock[4].
Despite multiple operations in that case, the effect of fat transplantation was limited[4]. The authors concluded that severe post-liposuction infragluteal deformity is very difficult to correct[4].
A single-centre study over a thirteen-year period included 72 patients treated with combined liposuction and lipofilling (fat grafting) for pseudo genu varus deformity, a problem of lower-leg shape[8].
In that study, a second round of lipofilling was required in 17 patients (23.6%) within six months to one year after the operation[8]. The need for additional lipofilling or liposuction was not noted for any other patients, over an average follow-up of 5 years (range 1 to 9 years)[8].
None of the 72 patients developed major complications such as fat necrosis, infections, contour deformities or medial concavities during knee flexion[8]. The authors concluded that the combined approach is a feasible, effective and safe alternative that seems to offer benefits compared with fat grafting alone[8].
In reconstructive surgery rather than cosmetic liposuction, one series reviewed 41 flap revisions, using liposuction alone or with direct excision, performed on 33 free flaps (tissue moved from one part of the body to another)[9].
That series reported no postoperative complications except for 1 partial flap loss in a patient whose flap had been irradiated[9]. The authors concluded that secondary free flap revision using liposuction and direct excision is a safe technique for recontouring free flaps[9]. For flaps that had received radiotherapy, the authors advised delaying these procedures for several months after the acute effects of radiation have resolved[9].
In breast reconstruction with an abdominal perforator flap, 28 of 216 patients underwent secondary revision, and liposuction was the revision method in 22 cases[10]. In lower-extremity flap reconstruction, debulking by liposuction (51 patients) and by conventional lipectomy, cutting the fat away (69 patients), had a similar rate of complications, with partial necrosis in 7.8% and 7.2% of flaps respectively[11].
In a series of 21 secondary abdominoplasties among 298 abdominoplasties, the authors reported that it was possible to solve the problem in each case and to improve both trunk contour and patient satisfaction[5].
That secondary abdominoplasty series also found that the risks of a secondary abdominoplasty were similar to those of the primary procedure[5]. Of those 21 secondary cases, 17 patients had surgery during the first year after the primary procedure and 4 had surgery more than 5 years after it[5].
More than one session may be needed, as shown by the 23.6% of patients who needed a second round of lipofilling in the pseudo genu varus study[8]. In the severe infragluteal case, by contrast, multiple operations produced only a limited effect from fat transplantation[4].
The secondary abdominoplasty findings come from a series of 21 cases[5]. The pseudo genu varus findings come from a single-centre study of 72 patients[8]. The infragluteal findings come from a single case report[4].
Any new or changing lump after liposuction or a revision procedure is worth raising with your surgeon. If you notice a rapidly growing swelling, fever, chest pain or shortness of breath, contact your surgeon or emergency services right away.
Before agreeing to a revision, it may help to ask a board-certified surgeon questions like these:
A meta-analysis of 39 studies with 29,368 patients found contour deformity was the most common complication of liposuction, with a prevalence of 2.35%[1].
Fat grafting uses a person's own harvested fat, injected into the soft tissues, to correct contour and other abnormalities[3]. In one case report of a severe infragluteal fold deformity after liposuction, though, the effect of fat transplantation was limited despite multiple operations[4].
In a study of combined liposuction and lipofilling for pseudo genu varus deformity, a second round of lipofilling was required in 17 of 72 patients (23.6%)[8].
For secondary abdominoplasty, one series found that the risks were similar to those of the primary procedure[5]. Risks for other revision procedures should be discussed with a board-certified surgeon.