The Risks of Liposuction

Summarized by Robert W. Griffith, MD
June 30, 2005

Liposuction is the most frequently performed cosmetic surgery procedure today. Occasional reports that highlight the dangers of liposuction led the American Society of Plastic Surgeons to direct their Committee on Patient Safety to examine the possible risks associated with the procedure and make recommendations for their avoidance. This is a summary of their recommendations, which may be useful for anyone considering this type of surgery.

Liposuction was originally used for correcting minor irregularities of body shape due to fat deposits; now-a-days, thanks to improvements in techniques, there is recontouring of large, sometimes multiple areas of the body, so that it often qualifies as major rather than minor surgery. As with all surgical procedures, there are risks, but the dangers of liposuction have been considerably exaggerated by media reports.

Technique: No one single technique is best for all patients in all circumstances. However, the so-called 'dry' method has now been replaced by 'wet' methods, which reduce the risk of excessive blood loss. In 'wet' liposuction, fluids are injected into the fat before the fat -and fluid - are sucked out.

Anesthesia: This represents one aspect of the dangers of liposuction. The procedure may be done in hospital, in a free-standing ambulatory surgical center, or a physician's office. While the latter may offer more convenience, procedures performed in doctor's offices carry a slightly greater likelihood of a serious adverse incident.¹ There are rules governing the administration of anesthetics that are more likely to be followed if the procedure is done in a hospital or an ambulatory surgery center.

Care must be taken in the addition of agents to the infiltration solution used in 'wet' liposuction. The local anesthetic bupivacaine should be avoided (it has a very long duration of action) and lidocaine dosage must be carefully controlled, to avoid possible heart or neurological side effects. Epinephrine is often added, to help reduce bleeding by constricting the blood vessels; too much, however, can reduce blood flow to the liver, and reinforce the effects of lidocaine or bupivacaine; it should also not be used in patients with heart or blood pressure problems.

Type of patients: Obese patients are at an increased risk of the dangers of liposuction. Poor wound healing, infection, deep venous thrombosis (a clot in a leg vein), and sleep apnea are all more likely in the so-called 'morbidly obese' - those with a body mass index (BMI) over 30. And while liposuction can benefit the appearance of overweight people, it does not, as a rule, improve the medical complications of obesity - raised blood pressure, high blood sugar, raised blood lipids, etc: (see the first link below).

The volume removed: Large volumes of fluid are sometimes removed; the fluid consists of fat together with the solutions used to infiltrate the area before suction begins. Removal of volumes over 5000 mL (1.3 gallons) are considered large, and should only be undertaken in an acute-care hospital or an appropriately accredited center. The postoperative care for such patients is very important, as profound metabolic changes can occur. Fluid management is vital to avoid one of the commonest dangers of liposuction - fluid overload. Although large amounts can be removed, equally large volumes are used in the infiltration process, and as much as 50-70% is usually left behind. This necessitates an extended period of observation and, maybe, treatment with diuretics (water pills).

Care during and after surgery: Steps must be taken to avoid deep vein thrombosis (e.g. leg-compression devices, and/or a heparin injection), and to correct any fluid imbalance. Pain must treated appropriately, but if excessive, the doctor must check for possible infection or another complication (see below).

Possible complications: Some of the main dangers of liposuction are related to complications that can occur: infection, pulmonary embolus, fat emboli, and hypothermia. Infection can spread rapidly, with dire consequences if not recognized and adequately treated. Pulmonary embolus occurs when a clot from a leg vein thrombosis breaks off and blocks a vein in the lungs; there is chest pain and difficulty in breathing, with decreased oxygen reaching the body organs. Fat emboli are less common; very rarely, globules of fat can enter the venous circulation, and, being too large to pass through the capillary vessels in the lungs, can produce a pneumonia-like condition. Hypothermia can occur postoperatively when there has been inadequate warming of the infiltrating solutions.

Before deciding on liposuction

The Committee emphasizes that liposuction is a safe, effective, and popular procedure for removing fat from the body. However, it must be performed by a surgeon with knowledge of the physiologic changes it can produce. To make sure that this is the case, prospective patients should select physicians who have had full surgical training, and have completed an accredited residency or fellowship that covers liposuction techniques. Preferably they should have had considerable experience in the procedure.

Equally important is the selection of the facility where the surgery will be done. If the surgeon recommends an office-based procedure, it is important to ensure that appropriate procedures are in place to handle any emergency that may arise. In particular, if a general anesthetic is to be used, the surgery must be done in an accredited facility. State health authorities can provide information on the status of individual facilities.

Conclusions

The recommendations coming from the American Society of Plastic Surgeons provide reassurance that the severe dangers of liposuction are, indeed, extremely rare, and can be avoided if the patient is alert to them.

Source

• Practice advisory on liposuction. RE. Iverson, DJ. Lynch,  the ASPS Committee on Patient Safety, Plast Reconstr Surg, 2004, vol. 113, pp. 1478--1489

Footnotes
1. A study from Florida has shown that 'adverse incidents' (i.e. something going wrong) occur in 66 per 100,000 office surgeries and in only 5.3 per 100,000 ambulant surgery procedures. The death rate was 9.2 patients per 100,000 in offices vs. 0.78 per 100,000 in surgery centers. (Vila H, Soto R, Cantor AB, Mackay D. Comparative outcomes analysis of procedures in physician offices and ambulatory surgery centers. Arch Surg 2003;138:991-995.)

Related Links
Liposuction Won't Reverse All the Health Risks of Obesity
American Society of Plastic Surgeons: Lipoplasty/Liposuction
FDA: Liposuction Information

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