This is a 39-year-old female following abdominal etching and VASER liposuction of the flanks, lower back, left breast medial pole tightening, right central pole tightening, right breast fat grafting, and RENUVION skin tightening of the back and breast.
Liposuction risks are multi-fold and range from minor side effects to major events. Undergoing surgery is a very important decision that requires understanding not only the benefits but also the risks. Removal of fat can allow patients to drastically improve their outer appearance by eliminating concern areas and subsequent improvement in self-confidence. Surgical procedures involving the removal of fat deposits have unique risks associated with volume shifts due to the use of generous tumescent liposuction fluid. In addition, since the soft tissues are being manipulated, poor skin elasticity and excess skin can pose unique challenges. A final consideration involves the need for a 360-degree circumferential approach that also increases risks to any cosmetic procedure since the scope of the areas being treated is expanded. As such, when considering liposuction cosmetic surgeries, plastic surgeons need to evaluate you early to avoid potential risks. Potential complications of liposuction surgery are affected by the liposuction technique chosen. The options for liposuction surgeries include traditional liposuction, ultrasound-assisted liposuction, power-assisted liposuction, and Laser liposuction.
The most frequent liposuction risks that should be discussed include the following:
- Permanent numbness or hypersensitivity. Liposuction requires using a cannula with holes in the tip that is used to suction out the fat. Proper liposuction requires uniform fat removal from a region that can only be achieved by crosshatching. This is a process of removing fat using multiple approaches so that a specific area is treated as evenly as possible. In doing so, sensory nerves in the region can be irritated and severed. This will result in temporary hypersensitivity or even numbness.
- Hematoma. Since liposuction requires the use of cannulas that are forced through the layers under your skin to pierce through and retrieve your fat, small and medium blood vessels that traverse the fat layers can be injured. If injured, blood can leak out and cause small or medium lakes of blood, called a hematoma. This liposuction risk may be treated with needle aspiration, especially if skin compromise is detected from the pressure created by the expanding lake of blood.
- Skin compromise. Skin compromise may occur following liposuction as the layer under the skin must be crosshatched with fat-removing cannulas to ensure uniform fat removal. When performing comprehensive fat removal, vascular structures (arteries and veins) can be injured to the point that small areas of skin may lose their vascular source. This liposuction risk can be minimized by avoiding smoking preoperatively and postoperatively. This liposuction risk can be reduced using VASER liposuction, which is gentler on the tissues. In addition, when skin compromise is detected early, the nitro paste can be applied topically to encourage increased blood flow to the region and avoid possible skin death.
- Lidocaine toxicity. Lidocaine toxicity may occur if too much lidocaine is used during the liposuction procedure. Lidocaine is an essential element of a tumescent solution which is the solution that is infiltrated into the fat layers before them being suctioned. If too much fluid is used (safe infiltration volumes are kept to <5L), there is a possibility of Lidocaine toxicity. Symptoms of lidocaine toxicity include numbness around the mouth or tongue, a metallic taste, dizziness, visual or auditory distortion, disorientation, and drowsiness.
- Injury to deeper structures. Since cannulas are used to remove fat forcibly, there is a theoretical risk of injury to deeper structures that could be detrimental. These include larger vessels, the diaphragm, organs, or intestinal structures.
- Pulmonary embolism. Pulmonary embolism refers to the clogging of the major arteries and veins that supply the lungs. This can occur from fat cells that enter the bloodstream and then travel up to the lung vessels, where they may get wedged and clog the blood supply to the lungs. This can be a detrimental liposuction risk and lead to death. This liposuction risk is increased in incidence in patients undergoing simultaneous liposuction with fat transfer to the buttocks.
Caution should be taken to avoid liposuction risks, as we do with all surgical risks.