Answer:
Several large studies address the issue of complication in liposuction patients: Teimourian (1989) conducted a national survery of 935 plastic surgeons who performed 76,000 “major” liposuctions from 1984-1989; overall complication rate was 0.1%; 2 deaths, one from PE and the other a fat embolus. Free fat can be found in the blood of all patients undergoing more than 900cc liposuction, according to one study. This is usually subclinical. Fat embolism syndrome is a separate entity that was first described in 1861, classically from a long bone fracture. Symptoms generally occur within 24 hours, they are tachycardia, tachypnea and fever; hemoptysis if there are pulmonary fat emboli, and neurologic symptoms if to the brain – the smaller fat globules go through the lung. Petechial hemorrhage is a classic finding with a rash on the anterior axillary fold, flank, and lower conjunctival sac – this is from thrombocytopenia not fat emboli. Might see retinal vessels with fat emboli. CXR shows edema. The fat is hydrolyzed to free fatty acids and glycerol and causes massive permeability changes and fluid shifts. The treatment is high dose steroids and vent support as needed. In liposuction, the few reported cases have occurred with concurrent abdominoplasty.
Hanke (1995) reviewed 15,000 cases under local anesthesia using the tumescent technique – no deaths, no hospitalizations, no transfusions. 2 % minor complications. Dillerud (1991) reported 3511 prodedures, no deaths, no PE, no lifethreatening complications. Gorney presented data from the Doctors Company – a professional liability carrier. Overall 0.15% serious or fatal complications. In CA and Nevada, there were 12 severe of fatal complications from 1990 to 1998. Included visceral perforations, PE, fat embolism, pulmonary edema, shock, necrotizing fasciitis, and lidocaine toxicity. The complication rate increased if the procedure was combined with other procedures that lasted longer than 6 hours. In 1998, a national survey was performed by the Lipoplasty Task Force – looking only at board certified plastic surgeons. 0.3% complication rate in 25,000 patients – the 3 most common complications were contour irregularities, unplanned admissions, and prolonged edema. Five deaths (0.02%). The factors that increased the risk were excessive amounts of fluid and local anesthesia, excessive fat removal, multiple procedures, poor health.