Is Liposuction Safe?

What are the known liposuction complications? Are they common?

In a 2020 editorial in the PRS Global Open journal, it noted the “liposuction is now considered one of the safest cosmetic procedures performed“. This is after years of refining techniques and improving surgeon training. (Reference link).

Liposuction is a procedure where cannulas are inserted under skin to remove fat tissue. The cannulas are highly-refined and purpose-designed instruments that do not injure or harm surrounding tissues. The layer which they are designed to slide within is the fat layer. Specifically, the subcutaneous fat. They do not penetrate the muscle or other deeper tissues because the tip of the instrument is rounded (blunt). In the hands of an experienced surgeon, liposuction is very safe. The published complication rate for major complications in 2020 was 2-3 per 100,000 cases.

Accidental perforations have occurred and one can only conclude that the surgeons must have been quite rough. Or perhaps there were unnoticed hernias in the area of liposuction. The important thing is to identify such accidents when they happen and get timely help from surgical colleagues to rescue the situation.

Fat embolism occurs when a large vein is torn in the process of liposuction and loose fat cells get injected into the vein. These fat cells will travel with the blood flow and get lodged in the fine arteries of the lungs precipitating a cardiac arrest. Here again if the surgeon is gentle enough he would not puncture the veins. The instruments are designed to slide past and avoid injuring the arteries and veins. The most important thing is not to push on if too much bleeding occurs. A sign that major vessels are punctured. It would be better to apply pressure and come back another day to complete the liposuction.

Other complications that can occur include hematomas (from minor bleeds), and infection. These can generally be prevented and are quite easily treated although sometimes referrals to another specialist may needed.

The above so called “major” complications are very rare. What is more common are complications related to sub-optimum outcome resulting from either techniques or expectations. The published minor complication rate is about 4%. (Reference link)

Skin contour irregularities can occur if the original skin quality was not that great to start with. Assessment is important. This can be explained beforehand to the patient as a potential problem. The surgeon can get round the problem by not removing too much fat such that the skin loses its supports. Or perhaps even advise the patient not to treat that area at all. However, should it occur, often a secondary procedure to transfer some fat back to the “overtreated” area can sometimes help.

Skin burns have been reported with certain power-assisted liposuction devices when too much energy was used in the procedure. This is really down to the lack of experience of the surgeon operating the device. Device failures are really rare. Most of the time they heal, albeit not completely, after a period of inconvenience. Rarely, skin grafting can help to improve the appearance.

Hemosiderosis occurs when a haematoma stains the skin with a bluish-brownish discolouration. It always fades over time (although sometimes many months), and can be hastened with non-invasive external body treatments.

Lymphedema occurs when the skin over the are treated takes on a leathery hard appearance due to the disruption of lymphatic flow from that area. This is more common with power-assisted liposuction techniques. However the disturbed lymphatic channels can reorganize over time (sometimes many months) and the skin would look like normal again. Non-invasive external body treatments can help hasten the recovery a little.

And then there are anesthetic complications. These can include severe allergies or reactions to certain drugs administered by the anesthetist. In a properly equipped and staffed operating theatre, and with an anesthetist present, these complications can be managed.

In summary, like with any medical or surgical procedure, there will be some inherent risks. And like with all other disciplines in Medicine, doctors who specialize in liposuction would have in place all measures to ensure safety and manage complications if they occur. Real world complication rates are very low. They only get amplified by news media.

However good outcomes are still very much a function of the skill and experience of the surgeon. And that is what every liposuction patient wants. Safety above everything else and good outcomes.

Find out more about Liposuction here