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Liposuction Risks and Complications

 

Severe complications can be minimized by making sure you disclose your entire medical history to your doctor and discussing all prescription and other medication that you take on a regular basis.  In most cases the side effects associated with liposuction surgery are minimal. Do your home work so that you understand all the risks, problems, and complications associated with the liposuction procedure.

 

                               

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  • RISKS AND COMPLICATIONS OF LIPOSUCTION

General Risks include:

 

 

Specific Risks include the following:

  • Scarring

  • Skin loss/slough

  • Asymmetry

  • Skin sensitivity

  • Lumpiness

  • Waviness

  • Irregularities

  • Loose Skin

  • Areas of hard scar tissue

  • Discoloration (pigmentation issues)

  • Injury to deeper structures (rare)

 

 

                                         

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Although, not very common sometimes a bleeding episode can occur after liposuction or lipotrophy procedures. If post operative liposuction bleeding occurs, it may require an emergency treatment to either have blood drained which might have accumulated (such as a hematoma) or possibly a blood transfusion. It is of utmost concern that you follow your plastic surgeon's post operative instructions with making sure you stay away from certain types of medication that might contribute to thinning the blood.  

 


 

Sometimes the cannula movement can cause friction burns to skin or nerves. Ultrasound-Assisted Liposuction can produce a large amount of heat - which can increase the risk of burning the skin, causing blisters or possible scarring.  

 

 

 

DVT is a blood clot that forms in a vein deep in the body. Blood clots occur when blood thickens and clumps together. These blood clots form after prolonged immobility (such as bed rest after surgery). During recovery, it is important to stand often and flex the feeet more often to keep the blood flowing in the legs. Most deep vein blood clots occur in the lower leg or thigh however, they can occur in other parts of the body as well.  

 

 

 

A Pulmonary Fat Embolism is a very rare event after liposuction. The liposuction procedure involves suction of fat cells from specific parts of the body after loosening the fatty areas up first with a solution (tumescent). A Fat Embolism can occur when fat is loosened and a fat particle enters the blood through a blood vessel that was either torn or ruptured during liposuction.  Fat particles can sometimes get trapped in the blood vessels, go to the lungs or to the brain. 

Symptoms of a Pulmonary Fat Emboli (fat clots in the lung)

  • shortness of breath

  • difficulty in breathing

Any patient that has these symptoms after surgery needs to contact medical help immediately.  Fat emboli can cause permanent disability or in some cases - cause death. 

 

 

 

 

An instrument called a cannula is used to suck out fat accumulations during the surgical procedure called liposuction. The surgeon is unable to see where the cannula goes during the procedure, so the chance of puncture or damage to internal organs is a risk. Visceral Perforations basically causes "puncture wounds" in the organs. When this happens, surgery may be required to repair them. This complication can be fatal.

 

 

 

 

A hematoma is a collection of whole blood that has leaked out of injured blood vessels and become trapped inside the body. The vasoconstriction produced by the tumescent technique for liposuction has virtually eliminated the occurrence of hematomas.

 

 

 

 

Seromas after liposuction are the result of surgical trauma which injures or destroys the lymphatic vessels within the targeted fatty tissue. Lymphatic vessels are tiny, thin-walled tubular structures located throughout the body, and have the specific function of draining tissues of fluids that leak out of capillary blood vessels. Large liposuction cannulas can sometimes create large empty pockets within targeted fatty tissues as well as removing lymphatic vessels.

Both of these conditions encourage the formation of seromas after liposuction. Unfortunately, seromas are a common problem after ultrasonic assisted liposuction (UAL). Ultrasonic liposuction cannulas create a considerable amount of heat which injures blood vessels as well as the delicate lymphatic vessels. Without lymphatic vessels to drain away excessive lymph fluid, the fluid collects within the excavated spaces in the fatty created by the liposuction process.

Preventing Seromas:

The use of micro-cannulas have been proven to reduce the risk of seromas. Micro-cannulas are very small liposuction cannulas which has an outside diameter of less than 3 mm. The purpose of using the micro-cannulas is that it creates smaller tunnels which will not leave the larger cavities that a larger cannula can cause.  It is these larger cavities of space that tend to be perfect place for seromas to form.  Also, larger cannulas because they remove fat faster can damage the lymphatic vessels and create larger cavities within the fat.

Incisions that are not closed with sutures helps with the drainage of the tumescent anesthetic solution and also the lymphatic system. This is known as the "open drainage technique. Also wearing a compression garment helps with squeezing the walls of the empty tunnels together so that they adhere faster and close up the empty cavities - making it less likely for a seroma to form.

 

 

 

 

Malignant hyperthermia is a very rare complication from general anesthesia, which can sometimes be fatal.  The inhaled agents used in the anesthesia can sometimes cause a biochemical reaction which is marked by intense muscle contractions that will eventually lead to rigidity in muscle tissue.  Hyperthermia is another word for an abnormal high fever and muscle breakdown.

How Malignant Hyperthermia Happens:

  • This condition only happens to patients who are genetically susceptible to malignant hyperthermia

  • Patients produce abnormal proteins inside their muscle cells.

  • These proteins will trigger the response or release of excess calcium when the person inhales certain common anesthetics

  • Increased calcium activates the sustained muscle contractions - which will increase the amount of energy the body will use

  • The end result is an increase in heat production (hyperthermia)

  • The overactive muscle cells eventually run out of energy and die off.

  • With the cells dying, high levels of potassium and a protein are released into the bloodstream causing muscle damage, cardiac arrest, brain damage, massive internal bleeding, kidney failure, other organ failure and death

  • These events can be prevented if the anesthesiologist administers the proper treatment immediately 

  • This complication is not always fatal, in fact death rates have been dropping significantly.

  • Death rate in the 1960-1970 - 80 percent - Death rate today is close to 10 percent

  • Very rare complication

 

 

 

 

Lymphedema is an injury that damages your lymph nodes or lymph vessels.  Lymphedema has been reported with ultrasonic liposuction because of the potential of it to burn the vascular system. 

Ultrasonic liposuction cannulas create a considerable amount of heat which injures blood vessels as well as the delicate lymphatic vessels.

 

 

 

 

Phlebitis means inflammation of a vein. Thrombophlebitis refers to a blood clot which causes inflammation. Phlebitis can be superficial, in the skin, or deep in the tissues. Symptoms of phlebitis include constant pain, swelling and redness.

 

 

 

 

Cellulitis is a skin infection which is caused by bacteria. Our skin normally helps protect our body from infection. If we have a cut, sore, insect bite or recovering from surgery - sometimes bacteria can get into the skin and spread to the deeper tissues. This complication requires antibiotics immediately, as the infection has the capability of spreading to the blood or the lymph nodes.

Most surgeons prescribe antibiotics as precaution after every surgical procedure so an infection or cellulitis cannot occur. Without treatment, this could be fatal.

Symptoms of Cellulitis:

  • Infected area is warm to the touch

  • Inflammation can cause the area to be red, swollen and tender

  • Fever and chills

  • Swollen glands

 

 

 

 

One of the longer term effects of liposuction can be nerve damage. This can occur due to the stripping of the outer sheath of nerve cells containing a fatty layer which is called myelin.  Six percent of all patients can experience some sort of problem with damage to the sensory nerves.  Damage to the sensory nerves will create the feeling of pins and needles.

Liposuction to the lower face area also can sometimes cause damage to the facial nerves due to suctioning out the fat along the jaw line. These nerves in the facial area tend to recover on their own requiring no treatment.

 

 

 

 

You many experience numbness around the area where your liposuction surgery was performed. This is also known as "paresthesia" - and is very normal. A numbing sensation may occur off and on for 4-8 weeks, but feeling and sensation should return after that time.

Permanent numbness is very rare and occurs less than 1 percent of the time. The method of liposuction that has the majority of nerve problems is with the ultrasound assisted liposuction (UAL)

 

 

 

 

Toxicity from anesthesia is a risk factor with surgery. Lidocaine is a drug that numbs the skin and is used frequently as a local anesthetic during the procedure of liposuction.

Some of the side effects of Lidocaine are:

  • feeling light-headed

  • restless

  • dowsy

  • tinnitus (ringing in the ears)

  • slurred speech

  • metallic taste in the mouth

  • numbness of the lips or and tongue

  • shivering

  • muscle twitching

  • convulsions

Toxicity with lidocaine may cause the heart to stop. Any type of anesthesia is considered a risk during surgery. Lidocaine toxicity is a rare complication with tumescent liposuction. With the tumescent liposuction procedure too much saline fluid may be injected or the "tumescent solution" contains too high of a concentration of lidocaine. Most surgeons are very skilled at knowing exactly how much to inject according to body size and their medical history.

 

Other Medication

 

Make sure you tell your surgeon any and all medication you are taking on a regular basis, including over the counter remedies. Drugs that increase bleeding can cause a hematoma or excessive bleeding requiring possibly hospitalization.

 

Drugs that interfere with clotting:

  • Aspirin

  • ibuprofen (Advil, Motrin)

  • Warfarin or Coumadin

  • Vitamin E

  • Red Wine

  • Herbal remedies

 

 

 

 

 

Having an infection with liposuction is normally a rare occurrence. Should an infection start - contact your surgeon immediately. Treatment for infections include a prescription of antibiotics or additional surgery depending on the severity of the situation.

 

 

 

 

To help with any hypertrophic scarring or keloid prevention, some surgeons will suggest silicone gel sheeting. This silicone sheeting comes in gel shapes which are commonly used for various different types of cosmetic surgery. 

Keloid scarring resembles a lumpy pink raised scar and normally occur in people who have this tendency.

Differences Between Hypertrophic and Keloid Scarring

 

 

 

Swelling or edema is a very common problem that may occur after liposuction. In some cases, swelling may persist for weeks or months after liposuction. This is not uncommon and can be considered part of the healing process in liposuction.

 

 

 

 

Shock can happen with large volume liposuction. Shock and blood dilution can occur after a patient has had excessive amounts of fluid injected and then excessive amounts of fat and body fluid removed (over 5,000 ccs or about approximately 11 pounds). Large volume liposuction should be considered carefully. It is generally not recommended. However there are surgeons that specialize in it.

 

 

 

 

Full Thickness Skin Necrosis is death of the affected skin. This complication can result from excess superficial liposuction that injures the vascular supply of the overlying skin. 

 

 

 

 

 

Bruising occurs often following the procedure of liposuction. Bruising will vary from patient to patient due to many factors. The severity of the bruise is associated with the time period that a bruise will appear after the surgery along with the color of the bruise.

Bruises are more likely to happen with:

  • Patients who have a low blood platelet level

  • Poor nutrition (which is in direction correlation of having inadequate nutrients for the body)

  • Patients who did NOT stop certain medications before their procedure (make sure you tell your surgeon and anesthesiologist everything you take in regards to medication and over the counter products). 

  • Read the section on "Medication to Avoid" before surgery.

Most surgeons will suggest to take Arnica or Bromelain to prevent and reduce the risk of bruising. Also, the use of compresses will help reduce bruising. Bruising can last up to six to eight weeks; however, depending on your body type it might be much less. 

 

 

 

 

 

Skin irregularities including depressions or dimpling of the skin might occur after liposuction.  Also including possible visible and palpable wrinkling of skin. If these irregularities happen, additional plastic surgery might be needed to treat these depressions, etc.

 

 

 

 

 

 

 

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