Complications of liposuction

With the right approach, liposuction is one of the safest surgeries, after which the percentage of complications is minimal. At the same time, liposuction is undoubtedly the most dangerous of all aesthetic surgeries, since the development of infectious complications poses a real danger to the patient's life.

All complications of liposuction can be divided into general and local, and local, in turn, into aesthetic and medical.

General complications: General complications that may develop after liposuction include anemia, fat embolism, and thromboembolism.

Postoperative anemia develops after massive intraoperative blood loss, usually associated with decreased sensitivity of the patient's tissues to adrenaline or excessively extensive surgery.

As a preventive measure when planning extensive operations, preoperative blood exfusion is used, which allows, after its return at the end of the intervention, to refuse transfusion of donor blood.

Fat embolism is a very rare complication of liposuction, usually occurring in combination with open surgery (for example, with plastic surgery of the anterior abdominal wall). Symptoms of fat embolism occur within the next 24 hours after surgery, and sometimes within 2-3 days (tachycardia, fever, increasing respiratory failure, skin manifestations, etc.).

Despite the extreme rarity of the development of general complications, each surgical clinic should have a set of medications for providing emergency medical care for these conditions, along with instructions for the doctor on duty. If necessary, this allows you to save those hours and minutes on which the effectiveness of the entire treatment may depend.

Local complications may include wound suppuration, hematoma formation, seroma, persistent swelling of the shins and feet, impaired skin sensitivity in the liposuction areas, phlebitis of the superficial veins, and even the development of necrosis of the skin and subcutaneous fat.

Infectious complications. The wound remaining after liposuction has the following specific features:

• During the intervention, damage to the subcutaneous and deep layers of adipose tissue occurs over large areas (in width and depth);
• unlike a typical (cut) surgical wound, fatty tissue is subject to significant mechanical damage;
• the damaged area is located at a distance from the skin wound, which has a minimal size, and therefore the outflow of wound contents through the wound is practically impossible.

Under these conditions, the developing infectious process, as a rule, acquires a "malignant" character and proceeds as an anaerobic (non-clostridial) infection. Typical features of such a course are sudden onset, rapid (sometimes lightning-fast) spread, rapid deterioration of the patient's general condition due to severe toxemia.

The following measures can be identified as preventive measures against infectious complications:

• Patients who are scheduled for liposuction must be carefully selected based on a sufficiently thorough preoperative examination;
• liposuction is performed only on practically healthy people with normal laboratory and other test results;
• in women, the operation is performed only between menstrual periods;
• immediately before the operation the patient must take a shower;
• During operations, it is necessary to strictly observe the rules of asepsis and antisepsis;
• In case of extensive operations, prophylactic use of antibiotics is necessary, which are administered one hour before the intervention.

A very important factor contributing to the development of infection is the formation of a skin and fatty deposit along the edge of the skin incision. It occurs as a result of repeated movements of the cannula with too narrow an incision and is determined as a clearly visible rim of dark tissue that must be excised at the end of the operation.

In the case of a developing infectious process, only timely initiation of complex therapy can give the desired effect. Otherwise, a fatal outcome becomes a real possibility.

In more than 800 liposuction operations performed at the Center for Plastic and Reconstructive Surgery, infectious complications were noted in two cases.

Both patients were young (23 and 24 years old) with local forms of fat deposits. One of them underwent liposuction on the anterior and posterior surfaces of the shins with a total extraction of about 800 ml of fat. The other underwent liposuction of the inner thighs and knee joints with a similar volume of removed fat. In both cases, the inflammation developed as an anaerobic non-clostridial infection with unexpressed clinical manifestations in the first 2 days after surgery. Rapid development of severe general intoxication with increasing symptoms and significant expansion of the cellulite zone was previously noted.

The treatment included early and complete opening and drainage of inflammatory foci, use of the most powerful broad-spectrum antibiotics in maximum doses, adequate infusion therapy, plasma exchange, and a course of oxygen barotherapy. As a result, the inflammatory processes were stopped within a week. Cosmetic defects were relatively minor.

Swelling of the shin and foot may occur with extensive treatment of the thighs on their inner surface and at the knee joint level. Disturbances in the lymphatic drainage pathways are manifested by the occurrence of swelling at the level of the lower third of the shin, ankle joint and foot; as a rule, they disappear within 1-2 months.

Seroma formation and skin necrosis are rare complications when performed correctly. They may occur when the operation is performed aggressively, when cannulas of an excessively large diameter are used with a relatively small thickness of the fat layer, and when there is insufficient compression by medical underwear. Treatment of seromas involves puncture evacuation of serous fluid and wearing tights of sufficient density.

Skin sensitivity disorders in the liposuction area occur as a result of trauma to nerve fibers and manifest as hypoesthesia, which may be combined with hyperesthesia areas. The impaired sensitivity is gradually restored.

Skin discoloration and scarring. As a result of hemosiderin deposition, in very rare cases skin pigmentation develops in the treated area, which disappears only after several months.

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