What risk factors and complications are associated with liposuction?
1. Medical conditions as associated risk factors
The following conditions are considered risk factors in liposuction procedures:
- A history of heart related problems, such as heart attack (myocardial infarction)
- Hypertension (high blood pressure)
- Lung-related / pulmonary problems, such as air pockets in the bloodstream or shortness of breath
- Medication-related allergic reactions (especially those which may be used for the procedure, asthma treatment or antibiotics)
- Substance abuse (relating to over-consumption of alcohol, illicit drug use, or smoking habits)
- Indications of poor wound healing
A surgeon may not consider patients as ideal candidates for the following reasons:
- He / she has a history of thromboembolic events or phlebitis (vein inflammation).
- He / she has a tendency towards developing superficial vascular problems – like varicose veins, spider veins or oedema (swelling).
Before a procedure is agreed upon a plastic surgeon will likely discuss medication use in some detail. It is necessary for a surgeon to be well aware of a patient’s medication usage (including over-the-counter, supplements and herbal varieties) so as to assess risk factors which could have an impact on the procedure itself.
To avert complications (namely bleeding and the formation of haematomas), a surgeon will request that aspirin-based medications / anticoagulants be discontinued (where possible) at least 2 weeks before a liposuction procedure.
Herbal supplements may sometimes negatively interact with the anaesthetic used during the procedure and must thus be disclosed prior to surgery. A patient does run the risk of experiencing bleeding complications if these are not discontinued.
Should a medication that is considered high-risk need to be taken for any reason (and cannot be discontinued for any amount of time), a surgeon may not consider the individual a possible candidate for liposuction. Where possible, less risky replacements may be implemented. A surgeon will assess this very carefully.
A surgeon will also take into consideration how certain medications may interfere with the necessary anaesthetic during the procedure. Lidocaine is commonly used and is a medication that is metabolised by the cytochrome P-450 enzyme in the liver. This enzyme functions by metabolising toxic compounds in the body. Any medications, such as beta-blockers, histamine H₂ receptor antagonists like Cimetidine (Tagamet) or anti-anxiety / anxiolytics, being used by a patient that are similarly metabolised will be noted during consultation. Such medication may carry a risk of lidocaine toxicity during a procedure and thus cause complications.
3. Complications associated with the liposuction procedure
- Patient dissatisfaction
- Asymmetry (an uneven removal of fat cells / tissues)
- Over-correction (more fat being harvested than was desired to achieve ideal contouring) and under-correction (excess fat not being sufficiently removed in a targeted body area)
- Skin dents (due to abnormal contouring), sagging (skin laxity) or irregularities (ripples and dimples)
- Scarring (particularly at the port sites – poor placement of incisions, scar depressions, hyperpigmented scars, hypertrophic or keloidal scars)
- Seromas (fluid build-up under the surface of the skin)
- Haematomas (an abnormal collection of blood outside a blood vessel that results in a swelling of clotted blood within the tissues)
- Skin hyperpigmentation or dyschromia (discolouration of the skin and nails – resembling liver or age spots)
- Hypesthesia (a partial or reduced sense of sensation – ‘numbness’) or dysesthesia (sensation abnormalities as a result of nerve damage)
- Umbilical deviation (the displacement of the belly button affecting abdominal / trunk liposuction patients)
- Ecchymosis (skin discolouration as a result of subcutaneous bleeding)
- Blood clot (risk of deep vein thrombosis and pulmonary embolism / thromboembolism)
- Fat embolism (tiny beads of fat enter the bloodstream and hinder normal blood flow to other tissues)
- Bacterial infections
- Pulmonary oedema (excess fluid in the lungs)
- Shock (more typical if an insufficient amount of fluid is replaced in the body during the procedure)
- Fluid overload (during the surgical procedure)
- ARDS (adult respiratory distress syndrome)
- Nerve and tissue damage (including those of the skin or organs) due to injuries incurred during the surgery (either via burns if heat is used or due to incorrect handling of the surgical instruments)
- Perforation of intra-abdominal tissues or structures
- Adverse reactions to the anaesthetic used during the procedure
- Hypothermia (this is a rare complication as a result of anaesthesia, especially when chilled solutions are used during tumescent procedures)