On the whole, liposuction is a safe procedure. But being a surgical procedure, it presents the usual risks of any surgery, as well as a few that are specific to liposuction. The studies of liposuction complications show a variety of results. The main complications of liposuction are:
- Fluid imbalance
- Toxicity from anesthesia
- Blood clots
- Excessive blood loss
- Skin irregularities
- More minor post-op conditions
Infection is always a surgical risk but can be avoided if both the plastic surgeon and patient take care. An antibiotic may be prescribed as a preventive measure. Be sure and keep the incision area(s) clean afterwards until they’re fully healed.
Serious infections are rare but possible. One is called necrotizing fasciitis, (an infection where bacteria in the wound feed on the tissue, destroying it). Another is toxic shock syndrome, (an acute infection of Staphylococcus bacteria which causes nausea, diarrhea and shock). When the body goes into shock, its physiological process slow down and weaken dangerously; e.g., shallow breathing, weak pulse, and low blood pressure.
An embolism is an abnormal particle circulating in the blood. After liposuction it’s most likely to be a fat embolism, where fat particles have been loosened, and one finds it way through a ruptured blood vessel into the circulatory system. It can then get caught in the lungs or brain. An embolism can cause permanent disability or death.
Perforation of internal organs such as the intestines during abdominal liposuction is a possibility. This can happen because during the procedure, the surgeon can’t see exactly where the tube, or cannula, is as he works to loosen and remove fat. Such visceral punctures can be fatal but an experienced and careful surgeon is very unlikely to cause one.
Fluid Imbalance is possible in any liposuction procedure, but especially when too large an amount of fat is removed. “Too large” would be over 11 pounds or so (5,000 cc’s). Fat contains a lot of water. When, at the same time, large amounts of diluted local anesthetic are injected into the body, fluid imbalance can result. The kidneys will then overwork themselves trying to correct the balance, and excess fluid can collect in the lungs, causing difficulty with breathing.
Toxicity from anesthesia: Lidocaine is often used as a local anesthetic, injected in a saline solution. In tumescent liposuction, where a very large amount of this fluid is injected, the body may end up with too much lidocaine. If the person for any reason has diminished liver function (e.g. from excess alcohol consumption over a period of years), the body may not be able to process this lidocaine infusion adequately. Symptoms of lidocaine poisoning are light-headedness, numbness in the mouth, shivering, sleepiness, and twitching muscles. In a severe case, the heart can stop. However, this toxicity occurs in a very tiny percentage of cases.
Blood clots are a danger any time we remain still for too long, as in bedrest, surgery, or long plane flights. The blood pools, typically in the leg veins, and clots from lack of circulation. If a clot then breaks free and travels through the circulatory system, it’s known as an embolism (see above) and can get caught in the lungs or brain.
Excessive blood loss is seldom a complication any more. The techniques that caused it have been mostly abandoned (i.e., the dry technique, wet technique, and the super-wet technique). With the tumescent technique, which is most commonly used today, only about 1% of the total fluid removed is blood.
Skin slough refers to the death and detaching of skin. If a surgeon uses too large a cannula it can damage skin, causing it to slough off. And if the patient has impaired blood circulation for any reason (e.g., diabetes, excess smoking) that can be conducive to skin sloughing, but a responsible surgeon would screen his patients for this type of pre-condition.
Loose skin post-op can be a problem for a short while but usually the skin shrinks to fit the new shape. In older patients there may be a residual loose flap or two and these can be corrected later on by further surgery.
Some post-op conditions that don’t rise to the level of being “complications” are:
Swelling and bruising: Swelling is caused by the injection of saline solution at the beginning of the liposuction. (This is part of the tumescent technique and the solution contains lidocaine as an anesthetic and epinephrine to reduce bleeding.) So when the procedure is finished, rapid draining is important to facilite healing and minimize swelling and bruising and the accompanying pain. Also the patient should wear a compression garment to encourage the drainage. Swelling may last up to 6 months or so.
A seroma is a pooling of the watery component of blood, the serum. It can be drained out with a needle.
Numbness usually lasts only for several weeks.
Keloid scars are red and raised. They occur rarely and generally in people who are predisposed to get them by their genetic background. Treatments are not always successful.
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