The Risks of Liposuction

Liposuction is one of the most frequently performed operations in aesthetic surgery, which sometimes gives the impression that it is a minor one. It is not. It is surgery, and it carries the risks of surgery.

How the operation is performed

The treatment areas are marked and photographed before the patient goes to theatre. Local or general anaesthesia is administered depending on the extent of the work. A cannula is introduced through a small incision and used to break up and suction the fat. The incisions are then closed with sutures and a dressing applied.

Medical risks

• Fat embolism. Fragments of fat enter the bloodstream and travel to other organs. This is a medical emergency.
• Internal puncture. The cannula penetrates an internal organ. Rare, and requires emergency intervention.
• Seroma. Fluid collects in the space created, following tissue damage from the cannula.
• Infection. More likely where post-operative restrictions on movement are not observed.

Anaesthetic risks

Hypothermia from temperature fluctuation during the operation; allergic reaction, which can present as swelling or difficulty breathing; muscle aches; nausea and vomiting; and a sore throat following intubation.

Aesthetic risks

• Bruising — expected, and fades.
• Scarring — expected, and more conspicuous in some sites than others.
• Loose skin — where skin does not retract over the reduced volume. Correcting it may require a further operation.
• Contour irregularity — where fat has been removed unevenly.

What liposuction does not do

It does not treat skin laxity, cellulite or stretch marks. It is not a weight loss operation, and it is not a substitute for a change in diet or activity. It removes fat cells from the treated area; it does not stop the body storing fat in future. Weight gain, pregnancy and ageing can all change the result, and fat may redistribute to both treated and untreated areas.

Who should not have it

Liposuction is unsuitable for patients with severe or chronic medical conditions, a compromised immune system, or a body weight above the thresholds considered safe for the procedure. It is also the wrong operation for someone whose main problem is sagging skin or cellulite in the target area rather than localised fat.

A history of diabetes, cardiovascular disease, deep vein thrombosis or seizures must be disclosed, as must any blood-thinning medication.

Pre-operative assessment

A full evaluation precedes the decision to operate: medical history, allergies, previous surgery and current medication. Blood thinners such as aspirin are stopped some weeks beforehand on medical advice. Smoking and alcohol are stopped at least two weeks before surgery.

A good candidate has localised fat deposits that have not responded to diet and exercise, good skin elasticity, minimal excess skin, a stable healthy weight, and is a non-smoker in general good health.

Recovery

Swelling, bruising and discomfort are normal and settle with time. Rest and avoidance of strenuous activity are required for the first few weeks. A compression garment is worn to control swelling. The incisions are kept clean and any antibiotic protocol is followed. Numbness in the treated area is common and temporary.

The five principles of patient safety

The American Society of Plastic Surgeons has set out five areas that govern safety in this operation, published in Plastic and Reconstructive Surgery — Global Open:

1. Pre-operative evaluation and planning, including establishing realistic expectations.
2. Intra-operative monitoring, under anaesthetic supervision.
3. Management of wetting solutions and fluid status, particularly in larger-volume procedures.
4. Contouring technique and prevention of complications, including the use of fat grafting to address irregularities.
5. Post-operative care and measurement of outcomes.

Weighing it up

Real risks accompany any operation of this kind, and there is discomfort involved. What reduces the risk is the surgeon: their certification, their experience with the specific technique, the standard of the facility, and whether they are willing to have an honest conversation with you about what the operation can and cannot achieve before you consent to it.