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Liposuction and Fat Grafting: Preventing & Managing The 8 Most Common Possible Complications

Annually, the average number of liposuction and fat grafting related procedures performed in the United States alone is more than 300,000. As it becomes increasingly popular in the aesthetic arena over the last couple of years, it is imperative for physicians to understand the causes, preventative measures, and management of the different possible complications of liposuction and fat grafting.

Image credit: info@clinicalillustration.com

Liposuction

Liposuction is a surgical intervention designed to treat superficial and deep deposits of subcutaneous fat distributed in aesthetically unpleasing proportions. Over the years, it has proven to be a successful method of improving body contour, and is now performed in many office-based surgeries.

Due to it being one of the safest aesthetic surgery procedures, it has become one of the most commonly performed by plastic surgeons around the world. The indications are and have been progressively increasing, ranging from functional to aesthetic surgery. In fact, in the recent years, it has also entered the fields of regenerative medicine, and the inherent limitations as well as safety issues related to the procedure are to be respected if complications and unfavourable results are to be avoided as far as possible.

Fat Grafting

Fat grafting, also called fat transfer, plumps up facial or body features with a patient's own fat. Fat transfer is designed to minimise wrinkles and fill in parts of the face or body that has a “sunken” or “hollowed" appearance by harvesting fat from one area (such as the tummy or thighs) whilst removing unwanted fat. It can also reduce scarring and correct deformities. Since it uses uses fat cells harvested from and injected into the patient, there is no risk of the body rejecting the tissue. However, as with all procedures, there are risks, and a competent physician should be able assess, avoid, manage and educate patients on the possible complications and risks.

8 Common Possible Complications of Liposuction & Fat Grafting

While liposuction and fat grafting procedures are regarded as some of the safest procedures available on the market, there are still risks of complications like in any other procedures. This week, #IFAAS faculty Dr Kasey Sung shares the following:

The 8 Most Common Possible Complications of Liposuction & Fat Grafting are:

1. Fat Necrosis: Necrosis of grafted fat tissue induces cicatrization, calcifications, and oil cysts if the necrosis size is substantial.

2. Infection & Sepsis: Unrecognised or untreated infections could lead to compromise of a large surface area or even to necrotizing fasciitis and other more severe systemic manifestation.

3. Skin Irregularities / Skin Necrosis: When violated or traumatized, the subdermal plexus may be prone to necrosis and scarring.

4. Hematoma & Seroma: Localised bleeding outside of blood vessels, due to either trauma including injury may cause blood to continue seeping, as the liquid form spread among the tissues including in sacs between tissues, coagulates and solidifies, thus leading to hematoma.

On the other hand, seroma is often related to excessive liposuction with inappropriate post-operative management. Both conditions are often associated to the lack in a practitioner’s training or incorrect techniques.

5. Fat & Pulmonary Embolism: Considered as a medical emergency, fat and pulmonary embolism can happen when pieces of loosened fat break away and become trapped in a blood vessel and gather in the lungs or travel to the brain.

6. Lidocaine/Epinephrine Toxicity: Although generally safe, in rare circumstances, lidocaine or epinephrine toxicity can occur, causing serious heart and central nervous system problems.

7. Cerebral/Ocular Artery Thrombosis: Regarded to be a medical emergency, cerebral/ocular artery thrombosis can lead to blindness or worse.

8. Undesired Perforation: Usually related to lack of training or use of wrong techniques, undesired perforation can lead to catastrophic outcomes requiring more aggressive interventions with increased morbidity and even risks of death.

Prevention and Management of the 8 Possible Complications

Prevention is always better than cure, it is therefore crucial for a practitioner to understand the cause and effect of any complication associated to a procedure so that preventive measures can be taken and/or manage them if they occur.

1. Fat Necrosis: Statistical studies show that the larger the fat graft particles are, survival and regeneration cannot be grafted at 100%. Fat necrosis after grafting largely depends on the injection technique/volume and micro-environments of the recipient site. Therefore, it is important for the performing practitioner to have an in-depth understanding of techniques and patient anatomy to reduce the chances of adverse effects resulting from fat necrosis.

2. Infection & Sepsis: Careful aseptic technique is essential including skin prep and proper instrument management. Pre and post-operative antibiotics play a significant role in managing and preventing infection and sepsis. Proper antibiotic delivery during procedures is essential.

3. Skin Irregularities / Skin Necrosis: Skin irregularities and necrosis can be largely associated to the incorrect use of techniques that violates and traumatises the anatomical structures. It is therefore preventable if a practitioner has a good understanding of the tissue anatomy and techniques.

4. Hematoma & Seroma: Hematoma and sermon can be effectively prevented if the performing physician has had adequate training and that the appropriate techniques are applied during the procedure.

5. Fat & Pulmonary Embolism: A rare occurrence, fat and pulmonary embolism can lead to fatal outcomes, and this can be largely prevented if the practitioner has good understanding and knowledge of techniques as often than not, diagnosis is difficult and the treatment is supportive with corticosteroids being used for management of this rare entity.

6. Lidocaine/Epinephrine Toxicity: Lidocaine and epinephrine toxicity can be prevented if a practitioner has a sound knowledge of dosage and uses the right techniques. Generally, the suggested maximum lidocaine is approximately 400-600mg per 1 litre of saline, and 0.6mg to 1.0mg per litre for epinephrine.

7. Cerebral/Ocular Artery Thrombosis: The lack of anatomic knowledge, incorrect dosage and most importantly, use of incorrect techniques are the main causes of cerebral/ocular artery thrombosis. Hence, it is imperative for a practitioner to fully understand the anatomical safe zones and administer the right techniques so as to prevent cerbral or ocular artery thrombosis.

8. Undesired Perforation: Undesired perforation can lead to catastrophic outcomes and only with the proper anatomical knowledge and soft tissue handling experience can a practitioner prevent undesired perforation. Aside from knowledge and skills, patient positioning and the type of cannula used are also some of the many important factors to be considered during the procedure.

While liposuction and fat graft procedures are known to be some of the safest available procedures in the aesthetic and cosmetic fields, the 8 Common Possible Complications of Liposuction and Fat Grafting can be said to stem from inadequate training and use of incorrect techniques by a practitioner; hence, it is undeniable that the key to preventing any adverse complications, is that a practitioner MUST be equipped with the right training and administer the correct techniques.

Hope you have enjoyed the article & video! Stay tuned for our future posts about more techniques and information related to our advanced aesthetic and cosmetic training courses!

Reference:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3901919/

https://www.sciencedirect.com/science/article/pii/S2049080117302406

Learn more about advanced cutting-edge techniques on Liposuction & Fat Transfer under Local in Dr Sung's own OR in Seoul:

IFAAS Mini-Fellowship (Hands-On)

Liposuction & Fat Transfer for Face & Body

Under Local Anaesthesia

July 16-17, 2019: Seoul, South Korea

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