Age 38, 140lbs, risks of fat embolism during or after liposuction with regional anesthesia?

Question

I have never had plastic surgery before. I am considering a tummy tuck with liposuction of the flanks, but have always been aware of risks of any surgical procedure. Recently I saw on the news a case of a very young patient who passed away due to massive fat embolism after a "simple" liposuction to the knees. Obviously I do not have all the details on this, but made me concerned and wonder what could've happened to this young woman. I am 38 years old, weight 140 lb

Matthew Schulman, MD · Answer

The story you refer to is an unfortunate one, but is rare.  None of knows teh real details and it is unclear how "simple" the procedure was. It may have been combined with other procedures or she may have had some medical issues that may have made this more likely. Fat embolism is usually a risk that can occur with fat transfer, not usually with liposuction. So this is another reason why the story is a bit mysterious.  Regardless, the risk of a serious complication is rare, when your surgery is performed by a Board Certified Plastic Surgeon, in an accredited facility, with a Board Certified Anesthesiologist, and you have been medically cleared by your primary physician. These are things that you will be able to discuss with your surgeon during your consultation.

Semih Yildiz, MD, FEPOBRAS · Answer

It is understandable to feel concerned after hearing about a death after liposuction. Without the details of that case, no one can say from the outside whether it was fat embolism, a blood clot, an anesthesia event, bleeding, medication reaction, or another complication.

Fat embolism after liposuction is generally considered uncommon, but it can be serious. Regional anesthesia does not remove all surgical risk, because the operation still involves fluid shifts, tissue trauma, positioning, and possible clot risk. A tummy tuck combined with flank liposuction is also a larger operation than small-area liposuction, so your individual safety plan matters.

Before surgery, ask your plastic surgeon about your personal risk assessment, BMI, medical history, smoking/vaping, medications, clotting history, planned volume of liposuction, operative time, facility accreditation, anesthesia provider, and blood-clot prevention plan. Your surgeon should also review warning signs after surgery, such as chest pain, shortness of breath, fainting, severe calf pain, or sudden worsening symptoms, which should be treated as urgent.

Risk can never be reduced to zero, but careful patient selection, an accredited surgical facility, appropriate anesthesia support, conservative surgical planning, and close post-op monitoring are important parts of safer surgery. If the risk discussion still does not feel clear, it is reasonable to get another in-person consultation before scheduling.

John L. Burns Jr., MD · Answer

Liposuction is the most commonly performed procedure in plastic surgery.  If done correctly it is very safe.  Procedures should be done in a fully accredited facility by a board certified plastic surgeon using anesthesia provided by a board certified anesthesiologist.

Emmanuel De La Cruz, MD · Answer

The risk of fat embolism during or after liposuction is generally considered low, but it's essential to be aware of potential complications associated with the procedure. Fat embolism is a rare but serious complication that occurs when fat particles enter the bloodstream and travel to the lungs, heart, or other organs. Here are some factors to consider:

Low Overall Risk:

In general, the risk of fat embolism during liposuction is low, especially when performed by a skilled and experienced surgeon in a controlled medical setting.
Choice of Anesthesia:

Liposuction can be performed under various types of anesthesia, including local anesthesia, regional anesthesia, or general anesthesia. Regional anesthesia, which includes techniques like tumescent anesthesia, is commonly used for liposuction. The choice of anesthesia is influenced by factors such as the extent of the procedure and patient preference.
Tumescent Technique:

The tumescent technique involves injecting a solution into the fatty tissue to facilitate the removal of fat. This solution typically contains a local anesthetic and a vasoconstrictor. The use of the tumescent technique has contributed to a reduction in the amount of bleeding during liposuction, minimizing the risk of complications.
Surgeon's Expertise:

The surgeon's experience and skill play a crucial role in minimizing the risks associated with liposuction. A qualified plastic surgeon will take precautions to ensure patient safety and carefully manage the procedure.
Patient Health:

Individual health factors, such as pre-existing medical conditions, can influence the overall risk profile. It's important to disclose your complete medical history to your surgeon during the preoperative evaluation.
Monitoring and Aftercare:

Close monitoring during the procedure and vigilant postoperative care are essential for early detection of any complications. Adhering to postoperative instructions, attending follow-up appointments, and promptly reporting any unusual symptoms are crucial for a safe recovery.
While fat embolism is rare, it's important to be aware of the potential risks associated with liposuction. Choosing a board-certified plastic surgeon, discussing your health history openly, and following all preoperative and postoperative instructions will contribute to a safer and more successful liposuction experience. Always consult with your surgeon to address any concerns or questions you may have about the procedure and its associated risks.

Zoran Potparic, MD · Answer

The risk of thromboembolic events is highest in patients undergoing abdominoplasty and is significantly higher than fat embolism; it will depend on the patient's weight, medical history, history of previous vein thrombosis, family history, etc. Only on the basis of in-person evaluation and detailed history, a surgeon can give you an estimate of risks (low, moderate, high) based on the Caprini score. Every patient undergoing abdominoplasty in our surgery center will go through a rigorous preoperative evaluation, perioperative measures as well and an intensive follow-up. In high-risk patients, perioperative and postoperative antithrombotic medications are given for 1-2 weeks after surgery.

Finny George, MD · Answer

Hi, thank you for sharing your question. The risk of fat embolism will depend on the treatment area, surgical technique and whether fat grafting is also involved. Generally speaking, the risk is relatively low for most patients but speak with your surgeon to determine the best course of action.

Camille Cash, MD · Answer

Safety is the number one priority in surgery.  There are several steps that are taken to keep your risk as low as possible.  Many of them are within your control.  The first is to select an experienced board certified plastic surgeon with whom you feel comfortable and confident.  Board certification ensures your surgeon has gone through additional extensive training in their specialty. During your visits your surgeon should listen to your concerns, review your medical history, and determine if you are a good candidate for the procedure.  Your surgery should be performed in an accredited facility.  This means that the facility has undergone rigorous surveys to ensure high quality standards. You can also keep your risk low by avoiding any nicotine or TCH use, maintaining a healthy diet and exercise routine, and closely following all of your surgeon's preoperative and post operative instructions.

Connie Hiers, MD, FACS · Answer

The risk of fat emboli with liposuction is very low since fat is being sucked out rather than blown into tissue. Plus, blood vessels are left intact with liposuction. This is higher risk with a tummy tuck since it is more invasive, especially with blood and not fat emboli. Precautions will be used in surgery to decrease your risk.  Fat emboli are more associated with fat transfers than liposuction.

Mats Hagstrom, MD (license on probation) · Answer

All surgical procedures carry some inherent risk. Risk needs to be stratified in regards to the incidence versus impact.
Liposuction and tummy tuck surgery both have potential for serious medical complications, including fatality.
The risk of having these types of procedures is usually about the same risk in regards to mortality as driving an automobile for about a year. In reality serious medical complications are still relatively rare, and in reality most patients who have regrets regarding cosmetic surgery. It is not because they had a serious medical complication, but rather that the results did not turn out the way they had hoped. For that reason, disfigurement is probably the most realistic complication Patients should actually be worried about.
The chance of having undesirable outcomes, whether it is, poor aesthetic, outcomes, or medical complications, can to some degree be lessened by carefully selecting providers, who have sufficient skill and experience.
Finding the right plastic surgeon is much more difficult than most people think.
Simply reading providers reviews on various websites is generally insufficient to properly vet, plastic surgeons, regarding overall skill and experience
The following are some general guidelines for finding the best provider for your needs.
Provider selection is important for any cosmetic surgical procedure, but is especially critical for procedures like liposuction, which have a high degree of variance based on provider selection
The following are some general guidelines for finding the right provider
To find the best provider, I suggest patient schedule multiple in person consultations with experienced plastic surgeons in their community. During each consultation, ask each provider to open up their portfolio and show you their entire collection of before and after pictures of previous patients who have similar body or facial characteristics to your own. An experienced plastic surgeon should have no difficulty showing you the before and after pictures of at least 50 previous patients. An experienced provider should in fact have hundreds or preferably thousands of before and after pictures to choose from for commonly performed procedures. 
Being shown a handful of preselected images, representing the best results of a provider’s career is insufficient to get a clear understanding of what average results will look like in the hands of each provider.
There is no correct number of consultations needed to find the best provider. The more consultations you scheduled the more likely you are to find the best provider for your needs. 
Take careful notes during each consultation, especially regarding the quantity and quality of before and after pictures. It’s not a bad idea to bring pictures of your own body/face to use as reference when reviewing before and after pictures. 
The biggest mistake patients make is scheduling only one consultation without properly vetting or comparing providers before scheduling surgery.
Best,
Mats Hagstrom, MD

Age 38, 140lbs, risks of fat embolism during or after liposuction with regional anesthesia?

Answers (9)

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