How does fat embolism happen from lipo alone?

Dear Dundiko,During liposuction surgery, disruption of vessels is the reason for fat embolism, fatty acids can pass trough a vessel and enter vascular system. Even we use a combination of medicine with tumescent solution that contract vessels there is a small possibility to damage vessels.

Fat embolism can still happen even with liposuction alone. The pathophysiology of an embolus is fat entering the circulatory system. Liposuction does tear some subcutaneous vessels including both arteries and veins. During this trauma, it is possible for some fat to enter the circulatory system, but these chances are very small.

While this is very rare fat embolisms could occur with liposuction if a large enough thing is damaged and the negative pressure in the vein sections up surrounding it. Typically with  liposuction and not fat transfer you get more of a micro embolization and not macro embolization. Micro embolization results in tiny fat particles throughout the lungs and resolve with supportive care.

Fat embolism after liposuction occurs at a very low rate, far less than 1%. It typically presents as multiple small bruises all over the body indicating a shower of microscopic emboli that enter the venous system. The mechanism is unknown. Although it can be life threatening, it typically does not cause major obstruction of blood flow at the lungs, which leads to cardiopulmonary collapse, as seen in fat grafting into the gluteus muscle.

Adipose (fat) tissue consists of adipocytes (fat cells), fibrous tissue, and blood vessels. During liposuction, some small blood vessels are torn and some of the adipocytes break free or are ruptured releasing their triglycerides /fatty acids. These cells and molecules can enter the torn blood vessels and travel to the lungs, creating difficulties with oxygenation etc. Fortunately, the main effects of this microembolism problem are evident within a few hours of surgery and someone who is generally healthy will not suffer ill effects. The volume of fat removed at one time or percentage of body surface area treated are considered in estimating what is a safe limit to liposuction. Fat embolism can occur in orthopedic surgery as well, and someone with an atrial septal defect or patent ductus arteriosus might be at risk of stroke from fat embolism.

Liposuction itself rarely causes fat emboli, and the arteries are not cut with liposuction. Medication is used to decrease bleeding. However, long surgical cases under general anesthesia does increase the risk of embolism since the body is still and not moving.

During liposuction small vessels are damaged. This is where there is opportunity for a fat embolism to occur. The risk however is low because many steps are taken prior to, during, and after surgery to ensure your safety. What you can you do to minimize your risk? Closely follow all instructions by your board certified plastic surgeon. This includes medications to avoid before surgery, early ambulation after surgery, and paying attention to red flags.

I have a question that I consider very important. Yes, massive pulmonary thromboembolism may develop after abdominoplasty and fat removal surgery. This is not a situation to be afraid of anymore.Your plastic surgeon will definitely take an anamnesis to evaluate your risk of pulmonary embolism and take adequate care before abdominoplasty and vacuoplasty. Pulmonary embolism prophylaxis and protection from obesity are very important. This is important for patients who are already obese to gain early mobility in the postoperative period. If your doctor has included you in the risky patient group, prophylactic treatment should be started.

For a fat embolism to happen, fat has to get into a broken vein.Liposuction disrupts the adipose tissue and a small segment of fat can possibly enter a vein that is ruptured.This is a really rare complication and is one that most people are not common because the incident is extremely low from liposuction, The best way to minimize this complication is to use tumescent solution properly and give the solution enough time to create thorough vasoconstriction before starting the work.Worrying about devastating complications that are exceedingly rare is probably not what patients should be concerned about.I think the biggest concern patients should have is the risk of being disfigured because they didn’t pick the right provider correctly.This happens all the time and it’s pretty devastating when it happens.Best,Mats Hagstrom MD