Including Skin Loss, Burns, and Skin Death

Liposuction by itself if performed superficially and vigorously can lead to skin death or skin loss that results from devascularization. This occurs when the blood vessels are damaged so severely that the circulation is impaired and the skin dies. Skin death can also result from burns generated from heat. These larger burns have been reported hundreds of times or more anecdotally but Dr. Hughes does not use any energy-based forms of liposuction. This dramatically reduces the risk of these complications. It is not uncommon for Dr. Hughes to receive requests for reconstruction after these burns have occurred in other surgeries. Unfortunately, the reconstruction process for these larger burns produces a less than appealing cosmetic outcome. The best thing to do is to avoid large second and third degree burns, because treatment is never really satisfactory.

Bleeding and infection following liposuction surgery are known risks and these risks apply to any surgery. Bleeding is largely controlled in liposuction due to the epinephrine administered with the tumescent solution. This solution is added prior to liposuction to cause vasoconstriction of the blood vessels to reduce the risk for significant intraoperative or postoperative bleeding. A large amount of bleeding could necessitate a blood transfusion or more extraordinary measures including additional surgery. Surgical site infections typically occur with 5 days following surgery and are extremely infrequent in Dr. Hughes’s experience. What is far more common is an infection 2, 3, or 4 weeks after surgery due to bacterial contamination from the patient. Dr. Hughes has very specific and strict postoperative instructions to minimize this risk. Follow these instructions precisely as Dr. Hughes has developed his protocols after performing thousands of liposuction surgeries.

Contour deformities, dents, and dimples are largely things that the surgeon can avoid. In other words, the more skilled the surgeon in creating the liposuction flaps and the smoother the liposuction is the greater the likelihood of a nice, smooth liposuction result. These complications are largely what separates an elite, highly sought after surgeon from the average or above average surgeon. Patients should realize that healing following liposuction is critical to ensure success of the result. The garment for the abdomen must be worn for 6 weeks to help reduce the risk for fluid collection, also called seroma. If a fluid collection occurs, it will distort the result and can be potentially catastrophic to an otherwise perfect result. The fluid collection must be drained to smooth contours and must be closely monitored to ensure that it does not redevelop.

Nerve damage though possible is not nearly as common as some temporary numbness due to nerves being bruised but not cut or transected. There are various categories for nerve injury but liposuction causes a temporary situation in nearly all cases that largely resolves in a few months.

Some patients develop a great amount of bruising that can stain the skin, called hemosiderin deposition. This hemosiderin is largely a nuisance as it can persist for months and cause distress to the patients. Ultimately, it does improve over time in most cases. If it does not, certain modalities can be used to improve the appearance by targeting the pigments that remain in the skin.

Skin laxity issue can frequently occur in patients after pregnancy or weight loss or poor skin tone in general. Patients should always be aware that less than optimal skin can create less than optimal result despite optimal surgery being performed. It is a bit like limiting the smoothness of a sculptor’s clay in creating a sculpture. Further skin excisional or skin tightening procedures may be necessary in these individuals and this may be fairly obvious to some patients and not so obvious to other patients. Frequently, patients think that they will get a great result like a friend, but they may fail to realize the differences in skin quality, which makes this expectation unrealistic. Patients are simply not capable of discerning on skin type from another, and no patient should expect that he or she could. It is not productive to argue with an expert in the field of plastic surgery about this issue, so please try to be open to the expert’s opinions or recommendations based upon unique individual patient traits.

The liposuction cannula used by almost all surgeons is blunt and by its very nature is made to not cause damage to the underlying fascial and muscle layers and the internal organs. Some liposuction surgeons use sharper cannula though Dr. Hughes has never used this as this increased the risk of puncture and damage of organs. Patients need to realize that small abdominal wall defects or hernias may be present and may be difficult or impossible to realize through physical exam or even CT scan or MRI. Thus, there is always some amount of intrinsic risk to liposuction of puncture. The risk of puncture is probably 1:1500 or less. If puncture occurs, it would likely require additional surgery to repair the defects.

Finally, pulmonary embolus is a risk that is present in nearly all surgeries to some extent. Longer surgeries, particularly those longer than 6 hours, more invasive surgeries, orthopedic procedures, and tummy tuck are all known to have higher risk than one may have expected. In the tummy tuck, the pelvic inflow may be limited by placation of the abdominal wall. Liposuction surgery by itself has a much lower risk of pulmonary embolus than tummy tuck. All patients who undergo surgery under general anesthesia have sequential compression devices prior to induction of general anesthesia to help circulate blood artificially while surgery is performed. Early walking or ambulation is encouraged as well to prevent a blood clot in legs that can become an embolus, which can go to the lungs and cause respiratory compromise or even death.

Fat embolus has also been reported rarely with liposuction procedures. This occurs when fat enters a blood vessel and this fat travels to the lungs. This can also cause respiratory compromise and death. Fat emboli are more common with fat transfer procedures like the Brazilian butt lift. Every surgeon who is performing fat transfer procedures must understand these intrinsic risks and manage them accordingly.

Accordingly, all of these procedures should be performed in accredited surgery centers with board certified plastic surgeons and board certified anesthesiologists to help manage risk as much as possible. Advanced Cardiac Life Support measures are inherent parts of all such considerations. Functional automatic external defibrillators should be maintained and tested on a daily basis in the surgery center.

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