In October 2017, an article was published in the British Medical Journal by Dr. Adam Ali titled “Fat Attacks! A Case of Fat Embolism Syndrome Post Liposuction” (Adam A., 2017).
This particular report is in regard to a patient with lipedema who had a liposuction procedure performed on their lower legs and knees, and as a result suffered an incredibly rare complication known as Fat Embolism Syndrome. Just like any surgery, liposuction inherently comes with potentially devastating risks, and while this complication is rare, it does serve as a stark reminder that every effort needs to be made to reduce these risks on every procedure that is performed.
For those unfamiliar with the term, an embolism occurs when a mass of substance breaks off from the body and travels through the bloodstream, potentially clogging one of the body’s blood vessels. In the case of fat embolisms, a fat globule (or more commonly, multiple fat globules) has broken off in too small of a blood vessel and become lodged, causing one or more bodily systems to malfunction. Often, it is the smaller vessels of the lungs that are first affected, resulting in respiratory failure and other serious side effects.
Fat embolisms are a risk with traumatic injuries (especially long bone and pelvic fractures) and soft tissue damage, as well as orthopedic surgery and burns. And while they are extremely rare in the case of liposuction and fat transfer procedures, they are a real risk worth considering before undergoing any procedure. Learn more about fat embolisms below.
Fat embolisms are believed to be caused by fat escaping into the bloodstream via bone fractures, in which fat from the bone marrow enters the bloodstream, disease, or widespread bodily trauma. Liposuction can in rare instances cause fat embolism. This usually associated with large volume liposuction, where more than 5 liters of fat are removed using a larger diameter liposuction cannula without full tumescent anesthesia. With regards to fat transfer procedures, embolisms can be caused by injecting too large of fat globules (which should only be placed within the body as tiny droplets) or by injecting the fat globules at a time other than when the cannula is being withdrawn from the body.
Liposuction patients normally face a number of risks that come inherently with the surgery they are receiving, and those patients with lipedema typically face the same risks. That being said, patients who do have lipedema are normally at a higher risk for complications as a whole for a number of reasons, including:
Now that we know that lipedema patients face a much high risk of complications with liposuction surgery, it is important to keep in mind that there are a number of precautions that can be taken to make the entire process a little smoother.
One of the best precautions that can be taken is to use lymph sparing techniques, as this can help to minimize any injury that patients with lipedema may experience as a result of the surgery (though it should be noted that these techniques should not be performed under general anesthesia due to suppression of both cardiac circulation and the peripheral muscle movement). While large diameter cannulas may remove fat more quickly, these have proven to be more traumatic to those with lipedema. Therefore, it is recommended with these techniques to use the smallest size cannula possible. Also, it is critical to have knowledge of the location of lymphatic collecting ducts and the course of lymphatic channel. Ultimately, lymph sparing techniques are much easier on the patient and make the procedure much lower risk for lipedema patients.
Fat embolisms are dangerous, and are a rare but serious risk after any liposuction or fat transfer procedure. However, in the hands of an experienced surgeon who takes proper precautions and has lots of experience with the procedure you’re interested in, they are exceedingly rare.
A careful surgeon will use small cannula for liposuction and limit liposuction volume. The experienced surgeon will know to minimize the size of the fat globules into droplet form, to use a blunt cannula in order to avoid penetrating any blood vessels, and to inject fat only while withdrawing the cannula from a patient’s body.
Should a patient begin experiencing a fat embolism, supportive measures are taken to ensure that their arteries receive proper oxygen amounts. Fluid intake is often also restricted, and diuretics are used in order to minimize the accumulation of fluids in the lungs.
For additional information on surgical risks like fat embolisms, as well as how we mitigate these risks during the procedures we offer, contact our office and schedule your consultation appointment with Dr. Wright and the other fantastic members of our medical staff today! Dr. Wright’s team is very experienced with liposuction in St. Louis, MO, and will be happy to walk you through each step of the process, all while keeping you safe!