Complications in liposuction: systematic review

BARROS, LUIZ FERNANDO LIMA; TEIXEIRA, VINÍCIUS FIALHO; REIS JÚNIOR, JOSÉ AUGUSTO PÚPIO; FERRAZ, REBECA ANDRADE; ARAÚJO, DINÉIA DA CONCEIÇÃO; VENDRAMIN, FABIEL SPANI

doi:10.5935/2177-1235.2023RBCP0641-EN

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Revista Brasileira de Cirurgia Plástica

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Review Article • Rev. Bras. Cir. Plást. 38 (1) • 2023 • https://doi.org/10.5935/2177-1235.2023RBCP0641-EN copy

Complications in liposuction: systematic review

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Liposuction is among the most performed plastic surgery procedures in Brazil. According to data from the International Society of Aesthetic Plastic Surgery (ISAPS), 231,604 liposuctions were performed, 15.5% of all aesthetic procedures in the country in 2019. Adopting liposuction as a single procedure or adjunct to other cosmetic procedures stimulated its technical evolution from simple fat aspiration to more sophisticated body shaping. Thus, this review aimed to systematically evaluate the published data regarding the complications found in liposuction. A review was conducted using PubMed, SciELO, LILACS, Cochrane Library, SCOPUS, Web of Science, and gray literature databases, published between 2016 and 2021, using the descriptors “Liposuction” and “Complications.” A total of 187 articles were found in the searched databases, of which 16 were selected according to the outcome “to assess safety through the prevalence of complications in liposuction as a single procedure and associated with other procedures such as abdominoplasty and fat grafting.” We found a mortality rate ranging from 0 to 0.06 among all procedures and a predominance of venous thromboembolism, hematoma, seroma, and hyperpigmentation concerning all complications, being more common when liposuction is associated with other procedures. Therefore, through this review, it was possible to verify that liposuction as a single procedure has lower complication rates when compared to liposuction combined with other procedures.

Keywords:
Lipoabdominoplasty; Lipectomy; Adipose tissue; Postoperative complications; Intraoperative complications

Systemic and local complications in (%)
Study	Technique	Number of patients	Mortal age	Venous Thromboembolism (VTE)	Blood loss	Surgical site infection	Seroma	Hyperpigmentation	Irregular Contour	Bruise	Others
Xia et al., 2019¹1 Xia Y, Zhao J, Cao DS. Safety of Lipoabdominoplasty Versus Abdominoplasty: A Systematic Review and Meta-analysis. Aesthet Plast Surg. 2019;43(1):167-74.	Isolated and combined liposuction	14,061	-	0.2		Infection, dehiscence wound and	fat necrosis: 5.6	4.1		0.7	0.8
Halk et al., 2019^* * In the studies by Wu, Halk, and Montrief, there were no specifications about the number of patients undergoing the procedures. N°., number; Hb. Hemoglobin; ATX, Trenaxamic Acid; VTE, Venous Thromboembolism; g/dL, grams per deciliter. ⁶6 Halk AB, Habbema L, Genders RE, Hanke CW. Safety Studies in the Field of Liposuction: A Systematic Review. Dermatol Surg. 2019;45(2):171-82.	Isolated liposuction	-	up to 0.05% every 1000 surgeries	-	-	-	-	-	-	-	Combined procedures had an almost 5 times greater risk of serious adverse events than isolated procedures, especially for VTE and infection.
Wu et al., 2020^* * In the studies by Wu, Halk, and Montrief, there were no specifications about the number of patients undergoing the procedures. N°., number; Hb. Hemoglobin; ATX, Trenaxamic Acid; VTE, Venous Thromboembolism; g/dL, grams per deciliter. ¹⁴14 Wu S, Coombs DM, Gurunian R. Liposuction: Concepts, safety, and techniques in body-contouring surgery. Cleve Clin J Med. 2020;87(6):367-75.	Isolated and combined liposuction	-	0.01 in 26,259 patients	0.03% in 1,000 patients	-	-	2% in 451 patients	-	9% in 11,016 patients	-	-
Sozer et al., 2018¹⁵15 Sozer SO, Basaran K, Alim H. Abdominoplasty with Circumferential Liposuction: A Review of 1000 Consecutive Cases. Plast Reconstr Surg. 2018;142(4):891-901.	Combined liposuction	1,000	0.01	1.5	-	1.5	19	-	-	0.40	-
Vieira et al., 2018¹⁶16 Vieira BL, Chow I, Sinno S, Dorfman RG, Hanwright P, Gutowski KA. Is There a Limit? A Risk Assessment Model of Liposuction and Lipoaspirate Volume on Complications in Abdominoplasty. Plast Reconstr Surg. 2018;141(4):892-901.	Combined liposuction	9,638	0.06	0.46	0.24	1.83	3.6	-	-	0.84	-
Montrief et al., 2020^* * In the studies by Wu, Halk, and Montrief, there were no specifications about the number of patients undergoing the procedures. N°., number; Hb. Hemoglobin; ATX, Trenaxamic Acid; VTE, Venous Thromboembolism; g/dL, grams per deciliter. ¹⁷17 Montrief T, Bornstein K, Ramzy M, Koyfman A, Long BJ. Plastic Surgery Complications: A Review for Emergency Clinicians. West J Emerg Med. 2020;21(6):179-89.	Isolated and combined liposuction	-	-	The incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) in liposuction is less than 1%. However, there is a marked increase in the incidence of DVT when liposuction is performed, combined with abdominoplasty	-	-	-	-	-	3-15	Visceral perforation: 0.00014
Kaoutzanis et al.,2017¹⁸18 Kaoutzanis C, Gupta V, Winocour J, Layliev J, Ramirez R, Grotting JC, et al. Cosmetic Liposuction: Preoperative Risk Factors, Major Complication Rates, and Safety of Combined Procedures. Aesthet Surg J. 2017;37(6):680-94.	Isolated and combined liposuction	31,010 Isolated liposuction (11,490-37.1%) and combined (19.520 -62.9%)		0.06 isolated 0.6 combined	-	0.1 isolated 0.7 combined	-	-	-	0.15 isolated 0.60 combined	Pulmonary disorders: 0.1 isolated 0.2 combined
Campos et al., 2018¹⁹19 Campos R, Soley N, Campos B. Patient safety: changes in hemoglobin and serum iron after liposuction and/or abdominoplasty. Rev Bras Cir Plást. 2018;33(4):511-7.	Isolated and combined liposuction	30	-	-	Drop in hemoglobin between 2 - 6g/dl, with an average of 3.0lg/dl corresponding to 22.16% of the preoperative hematocrit operative	-	-	-	-	-	50% had dizziness, dyspnea, tachycardia, orthostatic hypotension
Vend ramin et al., 2019²⁰20 Vendramin S F, Ferreira DR, Carrera MG. Clinical and laboratory recovery of patients undergoing body liposuction associated with lipoabdominoplasty. Rev Bras Cir Plást. 2019;34(4):468-76.	Combined liposuction	16	-	-	Post-surgical Hb values between 8.92 g/dL and 10.4 g/dL. The percentage reduction in Hb between the beginning and the end of the surgery averaged 19.7%	-	-	-	-	-	-
Restifo 2019²¹21 Restifo RJ. Sub-Scarpa’s Lipectomy in Abdominoplasty: An Analysis of Risks and Rewards in 723 Consecutive Patients. Aesthet Surg J. 2019;39(9):966-76.	Combined liposuction	304	-	-	-	4.27	14.38	-	-	0.9	5.92 of the patients had fat necrosis
Al Dujaili et al., 2018²²22 Al Dujaili Z, Karcher C, Henry M, Sadick N. Fat reduction: Complications and management. J Am Acad Dermatol. 2018;79(2):197-205. DOI: 10.1016/j.jaad.2017.07.026 https://doi.org/10.1016/j.jaad.2017.07.0...	Isolated liposuction	15,336	-	0.34-0.6	-	-	0.17 - 1.6	0.02	0.26-2.1	-	-
Husain et al., 2019²³23 Husain TM, Salgado CJ, Mundra LS, Perez C, AlQattan HT, Bustillo E, et al. Abdominal Etching: Surgical Technique and Outcomes. Plast Reconstr Surg. 2019;143(4):1051-60.	Isolated liposuction	50	-	-	-	-	10	two	12	-	-
Gould et al., 2018²⁴24 Gould DJ, Macias LH, Saeg F, Dauwe P, Hammoudeh Z, Grant Stevens W. Seroma Rates Are Not Increased When Combining Liposuction With Progressive Tension Suture Abdominoplasty: A Retrospective Cohort Study of 619 Patients. Aesthet Surg J. 2018;38(7):763-9.	Combined liposuction	619	-	-	-	-	2.16 with drain 9.17 without drain	-	-	-	-
Massignan 2019²⁵25 Massignan F. Evaluation of the safety of VASERTM in liposuction surgery to improve body contour. Rev Bras Cir Plást. 2019;34(4):458-67.	Combined liposuction	76	-	-	-	-	-	2.67	-	-	-
Weissler et al., 2021²⁶26 Weissler JM, Banuelos J, Molinar VE, Tran N V. Local Infiltration of Tranexamic Acid (TXA) in Liposuction: A Single-Surgeon Outcomes Analysis and Considerations for Minimizing Postoperative Donor Site Ecchymosis. Aesthet Surg J. 2021;41(7):NP820-8.	Isolated liposuction	120	-	-	-	-	-	-	-	Hematomas in patients who received ATX were significantly smaller than in patients who did not (1.6 / 10 vs. 2.3/10)	-
Bertheuil et al., 2017²⁷27 Bertheuil N, Chaput B, De Runz A, Girard P, Carloni R, Watier E. The Lipo-Body Lift: A New Circumferential Body-Contouring Technique Useful after Bariatric Surgery. Plast Reconstr Surg. 2017;139(1):38e-49e.	Isolated liposuction	25	-	-	-	8	-	-	-	-	40% presented dehiscence of the surgical wound, and 8% had some degree of necrosis of fat

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[1] *Corresponding author: Luiz Fernando Lima Barros Rua Municipalidade 985, sala 2005. Ed Mirai Office, Umarizal, Belém, PA, Brazil. Zip code: 66055-200 E-mail: lfbcirurgiaplastica@gmail.com