My book would not be complete if I omitted to discuss the complications I have faced over my fifteen years of performing liposuction. In surgery, we work on living tissue, which means that this tissue heals as it sees fit; the surgeon therefore has no control over the healing process.
Moreover, in medicine, zero risk does not exist. Thus, out of a total of 5120 liposuctions, I encountered the following difficulties:
- Infections 3
- Inflammations (panniculitis) 3
- Pneumothorax 1
- Phlebitis 1
- Localized drug eruptions 4
- Seromas or hematomas 63
- Xylocaine toxicity 3
- Exaggerated pain 2
- Skin redness called marbling (livedo reticularis) 18
1. Infections
At the very beginning of my career, I operated on a massive fat apron. This apron became infected, and the patient had to be hospitalized for a few days. I performed three other procedures on her later on other sites without any complications. Today, I no longer operate on such massive fat aprons because, in general, the BMI of these patients is too high. Another patient, whom I operated on the inner thigh, developed an infection in one calf, which is very unusual. She also had to be hospitalized for a few days without any unfortunate consequences.
The third case of infection occurred in a patient who, following her liposuction, developed blistering lesions at the intervention sites, known as localized drug eruptions. The patient was supposed to come to the clinic once a week for disinfection, dressings, and follow-up, but after a few weeks, she stopped coming to her appointments, only to return five weeks later with a mycobacterial infection on the anterior thigh. The wound had to be debrided, leaving a scar resembling a burn. If this patient had been faithful to her appointments, this scar could have been avoided. The mycobacterial infection therefore occurred several weeks after the liposuction and was not directly due to the procedure. I remind you that avoiding sutures after liposuction promotes drainage and prevents infection and inflammation.
2. Panniculitis
This is an inflammation, namely red patches on the skin, which resemble an infection, but there are no microbes. I encountered three cases of panniculitis. This inflammation is treated not with antibiotics, which would be useless, but with oral cortisone. The diagnosis can be difficult because, in appearance, this problem closely resembles an infection.
3. Pneumothorax
A nurse, who no longer worked for me, came to replace a sick colleague. Perhaps she had lost the habit, but while infiltrating a back, she hit a rib and sent a few drops of anesthetic fluid through the pleura. The patient developed a pneumothorax. She spent a night in the emergency room and was discharged the next morning without any further treatment or consequences; the pneumothorax resolved on its own.
4. Phlebitis
I had only one case of superficial phlebitis. A patient, the day after her procedure, experienced pain in her calf. Instead of calling me, she went to the emergency room where she was treated with anti-inflammatory drugs without any further consequences.
5. Localized drug eruption
Four patients developed blistering eruptions after their procedure. This complication, a kind of drug allergy, is well known and easily treated. There are no consequences unless the patient abandons their treatment, as in the case mentioned above, which led to infection and a scar.
6. Seroma or hematoma
This complication is the most common in liposuction, but it is very benign since it involves aspirating this collection of fluid or blood with a syringe, and that’s it.
I had 63 seromas or hematomas out of more than 5000 procedures. The patient calls you three or four days after the surgery to mention a lump, usually in the lower abdomen, soft, as if fluid had been trapped there. You have them come to the clinic, and with a syringe, you aspirate the fluid and replace it with the same amount of air to prevent the fluid from reforming. This complication always occurs during very large abdominal liposuctions. It would be very easy to avoid; it would involve being less aggressive and leaving more fat, which would greatly displease these patients and require touch-ups to finish the job. So, between two evils, I decided to choose the lesser one, because a touch-up, let’s remember, is a new surgery, new recovery, etc.
7. Xylocaine toxicity
Xylocaine is the medication that allows us to perform the procedure under local anesthesia. When I went to Dr. Klein in 1997 to learn about tumescence from the master himself, he recommended the following dosages of xylocaine:
- 50 mg/kg for thin patients
- 55 mg/kg for patients of normal weight
- 60 mg/kg for obese patients
Some surgeons exceed these amounts with ease. A patient in California died because she was injected with 105mg/kg of xylocaine. Needless to say, this surgeon lost his license.
In my practice, without exceeding the permitted dosages, three patients presented symptoms resembling “advanced drunkenness” on the evening of their procedure. They had to go to the emergency room where an intravenous solution was administered to dilute the xylocaine in their blood. They left the emergency room the next morning. Curiously, one of them had received a dosage well below what is permitted; perhaps it was due to drug interactions… and this patient may have omitted to mention, in her medical questionnaire, taking a medication that interacts with xylocaine.
8. Exaggerated pain
Pain after liposuction is comparable to a sunburn or numbness. Generally, patients stop their pain medication the day after or the day after their procedure. On two occasions, patients complained of very significant pain. In one case, it lasted two or three months. Importantly, I later performed a touch-up on her, six months later, without these pains reappearing. For the second, it lasted more than a year, and the last time I saw her, after this period, some sensitivity still persisted. Could it be a kind of neuritis? I did not investigate this phenomenon further, fortunately, it is very rare.
9. Marbling, skin redness (livedo reticularis)
Some liposuctions can leave red patches at the intervention sites. Generally, these red spots disappear spontaneously after a few months. Occasionally, we will use a laser to make them disappear. I had 18 cases of these marblings, of which only three chose the laser; the others judged that it was not worth it. This unpredictable complication is inherent to liposuction because the cannula always travels in the same place under the skin where there is a cleavage plane that any liposculptor easily identifies.
I therefore have a complication rate of about 2%, which, I believe, is quite reasonable since there are unavoidable complications inherent to liposuction that depend on how the patient heals.
I remind you that tumescent outpatient liposuction is infinitely less likely to have complications than the same procedure under general anesthesia. In summary, it is reassuring to know that a liposuction procedure is carried out in a context of reduced risks. The follow-ups offered at our clinic are designed to reduce discomfort by treating any potential complication without delay. It is for this purpose that I personally call all my patients the day after their procedure and, moreover, these patients have all the numbers at their disposal to reach me at any time of the day or night.
Source: LIPOSUCTION | Everything you need to know before, during, and after – Dr. André Dupuy
