There is no national database that tracks all complications for all procedures so any number is an estimate. Deaths may be reported to state agencies but the number of cases done is not reported anywhere so while we may have an estimated numerator, there is no accurate denominator, especially since a significant amount of liposuction cases are done by non-plastic surgeons in non-accredited facilities.
Some estimates from 20+ years ago had a death rate as high as 1 in 5000 liposuction cases, which is very high, but the methodology of the study was questionable.
The American Society of Plastic Surgeons maintains a registry of plastic surgery cases called TOPS (Tracking Operations & Outcomes for Plastic Surgeons) which is the largest database of plastic surgery cases. The American Society of Plastic Surgeons (ASPS) is the authority on patient safety and liposuction.
Based on this database, the attached papers[1] [2]did not find any deaths in about 4,500 cases done by plastic surgeons. However, non-plastic surgeons are not included in this study.
While liposuction is considered very safe, not all liposuction surgery is equal. Small volume liposuction (<1000 cc) done awake is different from large volume liposuction (>5000 cc, in some cases 10,000 cc) done with anesthesia and a hospital stay. Relative comparisons are hard to make since you have to account for other variables (ASA status, co morbidities, etc…) which is nearly impossible to do without data. The reported 1 in 10,000 death rate for liposuction is a reasonable estimate (this figure does not differentiate between reconstructive liposuction for lipedema and cosmetic liposuction).
In the (Chow I., et al., 2015) study listed above, sixty-nine of 4534 patients (1.5 percent) meeting inclusion criteria experienced a postoperative complication. Their conclusion was that: Liposuction by board-certified plastic surgeons is safe, with a low risk of life-threatening complications. Traditional liposuction volume thresholds do not accurately convey individualized risk. The authors’ risk assessment model demonstrates that volumes in excess of 100 ml per unit of body mass index confer an increased risk of complications.
Several studies support higher risks associated with higher BMI.[3] The Safety of Aesthetic Surgery in the Overweight Patient (Gupta V et al., 2016) paper concluded:
Overweight (BMI 25-29.9) and obesity (BMI ≥ 30) are both independent risk factors for post-operative infection and VTE in aesthetic surgery.[4]
Of the procedures analyzed, liposuction had the fewest number of complications.
- Abdominoplasty 3.5%
- Liposuction 0.9%
- Lower body lift 8.8%
- Combined breast and body procedures 4.2%
However, for all procedures complications were significantly higher in overweight patients.
In the (Habbema L, 2009) paper on safety he concludes:
RESULTS In a series of 3,240 procedures, no deaths occurred, and no complications requiring hospitalization were experienced. In nine cases, complications developed that needed further action.
CONCLUSIONS Liposuction using exclusively TLA is a proven safe procedure provided that the existing guidelines are meticulously followed.”[5]
Note that several of the studies apply to all plastic surgeries or all aesthetic procedures, not just liposuction. However, since the majority of lipedema patients also have obesity these issues are very relevant.
Death and other complications are clearly spelled out on the ASPS Liposuction Consent document available below.
ASPS List of complications[6]
- Liposuction risks include:
- Anesthesia risks
- Bruising
- Change in skin sensation that may persist
- Damage to deeper structures such as nerves, blood vessels, muscles, lungs and abdominal organs
- Deep vein thrombosis, cardiac and pulmonary complications
- Fluid accumulation
- Infection
- Irregular contours or asymmetries
- Irregular pigmentation
- Need for revision surgery
- Persistent swelling
- Poor wound healing
- Rippling or loose skin, worsening of cellulite
- Swelling
- Thermal burn or heat injury from ultrasound with the ultrasound-assisted lipoplasty technique
The two ASPS safety research papers are available here:
Is There a Safe Lipoaspirate Volume? A Risk Assessment Model of Liposuction Volume as a Function of Body Mass Index
Abstract
Background: No concrete data exist to support a specific volume at which liposuction becomes unsafe; surgeons rely on their own estimates, professional organization advisories, or institutional or government-imposed restrictions. This study represents the first attempt to quantify the comprehensive risk associated with varying liposuction volumes and its interaction with body mass index.
Methods: Suction-assisted lipectomies were identified from the Tracking Operations and Outcomes for Plastic Surgeons database. Multivariate regression models incorporating the interaction between liposuction volume and body mass index were used to assess the influence of liposuction volume on complications and to develop a tool that returns a single adjusted odds ratio for any combination of body mass index and liposuction volume. Recursive partitioning was used to determine whether exceeding a threshold in liposuction volume per body mass index unit significantly increased complications.
Results: Sixty-nine of 4534 patients (1.5 percent) meeting inclusion criteria experienced a postoperative complication. Liposuction volume and body mass index were significant independent risk factors for complications. With progressively higher volumes, increasing body mass index reduced risk (OR, 0.99; 95 percent CI, 0.98 to 0.99; p = 0.007). Liposuction volumes in excess of 100 ml per unit of body mass index were an independent predictor of complications (OR, 4.58; 95 percent CI, 2.60 to 8.05; p < 0.001).
Conclusions: Liposuction by board-certified plastic surgeons is safe, with a low risk of life-threatening complications. Traditional liposuction volume thresholds do not accurately convey individualized risk. The authors’ risk assessment model demonstrates that volumes in excess of 100 ml per unit of body mass index confer an increased risk of complications.
SAFETY ISSUES AND COMPLICATIONS
However, with liposuction being performed by untrained professionals, in non-accredited office settings, and with continually increasing lipoaspirate volumes, reports of serious complications have surfaced, prompting scrutiny into procedural safety. [7] [8] [9] [10] [11]
The reported incidence of death after liposuction varies dramatically between 2.6 and 20.6 per 100,000. [12] [13] [14]
In an American Society for Aesthetic Plastic Surgery survey, thromboembolism, abdominal/viscus perforation, fat embolism, and cardiorespiratory failure were the most common discernible causes of death.
The majority of deaths had no identifiable cause, leading to speculation that unrecognized volume overload and lidocaine toxicity may be more significant precipitants of mortality than previously thought. [15] [16]
CONCLUSIONS
Liposuction performed by board-certified plastic surgeons is safe, with an exceedingly low risk of life-threatening complications. Traditional liposuction volume thresholds do not accurately convey individualized risk. By incorporating body mass index, we demonstrate that liposuction volumes in excess of 100 ml per unit of body mass index confer an increased risk of complications.
References
[1] Chow I, Alghoul MS, Khavanin N, et al. Is There a Safe Lipoaspirate Volume? A Risk Assessment Model of Liposuction Volume as a Function of Body Mass Index. Plast Reconstr Surg. 2015;136(3):474-483. doi:10.1097/PRS.0000000000001498
[2] Haeck, Phillip C. M.D.; Swanson, Jennifer A. B.S., M.Ed.; Gutowski, Karol A. M.D.; Basu, C Bob M.D., M.P.H.; Wandel, Amy G. M.D.; Damitz, Lynn A. M.D.; Reisman, Neal R. M.D., J.D.; Baker, Stephen B. M.D., D.D.S. the ASPS Patient Safety Committee Evidence-Based Patient Safety Advisory: Liposuction, Plastic and Reconstructive Surgery: October 2009 – Volume 124 – Issue 4S – p 28S-44S doi: 10.1097/PRS.0b013e3181b52fcd
[3] Clavijo-Alvarez JA, Pannucci CJ, Oppenheimer AJ, Wilkins EG, Rubin JP. Prevention of venous thromboembolism in body contouring surgery: a national survey of 596 ASPS surgeons. Ann Plast Surg. 2011;66(3):228-232. doi:10.1097/SAP.0b013e3181e35c64
[4] Varun Gupta, MD, MPH, Julian Winocour, MD, Charles Rodriguez-Feo, MD, Ravinder Bamba, MD, R. Bruce Shack, MD, James C. Grotting, MD, K. Kye Higdon, MD, Safety of Aesthetic Surgery in the Overweight Patient: Analysis of 127,961 Patients, Aesthetic Surgery Journal, Volume 36, Issue 6, June 2016, Pages 718–729, https://doi.org/10.1093/asj/sjv268
[5] Habbema L. Safety of liposuction using exclusively tumescent local anesthesia in 3,240 consecutive cases. Dermatol Surg. 2009;35(11):1728-1735. doi:10.1111/j.1524-4725.2009.01284.x
[6] https://www.plasticsurgery.org/cosmetic-procedures/liposuction/safety
[7] Gilliland MD, Coates N. Tumescent liposuction complicated by pulmonary edema. Plast Reconstr Surg. 1997;99:215–219.
[8] Grazer FM, Meister FL. Complications of the tumescent formula for liposuction. Plast Reconstr Surg. 1997;100:1893–1896.
[9] Stephan PJ, Kenkel JM. Updates and advances in liposuction. Aesthet Surg J. 2010;30:83–97; quiz 98.
[10] Heitmann C, Czermak C, Germann G. Rapidly fatal necrotizing fasciitis after aesthetic liposuction. Aesthetic Plast Surg. 2000;24:344–347.
[11] Coleman WP, Lawrence N. Commentary on: Platt MS, Kohler LJ, Ruiz R, Cohle SD, Ravichandran P. Deaths associated with liposuction: case reports and review of the literature. J Forensic Sci 2002;47(1): 205-207. J Forensic Sci. 2003;48:697.
[12] Yoho RA, Romaine JJ, O’Neil D. Review of the liposuction, abdominoplasty, and face-lift mortality and morbidity risk literature. Dermatol Surg. 2005;31:733–743; discussion 743.
[13] Daane SP, Rockwell WB. Analysis of methods for reporting severe and mortal lipoplasty complications. Aesthetic Plast Surg. 1999;23:303–306.
[14] Grazer FM, de Jong RH. Fatal outcomes from liposuction: Census survey of cosmetic surgeons. Plast Reconstr Surg. 2000;105:436–446; discussion 447.
[15] Grazer FM, de Jong RH. Fatal outcomes from liposuction: Census survey of cosmetic surgeons. Plast Reconstr Surg. 2000;105:436–446; discussion 447.
[16] Rao RB, Ely SF, Hoffman RS. Deaths related to liposuction. N Engl J Med. 1999;340:1471–1475.