All About Fat Embolisms

With the advancement of medical technology, cosmetic procedures such as liposuction have become safer than ever for the patients. Highly trained professionals administer these procedures for your safety. An article was recently published in the British Medical Journal in September 2017 [1] that describes a patient who suffered from a fat embolism and warns against cosmetic procedures such as liposuction. Like any surgical procedure, great care should be taken, but a thorough review is needed to acknowledge the risks and associate them with how your surgeon addresses any potential risks.

What is a Fat Embolism?

An embolism is a mass substance that travels through the bloodstream after breaking off the body and can potentially clog a blood vessel. A fat embolism is a fat globule that does just that, usually after traumatic injuries, but sometimes they occur from surgical procedures. These cases are extremely rare, such as with the situation occurring in the research article.

What Causes Fat Embolisms?

Fat embolisms are typically caused when fat enters the bloodstream from bone fractures. They can be associated with large volume liposuction procedures—especially when large cannulas are used or varicose veins are in the area of treatment.

How to Prevent and Treat

While liposuction patients may face a number of risks, it is the patients who are receiving treatment for lipedema—particularly women—that have a higher risk for fat embolisms.

Possible conditions that can put a patient at greater risk for a fat embolism occurring include having a higher BMI[ Body Mass Index], having a higher volume of fat removed from the body, having varicose veins, and using general anesthesia during these types of procedures.

Female patients with lipedema have an increased risk of venous insufficiency and varicose veins—the presence of which presents a greater risk of bleeding, DVT, and embolism [3], and patients with lipedema often have higher BMI. Additionally, since lipedema patients tend to have an above-average level of subcutaneous fat large volume of fat, 5 liters or more can be removed in single liposuction.  The amount removed during each liposuction procedure is strongly correlated with the increased risk of liposuction complications. The rate of risk for these complications increases by as much as three times per liposuction procedure that removes an amount greater than five liters of fat within a single surgical procedure [2][4][5].

In fact, a high BMI or increased weight is a potential risk factor for not only liposuction, but any surgical procedure.  In the case study, the lipedema patient [7]  who had the liposuction procedure had a BMI of 65 (far above the normal BMI range of 18 to 25) and suffered from fat embolisms complications after having surgery under general anesthesia.

Even using general anesthesia itself presents an increased level of risk for complications in all types of surgeries, including liposuction. General anesthesia works by causing temporary circulatory and cardiac depression, immobilizing the body and leading to a greater risk of embolism. This means that general anesthesia alone can lead to potentially life-threatening complications or even death [6].

Finally, whether your surgeon utilizes local or general anesthesia, the diameter of the cannula used can affect your level of risk for fat embolisms. Cannulas with larger diameters result in more bodily traumatic liposuction procedures [8][9][10]. In one case study that Dr. Wright personally communicated about with Dr. Ali, cannulas with a diameter of five millimeters—considered large for a cannula—were used during a liposuction procedure in which a lipedema patient had a fat embolism.

A careful surgeon with experience is recommended for any liposuction procedure, along with them using a lymph sparing technique. Using the smallest cannula size possible will greatly reduce any associated risks of a fat embolism occurring. If a fat embolism does occur after any liposuction procedure, there are supportive measures to take to ensure the arteries receive a proper amount of oxygen along with improved blood flow. These supportive measures should be used in the exceedingly rare event of a fat embolism occurring.

Always Gather Additional Information

Liposuction procedures always have some associated risk, especially with individuals looking to remove a large volume of fat. However, doing your due diligence of reviewing all possible options will play a significant role in reducing your risk of experiencing a fat embolism during your liposuction procedure.  Contact Dr. Wright to learn more!

References

  1. Adam A., T. G. (2017, September 25). Fat Attacks! A Case of Fat Embolisation Syndrome Post Liposuction. British Medical Journal. doi: doi:10.1136/bcr-2017-220789
  2. Chow, I. H. (2015). Is There a Limit? A Risk Assessment Model of Liposuction Volume on Complications in Lipoabdominoplasty. Plastic Reconstructive Surgery, 10-01.
  3. Clavijo-Alvarez, J. M. (2011). Prevention of Venous Thromboembolism in Body Contouring Surgery. Plastic Surgery, 228-232.
  4. Gilliland MD, C. G. (1999). Safety Issues in Ultrasound Assisted Large-Volume Lipoplasty. Clinical Plastic Surgery, 317-35.
  5. Gilliland MD, C. N. (1997). Tumescent Liposuction Complicated by Pulmonary Edema. Plastic Reconstructive Surgery, 215-219.
  6. Gottschalk, A. H. (2011). Is Anesthesia Dangerous? Dtsch Arztebl International, 469-474.
  7. Gupta, V. W. (2016, June). Safety of Aesthetic Surgery in the Overweight Patient: Analysis of 127,961 Patients. Aesthetic Surgery, 36(6), 718-29.
  8. Lawrence N., C. W. (1996). Liposuction. Advanced Dermatology, 11, 19-49.
  9. Skouge, J. (1990). The biochemestry and development of adipose tissue and pathophysiology of obesity as it relates to liposuction surgery. Dermatology Clin, 8, 385-93.
  10. Venkatram J., C. J. (2008, Jul-Dec). Tumescent Liposuction: A Review. Aesthetic Surgery, 49-57. doi:10.4103/0974-2077.44159

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Meet Dr. Wright

Dr. Wright

Meet Dr. Thomas Wright, medical director of Laser Lipo and Vein Center. Dr. Wright is a board certified Phlebologist and cosmetic surgery specialist, with over 15 years of practicing experience. A graduate of the University of Missouri Columbia medical program, Dr. Wright was one of the first two hundred surgeons to become a diplomate in Phlebology.

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