Objective: Liposuction is the most frequently performed cosmetic operation in Germany with approximately 250.000 procedures in 2003. The public perception of liposuction as minor surgery fails to consider the potential of major complications or a possibly fatal outcome. Design, Settings: A retrospective analysis of severe or lethal complications related to cosmetic liposuction is presented. In order to collect pertinent information, we sent 3.500 questionnaires to all German, Swiss and Austrian Departments of Pathology and Forensic Medicine. In addition we contacted Intensive Care Units, Health Insurance Companies and the offices of District Attorneys. After the identification of cases with major complications, the second phase of the investigation consisted of interviews with the physicians performing the respective procedures. Following disclosure of clinical documentation, anonymous data was recorded on site. Details of any such cases were included as blinded data. Results: 2.275 questionnaires (65%) were returned. The analyzed data showed 72 cases of severe complications including 23 deaths following cosmetic liposuction in a 5-year period from 1998 to 2002. The most frequent complications were bacterial infections like necrotizing fasciitis, gas gangrene and different forms of sepsis. Further causes of lethal outcome were hemorrhages, perforation of abdominal viscera and pulmonary embolism. 57 out of 72 complications were clinically evident within the first 24 postoperative hours. 41 of these 72 procedures of liposuction were performed in tumescent anaesthesia and 17 in true tumescent anaesthesia. Discussion: Major risk factors for the development of severe complications are insufficient standards of hygiene, the infiltration of multiliter wetting solution, megavolume aspirations, the performance of multiple cosmetic procedures in one setting, permissive postoperative discharge and the selection of unfit patients. The lack of surgical experience was a notorious contributing factor, particularly regarding the timely identification of developing complications. This is in fact the first study reporting deaths related to liposuction performed entirely under true tumescent anaesthesia. Even cosmetic liposuction performed by an experienced surgeon in a proper operating room is far from being a harmless procedure. Liposuction carries all the known risks of surgery in addition to method-related complications, which require an appropriate management.
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