Important things to know about wet liposuction: Eight complications and safety precautions

Wet Liposuction

This technique, also known as traditional liposuction, is widely used.

Complications:

1. Hematoma and Ecchymosis: Due to the large potential wound area and numerous cavities, there is a significant amount of blood and serum exudate that easily accumulates, making hematoma a common early complication. Continuous and effective negative pressure suction and effective elastic bandaging can prevent it. If a large hematoma or seroma occurs, it should be incised, drained, and aspirated before applying pressure bandaging. Local ecchymosis generally does not require treatment and will subside within 2-3 weeks.

2. Numbness of Skin Sensation: Most cases experience varying degrees of decreased skin sensation, which usually recovers gradually within 3-6 months.

3. Unevenness and Skin Wrinkles in the Suction Area: These are prone to occur when there are inconsistent suction layers, repeated suction of the same area, or suction with a large cannula. During the procedure, it is important to maintain consistent suction layers, avoid repeated suction of the same area, and use a large cannula followed by a finer cannula for careful and even suction and reshaping. Skin folds are seen in patients with a thin subcutaneous tissue layer, uneven bandaging, or poor skin elasticity. During surgery, care should be taken to preserve a certain thickness of subcutaneous fat layer. For patients with poor skin elasticity, simultaneous skin and fat removal may be considered.

4. Infection and Delayed Wound Healing
Infection and delayed wound healing may occur when the patient is in poor physical condition. Aseptic technique, drainage, and postoperative antibiotics can effectively prevent infection. If capillaries at the incision edges are damaged due to friction from the suction tube, the incision edge tissue should be excised. If a small amount of bleeding is observed, the incision should be sutured.

5. Bleeding
Bleeding occurs in almost all patients, generally ranging from 100 to 300 ml during surgery. Therefore, coagulation time should be checked preoperatively, and women should avoid surgery during menstruation. Changing the aspiration site when there is a large amount of blood can reduce bleeding. If bleeding is heavy, fluid replacement should be provided promptly.

6. Ecchymosis
Most ecchymoses disappear within 2-3 weeks.

7. Pulmonary Fat Embolism Pulmonary fat embolism has been reported both domestically and internationally, and is the most serious complication of liposuction. According to foreign statistics, the incidence rate is 0.01%–0.1%. The cause is similar to that of long bone fractures, where free fatty acids accumulate in the pulmonary capillaries, leading to mechanical obstruction, platelet aggregation, and other secondary embolisms, resulting in pulmonary fat embolism. Some researchers have found that intravenous infusion of 5% low molecular weight dextran and 5% ethanol during the procedure can reduce the incidence of pulmonary embolism. The total amount of 5% ethanol is 50g, slowly infused over 0.5–3 hours. Its blood concentration is 2.08 mmol/L (80 mg%), lower than the toxic concentration. Because ethanol has an anesthetic effect, the anesthesiologist should be instructed to reduce the dosage of other anesthetic drugs. Experiments have shown that ethanol has the following effects: it can prevent the conversion of broken free fat into fatty acids; it stimulates the formation of plasminogen activator in tissues and produces prostaglandins; the latter two can enhance antiplatelet activity and reduce thromboembolic activity, and also have a vasodilatory effect.

8. Lipid Granuloma Lipid granulomas are relatively rare, and their formation is related to the liquefaction of necrotic adipose tissue after contusion. Clinically, they present as a palpable but painless subcutaneous mass; larger masses often require surgical excision.