Critical Differences between Microscopic (MIFE) and Macroscopic (MAFE) Fat Embolism during Liposuction and Gluteal Lipoinjection

Cárdenas-Camarena, Lázaro; Durán, Héctor; Robles-Cervantes, José Antonio; Bayter-Marín, Jorge Enrique

doi:10.1097/prs.0000000000004219

Cited by 57 publications

(16 citation statements)

References 45 publications

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“…The physiologic and clinical differences between macrofat emboli and microfat emboli syndrome were well described in the literature. 25 , 26 Microfat emboli syndrome carries a reported mortality in the 10% to 30% range. 27 , 28 A delay in treatment of the syndrome is associated with a 35% mortality, 29 which may be a frequent occurrence in the plastic surgery population undergoing outpatient surgery.…”

Section: Discussionmentioning

confidence: 99%

Brazilian Butt Lift–Associated Mortality: The South Florida Experience

Pazmiño

Garcia

2022

Aesthetic Surgery Journal

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Background Brazilian Butt Lift (BBL) surgery has been the fastest growing aesthetic surgical procedure over the past decade. Unfortunately, by 2017, the surgery was associated with the highest mortality rate of any aesthetic surgical procedure. South Florida carries the highest BBL mortality by far in the nation. Objectives The purpose of this study was to explore the factors involved in making South Florida an outlier, as it relates to BBL mortality. Methods The anatomical findings of the gluteal dissections in 11 post-BBL surgery autopsies (22 hemi-buttocks) were assessed for commonalities. The authors examined the records of patients who died from BBL-related Fat Emboli to determine commonalities. Results All cases had fat grafts injected into the gluteal musculature in multiple different levels. Another commonality in these cases involved the location of where the surgery took place, with the great majority of patients (92%) undergoing surgery at high-volume budget clinics located in South Florida. Short surgical times of approximately 90 minutes, appeared to be the norm for these cases. Conclusions South Florida has experienced 25 BBL related fat emboli deaths from 2010-2022, however 14 of those deaths have taken place after the Aesthetic Surgery Education and Research Foundation (ASERF) guidelines and the Florida Board of Medicine BBL “subcutaneous-only” rule. The working environment at the clinics and the short surgical times for these cases, may be the most important contributors to the BBL mortality in South Florida.

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Section: Discussionmentioning

confidence: 99%

Brazilian Butt Lift–Associated Mortality: The South Florida Experience

Pazmiño

Garcia

2022

Aesthetic Surgery Journal

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“…Micro‐cannular liposuction in TA is the gold standard in surgical treatment of lipedema (Schmeller & Meier‐Vollrath, ; Wollina & Heinig, ). The procedure is safe as along as the surgical standards for liposuction are respected (Cárdenas‐Camarena, Durán, Robles‐Cervantes, & Bayter‐Marin, ).…”

Section: Discussionmentioning

confidence: 99%

“…They following liposuctions were tolerated well without any problems. Fat embolism after liposuction have been observed in up to 8.5% of patients undergoing liposuction (Cárdenas-Camarena et al, 2018;Wang, Zheng, Deng, Liu, & Yang, 2008). There are no data indicating a higher risk of fat embolism in liposuction for lipedema compared to esthetic indication.…”

Section: Discussionmentioning

confidence: 99%

Treatment of lipedema by low‐volume micro‐cannular liposuction in tumescent anesthesia: Results in 111 patients

Wollina

Heinig

2019

Dermatologic Therapy

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Lipedema is a painful disease of subcutaneous adipose tissue leading to bilateral increase of leg and/or arm volume, but sparing hands and feet. Although conservative treatment with complex decongestive therapy has been considered as the fundamental treatment, micro‐cannular liposuction in tumescent anesthesia has become a surgical option. We report on 111 patients mostly with advanced lipedema treated by this technique in our center between 2007 and 2018. The median age of the patients was 44 years. Eighty percent of patients had at least one comorbidity. There was an association of longstanding and advanced disease to obesity and diseases of the metabolic syndrome‐spectrum. The median total amount of lipoaspirate was 4,700 ml, with a range of 950–14,250 ml. The median reduction of limb circumference was 6 cm. The median pain level before treatment was 7.8 and 2.2 at the end of the treatment. An improvement of mobility could be achieved in all patients. Bruising was also reduced. Serious adverse events were observed in 1.2% of procedures, the infection rate was 0% and the bleeding rate was 0.3%. Liposuction is an effective treatment for painful lipedema. The procedure should be performed in specialized centers.

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“…According to Cardenas-Camarena et al [ 113 ], the fat can enter into the blood stream in two different fashions during a fat grafting surgery. This difference in aetiopathogenesis generates two distinct pathologies: microscopic fat embolism (MIFE), commonly called fat embolism syndrome (FES), and macroscopic fat embolism (MAFE) [ 114 ]. When fat enters microscopically (MIFE), it produces the so-called FES, whereas when it enters macroscopically, it produces the direct occlusion of blood vessels and causes a MAFE [ 115 ], as shown by reports presenting this condition [ 113 , 114 ].…”

Section: Discussionmentioning

confidence: 99%

“…This difference in aetiopathogenesis generates two distinct pathologies: microscopic fat embolism (MIFE), commonly called fat embolism syndrome (FES), and macroscopic fat embolism (MAFE) [ 114 ]. When fat enters microscopically (MIFE), it produces the so-called FES, whereas when it enters macroscopically, it produces the direct occlusion of blood vessels and causes a MAFE [ 115 ], as shown by reports presenting this condition [ 113 , 114 ]. Due to small volumes involved in facial fat grafting, MAFE is clinically more relevant but MIFE cannot be excluded.…”

Section: Discussionmentioning

confidence: 99%

Facial Fat Grafting (FFG): Worth the Risk? A Systematic Review of Complications and Critical Appraisal

Schiraldi

Sapino

Meuli

et al. 2022

JCM

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Autologous fat is ideal soft tissue filler. It is easily accessible, biocompatible, cheap, and it provides both volume augmentation and skin quality improvement. Fat grafting has been used since 1893, but it has only gained widespread popularity since the development of modern liposuction by Colemann and Illouz in the 1980s. Every year more than half a million facial fat grafting procedures are carried out worldwide and the trend is rapidly increasing. Overall, general complications associated with facial fat grafting are assumed to be around 2%. Is that true? Material and Methods: Until July 2021, a systematic search of the literature was performed interrogating PubMed search engines. The following algorithm was used for the research: (fat graft OR lipofilling) AND face AND complications. Exclusion criteria applied hierarchically were review articles, not reporting recipient site complications; not in English and paediatric population. Abstracts were manually screened by LS, GS, JM and PDS separately and subsequently matched for accuracy. Pertinent full-text articles were retrieved and analysed and data were extracted from the database. The flow chart of article selection is described following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Results: In total, 462 papers were identified by PubMed search. A total of 359 were excluded: 38 papers were not in English, 41 were review articles, 279 articles did not report recipient site complications and 1 was not on human subjects. Average complication rate ranged from 1.5% to 81.4%. A total of 298 adverse events were identified: 40 (13.4%) intravascular injections, 13 (4.3%) asymmetry, 57 (19.1%) irregularities, 22 (7.4%) graft hypertrophy, 21 (7%) fat necrosis, 73 (24.5%) prolonged oedema, 1 (0.3%) infection, 6 (2%) prolonged erythema, 15 (5%) telangiectasia and 50 (16.8%) cases of acne activation. Conclusions: FFG related side effects could be resumed in three categories: severe, moderate, and minor. Severe (13.4%) side effects such as intravascular injection or migration require neurological or neurosurgical management and often lead to permanent disability or death. Moderate (38.3%) side effects such as fat hypertrophy, necrosis, cyst formation, irregularities and asymmetries require a retouch operation. Minor (48.3%) side effects such as prolonged oedema or erythema require no surgical management. Despite the fact that the overall general complication rate of facial fat grafting is assumed to be around 2%, the real complication rate of facial fat grafting is unknown due to a lack of reporting and the absence of consensus on side effect definition and identification. More RCTs are necessary to further determine the real complication rate of this procedure.

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Critical Differences between Microscopic (MIFE) and Macroscopic (MAFE) Fat Embolism during Liposuction and Gluteal Lipoinjection

Cited by 57 publications

References 45 publications

Brazilian Butt Lift–Associated Mortality: The South Florida Experience

Brazilian Butt Lift–Associated Mortality: The South Florida Experience

Treatment of lipedema by low‐volume micro‐cannular liposuction in tumescent anesthesia: Results in 111 patients

Facial Fat Grafting (FFG): Worth the Risk? A Systematic Review of Complications and Critical Appraisal

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