Deaths Associated with Liposuction: Case Reports and Review of the Literature

Abstract

Tumescent liposuction is a common cosmetic procedure that is performed as an outpatient service in physician's offices and is largely believed to be safe. The protuberant areas of the body containing the undesirable fat deposits are injected with normal saline containing lidocaine and epinephrine for pain control and hemostasis, and the waterlogged cells are suctioned out via cannula through a small incision. We recently encountered three cases in which deaths were attributed to this procedure. Two showed fat embolization in the lung and one died from fluid overload. The osmium tetroxide post-fixed lung sections showed fat emboli in the interstitial capillaries and arterioles. We reviewed the recent literature and found that pulmonary thromboemboli, fat embolization, fluid overload, and lidocaine and epinephrine intoxication are found at autopsy in many cases. Forensic pathologists responsible for determining the cause and manner of death should become familiar with the postmortem findings and risks of liposuction therapy and communicate them to their clinical colleagues and communities.

Nonthrombotic pulmonary embolism

“…Other unusual causes include mobilisation of fat in viral hepatitis after pre-existing fatty liver [21], in pancreatitis [22], or from the subcutaneous region due to a liquefying haematoma. Both pulmonary thromboemboli and FE have been found in lethal cases after tumescent liposuction [23]. In view of the large number of patients who are treated with liposome-embedded drugs, reports of fatal FE caused by intravenous liposome drug delivery or i.v.…”

Local anesthetic systemic toxicity

“…There continues to be reports of serious complications, including death. 62,63 Central nervous system toxicity of local anesthetics As the systemic concentration of local anesthetic increases, central neurotoxicity is seen in a stereotypical and sequenced manner. The amygdala appears to be the principal neurophysiologic focus for seizures, while the hippocampus has been posited as a secondary focus.…”

Non-Thrombotic Pulmonary Embolism

“…B. King & Harmon, 1994;Laub & Laub, 1990;Platt et al, 2002;Richards, 1997;Robert et al, 1993;R. M. Ross & Johnson, 1988) Intraosseous fluid and drug administration (Hasan et al, 2001;Vichinsky et al, 2000) Extracorporeal circulation such as extracorporeal membrane oxygenation or cardiopulmonary bypass (Akhtar, 2009;Bulger et al, 1997;Gravante et al, 2008;Jenkins et al, 2002;M.…”