Harmful effects of liposuction and lipolysis procedures questionable safety and scientific validity: A medico-legal perspective and advantages of "light" hypo-osmolar liposuction

Abstract

Liposuction (blunt suction lipectomy) is now well established and has generally gratifying aesthetic results. Since first described in 1977 by Illouz, changes or improvements to the technique of liposuction have been introduced regarding instruments (cannulas, pumps, syringes, and various devices), depth of suctioning (deep or superficial), volume of fluid infiltration (wet, super wet, tumescent), and osmolarity (isotonic, more or less hypotonic). Many other changes or "innovations" were also described that deserve being denounced. We report several complications resulting in severe skin necrosis, following liposuction and lipolysis methods of questionable scientific merits: ultrasonic liposuction, infiltration of hypo- osmolar solution, lipolysis without aspiration, or after unfortunately accidental infiltration of hypertonic saline solution. Ensuing skin necrosis required surgical debridement followed by prolonged secondary wound healing, resulting in severe aesthetic and functional sequelae with inevitable malpractice legal implications. It is essential that plastic surgeons be careful about using techniques widely advertised by the media but not yet scientifically validated; basic precautionary principles must be respected (light hypo-osmolar infiltration about 200 mOsm is safe), and the surgeons should not be dispensed from applying rigorous monitoring and strict safety measures in the operating room (checklist, traceability, qualification of nursing staff, etc.).