How rare are major complications of liposuction, and what raises the risk?

Before surgery, when someone asks, “How safe is it?”, simply answering “It’s safe” isn’t enough. Looking at the numbers is more accurate.

A 2017 study analyzed 31,010 liposuction procedures using data from a US cosmetic surgery insurance program (CosmetAssure). Here, a “major complication” meant going to the emergency room, being admitted to hospital or needing another operation within 30 days after surgery. Among the 11,490 cases of liposuction performed on its own, major complications occurred in 0.7%. The most common were hematoma (a collection of blood) at 0.15%, lung-related complications at 0.1%, infection at 0.1% and blood clots (blood clotting in a vein) at 0.06%.

The same study also calculated the factors that raise the risk. The biggest factor was having other surgery on the same day, which raised the risk about 4.8 times. In particular, blood clots rose 5.7 times, lung-related complications 2.7 times and infection 2.4 times. The risk rose by 5% for each 1-point increase in body mass index (BMI) and by 1% for each year of age. The researchers concluded that liposuction alone carries a relatively low risk, but that the risk rises meaningfully when several procedures are combined, especially in people with a higher body weight or older age.

There are things to know when reading these numbers. Only complications that led to an insurance claim were counted, so minor problems are not included. Discomforts that don’t require an emergency room visit, such as swelling, bruising and unevenness, are more common than this. Anything that happened after 30 days is not included either.

So in practice, I look at two things first. One is how much to do at once. Adding more areas and other procedures lengthens the operation, and risks such as blood clots rise accordingly. If you’d like many areas treated, it’s sometimes better to split them into separate sessions. The other is your health. I check your weight, age, the medications you take and whether you’ve ever had a blood clot, and set the scope and recovery plan accordingly.

At 0.7%, the number is low, but it isn’t zero. Reducing risk comes not only from surgical technique but also from deciding what not to do.