Mapping Fat Embolism as a Complication of Liposuction and Fat Grafting: A Systematic Review of Anatomical and Technical Risk Factors

Fat grafting (FG) and liposuction are widely performed aesthetic procedures with associated fat embolism risks. However, no comprehensive review has specifically mapped the anatomical distribution and technical causes of fat embolism events across these procedures. This review aims to characterize regional and procedural frequencies of fat embolism to inform safer surgical practices. A review was conducted using PubMed, Embase, Scopus, and Cochrane. Included studies were English-language case reports/series, retrospective reviews, and systematic analyses reporting fat embolism following liposuction or FG. Among 227 FG cases, the most frequent regions were the face (n=120), gluteal region (n=91), genitalia (n=9), and chest (n=7). Embolic locations included ocular (27.0%), pulmonary (26.3%), and cerebral (18.2%) arteries. All 16 reported deaths occurred following intramuscular gluteal injection; none occurred in non-gluteal cases, (X² = 14.13, p = 0.0002) or subcutaneous-only injection. 35 cases of liposuction-associated fat embolism were reviewed. The abdomen was the most frequent site (n=19), followed by the thigh (n=3), with remaining cases involving axilla/back, buttocks, waist/xiphoid, lower-leg, and flanks. 68.6% of these cases involved large-volume or high-force techniques. Across both procedural categories, 76% of patients developed symptoms within 24 hours, and overall mortality-rate was 9.54%, all occurring within 5 days post-op. Fat embolism risk is strongly influenced by anatomical site and technique. All deaths occurred after intramuscular gluteal FG, while subcutaneous injection and non-gluteal sites were not associated with mortality. Abdominal liposuction was most frequently implicated, especially after high-force techniques.