Possible ARDS Following Cosmetic Lipolysis: A Case Report Urging Caution in Aesthetic Medicine

BACKGROUND Fat-dissolving (lipolysis) injections are increasingly performed as non-surgical aesthetic procedures for body contouring. Although generally considered safe, these interventions can rarely result in severe and potentially life-threatening complications, especially in unregulated settings. We report an unusual case of acute respiratory distress syndrome (ARDS) following cosmetic lipolysis injections in a previously healthy woman. CASE REPORT A 41-year-old Vietnamese woman with no significant past medical history developed acute progressive dyspnea and bilateral chest pain about 30 minutes after receiving multiple abdominal, shoulder, and thigh lipolysis injections at an unlicensed cosmetic facility. Chest computed tomography showed diffuse bilateral infiltrates. Pulmonary embolism and macroscopic fat embolism were excluded; however, microscopic intravascular fat embolism could not be definitively ruled out. The patient's condition rapidly progressed to hypoxemic respiratory failure consistent with ARDS. Management with high-flow nasal cannula oxygen, intravenous corticosteroids, and empiric broad-spectrum antibiotics led to significant clinical improvement within days, with near-complete radiological resolution observed on follow-up imaging. CONCLUSIONS This case illustrates ARDS as a rare but serious complication of cosmetic fat-dissolving injections. While macroscopic fat embolism was excluded, the potential role of microscopic fat embolism remains a plausible mechanism. Clinicians should recognize that lipolysis injections, often regarded as minor aesthetic procedures, carry substantial potential pulmonary risks. Greater awareness, early intervention, and stricter regulation are essential to improve patient safety.