Macroscopic fat embolism after liposuction

Liposuction is the most frequently performed aesthetic surgical procedure on women worldwide. Thromboembolic events and fat embolisms are rare but typical complications of the procedure. To understand the associated risk factors, the occurrence of complications, and potential preventive measures, it is necessary to examine underlying pathomechanisms and frequencies of such events. Here presented is the case of a 34-year-old woman with grade 2 lipedema who underwent liposuction and autologous fat grafting of the lower extremities and lateral hips. During the outpatient procedure, cardiac arrest suddenly occurred. She died two days after the operation in the hospital. An autopsy revealed fat emboli in the pulmonary arteries on both sides, which had been macroscopically visible and were determined to be the cause of death. The literature discusses various preventive strategies aimed at reducing the complication rate and improving the prognosis of fat embolism in the context of liposuction throughout the pre-, peri-, and postoperative periods. These measures are intended to promote early recognition of clinical signs of fat embolism and thereby improve patient outcomes.