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Critical Differences between Microscopic (MIFE) and Macroscopic (MAFE) Fat Embolism during Liposuction and Gluteal Lipoinjection

Cárdenas-Camarena, Lázaro, M.D.; Durán, Héctor, M.D.; Robles-Cervantes, José Antonio, M.D., Ms.C., Ph.D.; Bayter-Marin, Jorge Enrique, M.D.

Plastic and Reconstructive Surgery: April 2018 - Volume 141 - Issue 4 - p 880-890
doi: 10.1097/PRS.0000000000004219
Cosmetic: Original Articles
Patient Safety CME

Background: Liposuction and gluteal lipoinjection are two of the most frequent surgical procedures in body contouring surgery, and two of the most important complications are microscopic (MIFE) and macroscopic (MAFE) fat embolism. Despite a high index of morbidity and mortality, few reports exist about these complications, and although they have the same causal agent, their etiopathogenesis, clinical evolution, treatment, prognosis, and prevention are totally different. Therefore, the authors performed a comprehensive review of the literature to exhaustively analyze both pathologic conditions and present the differences between them.

Methods: A detailed search was carried out in PubMed of studies on humans from 1946 to March of 2017 in any language and including the keywords microscopic fat embolism and macroscopic fat embolism with either liposuction or gluteal lipoinjection. The articles found were selected according to the search criteria and were analyzed to provide the final data and recommendations.

Results: Of the 1245 and 26 articles that were found on complications related to liposuction and gluteal lipoinjection, respectively, only 41 on liposuction and microscopic fat embolism and seven on gluteal lipoinjection and microscopic fat embolism met the specific criteria for inclusion in the analysis. Only two articles on liposuction and two on gluteal lipoinjection referred to macroscopic fat embolism as a complication.

Conclusion: Although microscopic fat embolism and macroscopic fat embolism are pathologic conditions with high morbidity and mortality rates in association with liposuction and gluteal lipoinjection, few reports about them exist; therefore, the authors made recommendations based on this study for their diagnosis, prevention, and treatment.

Zapopan, Jalisco, and Mérida, Yucatán, México; and Bucaramanga, Colombia

From Innovare Cirugía Plástica Especializada, the Divisions of Plastic Surgery and Internal Medicine, Jalisco Institute of Reconstructive Surgery “Dr. José Guerrerosantos”; the Jalisco College of Plastic, Esthetic and Reconstructive Surgery; private practice; and Clínica “El Pinar.”

Received for publication May 4, 2017; accepted October 18, 2017.

Disclosure:The authors have no conflict of interest to declare in relation to the content of this article.

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Lázaro Cárdenas-Camarena, M.D., Innovare Cirugía Plástica Especializada, Av Verona 7412, Fraccionamiento Viila Verona, Zapopan, Jalisco, México,

Copyright © 2017 by the American Society of Plastic Surgeons