Surgical Emphysema Post Liposuction Abroad: A Case Report

Abstract

Liposuction is the most common surgical procedure performed globally. It is generally associated with low rates of major complications. Cosmetic surgery tourism has seen a steep incline in popularity and is often favourable to patients due to lower costs. However, it can be associated with higher complication rates and poorer follow-up. This case report describes a case of severe symptomatic subcutaneous emphysema following air travel post-liposuction. A 49-year-old male presented to the emergency department with pain, bruising and swelling post liposuction to the abdomen and flanks. At day 5 post-operatively, the patient embarked on a 5-hour plane journey, during which they experienced a significant increase in pain and swelling. On examination, there was audible crepitus at the upper abdomen and chest. A CT scan revealed extensive subcutaneous emphysema with associated skin thickening, subcutaneous fat stranding and fluid. In this case, subcutaneous emphysema is likely a direct result of surgical technique. This case is unique in the severity of the symptoms described and the role of air travel in their exacerbation. It is important that patients are adequately counselled in risks that may arise because of flying in the close post-operative period. Another issue highlighted is the increasing number of presentations to NHS hospitals following cosmetic tourism. Subcutaneous emphysema is a recognised but rare complication of liposuction. Patients should be adequately informed of adverse events which can arise following cosmetic surgery and subsequent travel. There should be more focus from global governing bodies on patient education and legislature to regulate practitioners.