Kosin Med J.  2024 Sep;39(3):169-178. 10.7180/kmj.24.126.

Fat embolism syndrome: a review in cosmetic surgery

Affiliations
  • 1Department of Plastic and Reconstructive Surgery, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
  • 2Department of Plastic and Reconstructive Surgery, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
  • 3Department of Plastic Surgery, University of California, Irvine, Irvine, CA, USA

Abstract

The growing popularity of cosmetic procedures such as liposuction and fat grafting has been accompanied by a rise in associated side effects. Among these, fat embolism syndrome stands out as a potential complication that sometimes has critical consequences. It is important to recognize that fat embolism affects organs through distinct mechanisms from those involved with other types of embolisms. Early diagnosis is crucial. Unfortunately, no effective treatments have been established for this condition. Therefore, starting with a more detailed categorization of diagnoses, developing new treatment methods for each subtype is essential.

Keyword

Embolism; Fat; Ischemia; Hemorrhage

Figure

  • Fig. 1. The lung of a rabbit with experimentally induced fulminant-acute fat embolism syndrome, showing variable-sized small and large fat globules in the vessels of inter-alveolar septa with no remarkable change of the alveolar septa (Sudan Black B stain, ×100).

  • Fig. 2. The lung of a rabbit with experimentally induced subacute fat embolism syndrome, showing many variable-sized black fat globules in the lung and some vascular spaces with diffuse hemorrhage in intra-alveolar spaces (Sudan Black B stain, ×100).


Reference

References

1. Zenker FA; Royal College of Physicians of Edinburgh. Beiträge zur normalen und pathologischen Anatomie der Lunge. G. Schönfeld; 1862.
2. Illouz YG. Body contouring by lipolysis: a 5-year experience with over 3000 cases. Plast Reconstr Surg. 1983; 72:591–7.
3. Hunter GR, Crapo RO, Broadbent TR, Woolf RM. Pulmonary complications following abdominal lipectomy. Plast Reconstr Surg. 1983; 71:809–17.
Article
4. Lee JS, Kim JY, Jung C, Woo SJ. Iatrogenic ophthalmic artery occlusion and retinal artery occlusion. Prog Retin Eye Res 2020;78:100848.
5. Murray RK, Granner DK, Mayes PA, Rodwell VR. Harper's biochemistry. 25th ed. McGraw-Hill; 2000.
6. Lehman EP, Moore RM. Fat embolism: including experimental production without trauma. Arch Surg. 1927; 14:621–62.
7. Gauss H. The pathology of fat embolism. Arch Surg. 1924; 9:593–605.
Article
8. Peltier LF. Fat embolism. III. The toxic properties of neutral fat and free fatty acids. Surgery. 1956; 40:665–70.
9. Kim HI, In SK, Yi HS, Kim HY, Kim YS. Experimentally induced fat embolism syndrome: shift from obstruction to toxic effects. Arch Aesthetic Plast Surg. 2021; 27:47–55.
Article
10. Giyab O, Balogh B, Bogner P, Gergely O, Toth A. Microbleeds show a characteristic distribution in cerebral fat embolism. Insights Imaging. 2021; 12:42.
11. Kuo KH, Pan YJ, Lai YJ, Cheung WK, Chang FC, Jarosz J. Dynamic MR imaging patterns of cerebral fat embolism: a systematic review with illustrative cases. AJNR Am J Neuroradiol. 2014; 35:1052–7.
Article
12. Lee HS, Park JJ, Roh HG, Lim SD. Unusual clinicopathological presentation of nontraumatic cerebral fat embolism: two-case report. Medicine (Baltimore). 2020; 99:e19574.
13. Safran T, Abi-Rafeh J, Alhalabi B, Davison PG. The potential role of corticosteroid prophylaxis for the prevention of microscopic fat embolism syndrome in gluteal augmentations. Aesthet Surg J. 2020; 40:78–89.
Article
14. Duran H, Cardenas-Camarena L, Bayter-Marin JE, Ramos-Gallardo G, Robles-Cervantes JA. Microscopic and macroscopic fat embolism: solving the puzzle with case reports. Plast Reconstr Surg. 2018; 142:569e–577e.
15. Seixas E, Ferreira PG. Fat embolism syndrome presenting as diffuse alveolar hemorrhage: a rare (known) association. Pulmonology. 2018; 24:314–5.
16. Dhooghe NS, Maes S, Depypere B, Claes KE, Coopman R, Kubat B, et al. Fat embolism after autologous facial fat grafting. Aesthet Surg J. 2022; 42:231–8.
Article
17. Turkmen Samdanci E, Reha Celik M, Pehlivan S, Celbis O, Turkkan D, Ozdemir Kara D, et al. Histopathological evaluation of autopsy cases with isolated pulmonary fat embolism (IPFE): is cardiopulmonary resuscitation a main cause of death in IPFE? Open Access Emerg Med. 2019; 11:121–7.
18. Khan TT, Colon-Acevedo B, Mettu P, DeLorenzi C, Woodward JA. An anatomical analysis of the supratrochlear artery: considerations in facial filler injections and preventing vision loss. Aesthet Surg J. 2017; 37:203–8.
Article
19. Shiffman MA. Fat tissue embolism caused by autologous fat transfer. Am J Cosmet Surg. 2015; 32:247–53.
Article
20. Cantu CA, Pavlisko EN. Liposuction-induced fat embolism syndrome: a brief review and postmortem diagnostic approach. Arch Pathol Lab Med. 2018; 142:871–5.
21. Wang K, Rong X, Dang J, Yang J, Zheng H, Hou M, et al. Severe vascular complications caused by facial autologous fat grafting: a critical review. Ann Plast Surg. 2021; 86(3S Suppl 2):S208–19.
22. Wang HC, Yu N, Wang X, Dong R, Long X, Feng X, et al. Cerebral embolism as a result of facial filler injections: a literature review. Aesthet Surg J. 2022; 42:NP162–75.
Article
23. Byrick RJ, Mullen JB, Mazer CD, Guest CB. Transpulmonary systemic fat embolism: studies in mongrel dogs after cemented arthroplasty. Am J Respir Crit Care Med. 1994; 150(5 Pt 1):1416–22.
Article
24. Cheng Y, Yan G, Li C, Han X, Shang J, Shang S, et al. Case report and literature review: fatal cerebral fat embolism following facial autologous fat graft. Front Neurol. 2023; 14:1180333.
Article
25. Lee DH, Yang HN, Kim JC, Shyn KH. Sudden unilateral visual loss and brain infarction after autologous fat injection into nasolabial groove. Br J Ophthalmol. 1996; 80:1026–7.
26. Wu Q, Zhou G, Xu X, Liu B, Fu Q, Zhang J, et al. Exploring superselective intraarterial thrombolysis for autologous fat injection-induced vision loss. Aesthet Surg J. 2024; 44:NP337–46.
Article
27. Moellhoff N, Kuhlmann C, Frank K, Kim BS, Conte F, Cotofana S, et al. Arterial embolism after facial fat grafting: a systematic literature review. Aesthetic Plast Surg. 2023; 47:2771–87.
Article
28. Gurd AR, Wilson RI. The fat embolism syndrome. J Bone Joint Surg Br. 1974; 56B:408–16.
Article
29. Schonfeld SA, Ploysongsang Y, DiLisio R, Crissman JD, Miller E, Hammerschmidt DE, et al. Fat embolism prophylaxis with corticosteroids: a prospective study in high-risk patients. Ann Intern Med. 1983; 99:438–43.
30. Lindeque BG, Schoeman HS, Dommisse GF, Boeyens MC, Vlok AL. Fat embolism and the fat embolism syndrome: a double-blind therapeutic study. J Bone Joint Surg Br. 1987; 69:128–31.
31. He Z, Shi Z, Li C, Ni L, Sun Y, Arioli F, et al. Single-case metanalysis of fat embolism syndrome. Int J Cardiol. 2021; 345:111–7.
Article
32. Kao YM, Chen KT, Lee KC, Hsu CC, Chien YC. Pulmonary fat embolism following liposuction and fat grafting: a review of published cases. Healthcare (Basel). 2023; 11:1391.
Article
33. Kadar A, Shah VS, Mendoza DP, Lai PS, Aghajan Y, Piazza G, et al. Case 39-2021: a 26-year-old woman with respiratory failure and altered mental status. N Engl J Med. 2021; 385:2464–74.
Article
34. Christman KD. Death following suction lipectomy and abdominoplasty. Plast Reconstr Surg. 1986; 78:428.
Article
35. Laub DR Jr, Laub DR. Fat embolism syndrome after liposuction: a case report and review of the literature. Ann Plast Surg. 1990; 25:48–52.
36. Currie I, Drutz HP, Deck J, Oxorn D. Adipose tissue and lipid droplet embolism following periurethral injection of autologous fat: case report and review of the literature. Int Urogynecol J Pelvic Floor Dysfunct. 1997; 8:377–80.
Article
37. Gleeson CM, Lucas S, Langrish CJ, Barlow RJ. Acute fatal fat tissue embolism after autologous fat transfer in a patient with lupus profundus. Dermatol Surg. 2011; 37:111–5.
Article
38. Byeon SW, Ban TH, Rhee CK. A case of acute fulminant fat embolism syndrome after liposuction surgery. Tuberc Respir Dis (Seoul). 2015; 78:423–7.
Article
39. Stoeger A, Daniaux M, Felber S, Stockhammer G, Aichner F, zur Nedden D. MRI findings in cerebral fat embolism. Eur Radiol. 1998; 8:1590–3.
Article
40. Parizel PM, Demey HE, Veeckmans G, Verstreken F, Cras P, Jorens PG, et al. Early diagnosis of cerebral fat embolism syndrome by diffusion-weighted MRI (starfield pattern). Stroke. 2001; 32:2942–4.
41. Takahashi M, Suzuki R, Osakabe Y, Asai JI, Miyo T, Nagashima G, et al. Magnetic resonance imaging findings in cerebral fat embolism: correlation with clinical manifestations. J Trauma. 1999; 46:324–7.
42. Lee KM, Kim EJ, Jahng GH, Chang DI. Magnetic resonance findings in two episodes of repeated cerebral fat embolisms in a patient with autologous fat injection into the face. J Korean Neurosurg Soc. 2012; 51:312–5.
Article
43. Algahtani HA, Shirah BH, Abdelghaffar N, Alahmari F, Alhadi W, Alqahtani SA. Cerebral fat embolism syndrome: diagnostic challenges and catastrophic outcomes: a case series. J Yeungnam Med Sci. 2023; 40:207–11.
Article
44. Zhang LX, Lai LY, Zhou GW, Liang LM, Zhou YC, Bai XY, et al. Evaluation of intraarterial thrombolysis in treatment of cosmetic facial filler-related ophthalmic artery occlusion. Plast Reconstr Surg. 2020; 145:42e–50e.
Article
45. Taviloglu K, Yanar H. Fat embolism syndrome. Surg Today. 2007; 37:5–8.
46. Chieng H, Saha B, Foulke L, Wu GP, Chopra A. A 24-year-old man with dyspnea and a broken left femur. Chest. 2022; 161:e225–31.
Article
47. Wolfe EM, Weber LE, Wo LM, Samaha MJ, Mathew P, Garcia O, et al. Two cases surviving macro fat emboli complications following gluteal fat grafting. Aesthet Surg J. 2022; 42:902–6.
Article
48. Lari A, Abdulshakoor A, Zogheib E, Assaf N, Mojallal A, Lari AR, et al. How to save a life from macroscopic fat embolism: a narrative review of treatment options. Aesthet Surg J. 2020; 40:1098–107.
Article
49. Kim WJ, Kang JG. A case of rescuing a patient with acute cardiovascular instability from sudden and massive intraoperative pulmonary thromboembolism by extracorporeal membrane oxygenation. Kosin Med J. 2018; 33:477–82.
Article
50. Anderson DR, Morgano GP, Bennett C, Dentali F, Francis CW, Garcia DA, et al. American Society of Hematology 2019 guidelines for management of venous thromboembolism: prevention of venous thromboembolism in surgical hospitalized patients. Blood Adv. 2019; 3:3898–944.
51. Zhou K, Cai C. The successful mechanical lipectomy treatment of cerebral fat embolism following autologous fat injection. Plast Reconstr Surg Glob Open. 2019; 7:e2091.
Article
52. Armstrong BR, Devendra A, Pokale S, Subramani B, Rajesh Babu V, Ramesh P, et al. Can the rate of mortality and neurological recovery be predicted from the time of onset of symptoms and MRI grade in patients with cerebral fat embolism? A study of 34 patients. Bone Joint J. 2022; 104-B:142–9.
53. Mac Grory B, Lavin P, Kirshner H, Schrag M. Thrombolytic therapy for acute central retinal artery occlusion. Stroke. 2020; 51:687–95.
Article
54. Tobalem S, Schutz JS, Chronopoulos A. Central retinal artery occlusion: rethinking retinal survival time. BMC Ophthalmol. 2018; 18:101.
55. Zhang L, Luo Z, Li J, Liu Z, Xu H, Wu M, et al. Endovascular hyaluronidase application through superselective angiography to rescue blindness caused by hyaluronic acid injection. Aesthet Surg J. 2021; 41:344–55.
56. Kadouch J, Schelke LW, Swift A. Ultrasound to improve the safety and efficacy of lipofilling of the temples. Aesthet Surg J. 2021; 41:603–12.
Article
57. Mofid MM, Teitelbaum S, Suissa D, Ramirez-Montanana A, Astarita DC, Mendieta C, et al. Report on mortality from gluteal fat grafting: recommendations from the ASERF Task Force. Aesthet Surg J. 2017; 37:796–806.
Article
58. Florida Department of State. 64B8ER19-1 Standard of care for office surgery [Internet]. Florida Department of State; c2019 [cited 2024 Aug 30]. https://www.flrules.org/gateway/ruleNo.asp?id=64B8ER19-1.
59. Hufschmidt K, Bronsard N, Foissac R, Baque P, Balaguer T, Chignon-Sicard B, et al. The infraorbital artery: clinical relevance in esthetic medicine and identification of danger zones of the midface. J Plast Reconstr Aesthet Surg. 2019; 72:131–6.
Article
60. Chatrath V, Banerjee PS, Goodman GJ, Rahman E. Soft-tissue filler-associated blindness: a systematic review of case reports and case series. Plast Reconstr Surg Glob Open. 2019; 7:e2173.
Article
61. Liu C, Cai Z, Zhang L, Zhou M, He L. Case report and literature review: catastrophic embolism following cosmetic injection of autologous fat in the face. Front Med (Lausanne). 2021; 8:646657.
62. Tansatit T, Apinuntrum P, Phetudom T. Periorbital and intraorbital studies of the terminal branches of the ophthalmic artery for periorbital and glabellar filler placements. Aesthetic Plast Surg. 2017; 41:678–88.
Article
63. Allali J, Bernard A, Assaraf E, Bourges JL, Renard G. Multiple embolizations of the branches of the ophthalmic artery: an unknown serious complication of facial surgeries. J Fr Ophtalmol. 2006; 29:51–7.
64. Dettmer MS, Willi N, Thiesler T, Ochsner P, Cathomas G. The impact of pulmonary bone component embolism: an autopsy study. J Clin Pathol. 2014; 67:370–4.
Article
65. Park SM, Kim KH, Yoon NB, Jeong IH, Lee HW, Lee SK, et al. Clinical manifestations of 6 cases of septic pulmonary embolism at increased risk recently. Kosin Med J. 2012; 27:99–103.
Article
66. Kim HS. A case of acute pulmonary embolism with a large right ventricular thrombus. Kosin Med J. 2009; 24:207–10.
Full Text Links
  • KMJ
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr