Critical differences between microscopic (MIFE) and macroscopic (MAFE) fat embolism during liposuction and gluteal lipoinjection

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 fat embolism (MIFE) commonly called fat embolism syndrome (FES), and macroscopic fat embolism (MAFE). Despite having 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, we performed a comprehensive review of the literature to exhaustively analyze both pathologies, and we present the differences between each condition. MATERIAL AND METHODS: A detailed search was carried out in PUBMED of studies on humans from 1946 to March 2017 in any language and including the keywords MIFE and MAFE 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 MIFE and 7 on gluteal lipoinjection and MIFE met the specific criteria for inclusion in the final analysis. Only two articles on liposuction and two on gluteal lipoinjection referred to MAFE as a complication. CONCLUSIONS: Although MIFE and MAFE are pathologies with high morbidity and mortality rates in association with liposuction and gluteal lipoinjection, few reports about them exist; therefore, we made recommendations based on this study for their diagnosis, prevention and treatment Financial disclosure and products: The authors have no conflict of interest to declare in relation to the content of this article Corresponding author contact information Lázaro Cárdenas-Camarena , Innovare Cirugía Plástica Especializada, Av Verona 7412, Fraccionamiento Viila Verona, Zapopan, Jalisco, México e-mail: drlazaro@drlazarocardenas.com ©2017American Society of Plastic Surgeons