Liposuction associated fatalities in Istanbul from a forensic perspective: An autopsy study.

[BACKGROUND] Liposuction remains one of the most commonly performed cosmetic surgical procedures worldwide, yet fatal complications continue to occur despite advances in surgical techniques. This study aims to conduct forensic pathological analysis of liposuction-related deaths to identify specific complications, underlying causes, and patterns of fatal outcomes.

[METHODS] This retrospective study analyzed 35 fatal cases following liposuction procedures autopsied at the Council of Forensic Medicine, Turkey, between January 2022 and December 2024. Autopsy findings, histopathological examinations, demographic characteristics, and toxicological results were systematically evaluated.

[RESULTS] All cases were female with a mean age of 41.7 ± 9.5 years and mean BMI of 29.5 ± 3.7 kg/m. Postoperative clinical deterioration occurred in 80.0 % of cases, requiring hospitalization in 62.9 %. Multiple surgical procedures were performed in 85.7 % of cases, with abdominoplasty (94.3 %), mammoplasty (57.1 %), and gluteal fat grafting (54.3 %) being most common. Pulmonary thromboembolism was the most frequent complication (65.7 %), followed by deep vein thrombosis (40.0 %). Histopathologically, pulmonary edema (71.4 %) and pulmonary fat embolism (68.6 %) were predominant findings. BMI was significantly higher in cases with pulmonary thromboembolism (p = 0.004). All five intraoperative deterioration cases involved gluteal fat injection.

[CONCLUSION] Fatal liposuction complications have multifactorial etiology, with high BMI, multiple procedures, and gluteal fat transfer representing major risk factors. Comprehensive preoperative assessment, enhanced safety protocols, and close postoperative monitoring are essential for mortality reduction.