Background: Lipedema is a subcutaneous adipose tissue disorder mainly affecting women. Its progressive nature often requires high-volume liposuction for efficient pain reduction. However, aspiration volumes of more than 5 L within a single session may lead to a variety of complications. Thus, we examined the effect of high-volume liposuctions on lipedema patients and the incidence of associated complications. Methods: We analyzed perioperative differences in lipedema patients undergoing low- or high-volume liposuctions. Statistical analyses were performed, investigating postoperative complications and the correlation of patients’ BMI, total amount of aspiration, duration of surgery, hospital stay and hemoglobin alterations. Complications were investigated according to the Clavien–Dindo Classification. Patients were divided in two groups based on the volume aspirated at liposuction (low-volume vs. high-volume liposuction). Results: Overall, 121 sessions were investigated. Mean total volume of aspiration was 8227.851 mL ± 3643.891. Mean preoperative hemoglobin levels were 13.646 g/dL ± 1.075 g/dL. Preoperatively, 7.44% of patients were anemic (Hb < 12 g/dL). Mean postoperative hemoglobin was 10.563 g/dL ± 1.230 g/dL. Postoperatively, 90.10% of patients showed Hb levels below 12 g/dL. Hemoglobin loss differed significantly between the two groups (p = 0.001). Significant correlations between pre- (p = 0.015) and postoperative (p < 0.001) hemoglobin levels and pre- (p < 0.001) and postoperative (p < 0.001) anemia with Class II complications were also seen. The total volume of aspiration did not correlate with complication rates (p = 0.176). Conclusions: Complication rates in high-volume liposuctions are hemoglobin-dependent rather than volume-associated. Preoperative anemia was the most influential for the occurrence of postoperative complications. To safely conduct high-volume liposuctions in lipedema patients, adequate patient selection and preoperative patient preparation are imperative.

Background: The global rise in obesity rates has led to an increase in bariatric procedures, resulting in more patients needing relief from excess skin through body contouring surgeries (BCS), such as abdominoplasty. Although these procedures are generally considered safe, they can be associated with notable perioperative complications, including increased Hb-loss (hemoglobin loss) and drainage fluid volumes. Thus, this study analyzed risk factors for prolonged fluid secretion after abdominoplasty. Methods: We retrospectively analyzed 505 body contouring procedures performed between January 2018 and December 2023 at the Department of Plastic Surgery at the University Clinic of St. Poelten. The investigation focused on postoperative Hb-loss, drainage fluid volumes and hemoglobin levels in patients, comparing those with and without prior bariatric surgery. Statistical analyses utilized the t-test for Equality of Means, while correlation analyses were conducted using Spearman Rho and the Mann–Whitney U test. Results: Bariatric patients demonstrated markedly reduced hemoglobin levels both preoperatively (13.24 g/dL) and postoperatively (10.68 g/dL) compared to their non-bariatric counterparts (14.02 g/dL preoperatively and 11.71 g/dL postoperatively; p < 0.001). The prevalence of anemia was likewise substantially higher in the bariatric cohort, rising from 14.52% preoperatively to 82.48% postoperatively, versus 6.25% and 61.25%, respectively, in the non-bariatric group (p = 0.001). Moreover, prior bariatric surgery was significantly associated with increased postoperative drainage volume (p = 0.009) and prolonged operative time (p = 0.002). Notably, extended hospital stays exhibited a strong correlation with postoperative anemia (p = 0.005). Conclusions: Collectively, our findings underscore the potential risk of increased hemoglobin loss at BCS after bariatric weight loss. Tailored hemoglobin management and nutritional strategies are essential to improve the outcomes and safety of post-bariatric BCS. Meticulous preoperative identification of hematological discrepancies and adequate patient preparation are imperative for positive postoperative patient safety.