Adverse Events Related to Submental Aesthetic Liposuction: A Systematic Review

Aesthetic submental liposuction (ASL) is a widely performed procedure for lower facial and anterior neck contouring. Despite its clinical acceptance, there is no clear consensus regarding the frequency and characteristics of ASL-related adverse events.

This systematic review aimed to estimate prognosis panoramas: 1) the frequency of adverse events associated with ASL and 2) their principal clinicodemographic characteristics.

Eligibility criteria were based on the Population, Exposure, Comparison, Outcomes, and Study Design (PECOS framework: adult patients (≥18 years) undergoing ASL; outcomes comprising intraoperative or postoperative adverse events; and observational study designs limited to case reports and case series. Studies unrelated to mechanical ASL, employing other methodological designs, lacking full-text availability, or presenting duplicate samples were excluded. Electronic searches were performed in 6 databases and gray literature sources in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. Risk of bias was assessed using the Joanna Briggs Institute critical appraisal tools. Descriptive statistical analyses were performed.

Thirteen studies (0.14% of the 8,915 initially identified records), encompassing 2,085 ASL cases, were included. A total of 270 ASL-related adverse events were identified, corresponding to an event rate of 12.9% per procedure. Demographic data, when available, indicated a predominance of female individuals (80.0%), with a mean age of 40.5 ± 13.5 years. ASL was predominantly performed by nonoral and maxillofacial surgeons (n = 203/77.5%), in hospital-based surgical centers (n = 230/98.7%), most commonly under tumescent/local anesthesia (n = 133/54.7%). Isolated ASL was the most frequently performed procedure (n = 144/54.1%). Minor adverse events accounted for 74.8% of reported complications, mainly represented by seromas (n = 57/21.1%), skin surface irregularities or asymmetries (n = 52/19.1%), and platysmal banding (n = 50/18.5%). The mean time to onset of adverse events was 1.7 ± 3.2 months, and the median follow-up duration was 10 months (interquartile range, 4 to 12).

Adverse events following ASL appear to be not uncommon, most are minor in severity and can be effectively managed in outpatient settings. This review ratifies significant evidence limitations and the importance of further well-designed clinical studies to better estimate complication rates and identify predictive factors.