Liposuction surgery, when performed by a properly trained plastic surgeon, is a relatively straightforward procedure.  Risks associated with liposuction increase drastically when 'large volume' liposuction is performed.  Large volume refers to liposuction greater then a 4-5 L.  However, large volume liposuction has been shown to be a risky procedure and for that reason most surgeon avoid performing it.  Even though the risk of death is low, it significant enough to make most surgeons avoid this procedure."too much liposuction at once can cause an imbalance of the body’s fluids, which can have disastrous results. The patient can develop a condition called disseminated intravascular coagulation (DIC), which is characterized by blood clots forming all over the body because of a fluid imbalance or trauma. This condition has often proved fatal."

Another major problem with large volume liposuction is the large volume of tumescence fluid that is used in these procedures.  With the increase in tumescence, there is the associated increase in the amount of lidocaine that is injected into the body.  With large volume liposuctions, this can get up to 50mg/kg.  Intravascular limit of lidocaine with epinephrine is 7mg/kg.  The reason why liposuction patients can tolerate such a large volume of lidocaine is that the lidocaine is injected subcutaneously, is highly diluted, and is absorbed slowly over time.  Thus, the actual systemic level of lidocaine is actually much lower.  HOWEVER, it appears, that in rare cases lidocaine can spill over into the circulation and become toxic .  Cardiovascular effects may be seen in cases with high systemic concentrations. Severe hypotension, bradycardia, arrhythmia and cardiovascular collapse may be the result in such cases. Cardiovascular toxic effects are generally preceded by signs of toxicity in the central nervous system, unless the patient is receiving a general anesthetic or is heavily sedated with drugs such as a benzodiazepine or barbiturate  An article in Forensic Science International (2008 Jun 10;178(1)) by Martinez et al reported a fatality during tumescent liposuction.  This report documents the case of a 38-year-old woman who attended an outpatient clinic to undergo liposuction of the abdomen and bilateral hips and thighs. According to one witness, around 30 min after anesthesia administration, the victim suffered an episode of tonic-clonic convulsion. When the emergency medical services arrived the patient was in asystole. She died in spite of attempted cardiopulmonary resuscitation. The patient had no significant past medical history including no history of allergies or any known complications with anesthesia. A complete autopsy was performed and possible causes of death such as myocardial infarction, aspiration of food or foreign body, and pulmonary embolism were discarded. Anaphylactic shock was considered a possible but unlikely explanation for the fatality. Toxicological analyses revealed the presence of lidocaine and mepivacaine in heart blood, at concentrations of 4.9 and 16.2mg/L, respectively.  Based on the autopsy findings, case history, and toxicology results, the forensic pathologists ruled that the cause of death was an overdose of local anesthetic agents. The Court of Law ruled the death as an involuntary homicide due to gross negligence.