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Cosmetic liposuction is considered to be safe and effective in properly selected patients and is widely done as an outpatient or office procedure. When major complications occur, office-based practitioners may refer patients to a hospital emergency department, where medical personnel unfamiliar with this procedure may underestimate the risk of serious infection or other major complications. We present two cases of massive necrotizing fasciitis treated in a burn center after liposuction surgery. One patient died, and the second required lengthy hospitalization, extensive debridement, and split-thickness skin grafting of 22% of the total body surface area. Pain out of proportion to clinical findings is a hallmark of necrotizing fasciitis and should prompt consideration of this entity even in the absence of cutaneous signs of infection. Definitive diagnosis is made by biopsy and rapid section histologic analysis. Liposuction may result in major complications or death. Emergency department physicians or general surgeons may be called upon to manage such complications and should be aware of these risks. [ABSTRACT FROM AUTHOR]