During recent years, cases of toxic shock syndrome have been reported with increasing frequency in plastic surgery patients. The majority of reports relate to aesthetic plastic surgical procedures such as rhinoplasty, augmentation mammoplasty, liposuction, and chemical peeling. We report a case of toxic shock syndrome with necrotizing fascitis after liposuction in a 23-year-old woman who had erythema and edema, blister formation and gangrene in the skin. The patient was admitted to the intensive care unit, and treatment was initiated with vigorous fluid resuscitation and intravenous antibiotic therapy. During the next days, the condition of the patient worsened, and pulmonary insufficiency required intubation and mechanical ventilation. Surgical treatment with multiple incision and irrigation was performed on the first, third and eighteenth day. The patient was discharged in good health on the 30th day after admission. Toxic shock syndrome with necrotizing fascitis is a rare disease; therefore, it is important to review its diagnostic and clinical features as only early diagnosis and prompt, radical surgery improves the survival rate.