In a randomized trial, thirty-six healthy normal-weight women had a small-volume abdominal liposuction, and two months after surgery they were randomly allocated either to a four-month exercise program or to no training[1]. The women who did not train showed a significant 10% increase in visceral (intra-abdominal) fat from before surgery to six months after it, compared with the trained women[1][2]. The trial authors concluded that this compensatory increase in visceral fat was effectively counteracted by physical activity[1].
Your own date for returning to exercise is something to agree on with your surgeon.
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Please ask your own surgeon to set your return-to-exercise plan. In the randomized trial, the timing was set by the study design: the women were randomly allocated two months after a small-volume abdominal liposuction, and the exercise program then lasted four months[1].
Whether an earlier or a later start would suit your body, your procedure and your treated areas is a question to ask your surgeon. It is also worth asking your surgeon which kinds of activity are allowed at each stage, from walking to lifting to high-intensity training.
In a study in rats, a swimming program started seven days after partial surgical removal of fat pads (lipectomy) and continued for six weeks[3]. Ask your surgeon how, if at all, an animal-study timeline relates to your own recovery.
For more on the weeks after surgery, see our post-op recovery FAQ and our guide to what to do after your liposuction surgery, and bring any questions to your surgeon.
The trial tracked where body fat sat, using computed tomography (CT) scans, before surgery and at two and six months after surgery[1]. Secondary measures included body composition, metabolic markers, dietary intake, total energy expenditure, physical capacity, and the size and gene activity of fat cells under the skin[1].
Liposuction was effective in reducing abdominal fat under the skin (subcutaneous fat) between the scan before surgery and the scan two months after it[1]. That reduction in subcutaneous abdominal fat was still present at six months[1].
Compared with the trained group, the untrained group showed a significant 10% rise in visceral fat from before surgery to six months, along with a decrease in energy expenditure[1]. Dietary intake, fat-cell size and gene expression did not change over time[1].
The authors summed up their findings in two parts: abdominal liposuction did not induce regrowth of fat, but it did trigger a compensatory increase of visceral fat that physical activity effectively counteracted[1].
The trial population was narrow: healthy normal-weight women who had a small-volume abdominal liposuction at the University of Sao Paulo in Brazil[1]. Whether results from that group would apply to you is worth discussing with your surgeon.
A review describes intra-abdominal visceral fat, which characterises upper-body obesity, as a major contributor to the development of high blood pressure, glucose intolerance and raised blood lipids (hyperlipidaemia)[2].
A study of 126 morbidly obese subjects who had laparoscopic gastric banding, a weight-loss operation, found that most metabolic abnormalities were associated with visceral fat[4]. In that bariatric surgery group, changes in metabolic markers virtually never correlated with changes in subcutaneous abdominal fat[4].
The exercise trial's authors noted that liposuction has been suggested to cause long-term body fat regain that could lead to increased cardiometabolic risk, and they hypothesized that physical activity could prevent this effect[1].
Two of the sources disagree directly on this question[2][1]. An older review states that liposuction simply removes subcutaneous fat, which is often rapidly replaced, and that it has no beneficial metabolic effects[2]. The randomized trial, by contrast, concluded that abdominal liposuction did not induce regrowth of fat, although the untrained women showed a rise in visceral fat compared with the trained women[1].
A narrative review on weight loss and liposuction describes a preferential reaccumulation of fat in certain areas after liposuction, and the ability to avoid this with a negative energy balance[5]. The same review notes that the body mounts a complex compensatory response to any intervention that depletes its energy stores[5]. Its authors concluded that optimizing one's weight status may in turn optimize the aesthetic outcomes of liposuction[5].
A systematic review of 40 articles, 12 of them animal studies and 28 human studies, found that all articles pointed to a decrease in body weight after suction-assisted lipectomy[6]. That review reported that the weight lost affected only fat mass, without any change in lean mass[6].
The same systematic review concluded that the potential compensatory growth of visceral fat seems to be counteracted by physical activity[6]. It also found that resting energy expenditure seems to stay stable or decrease after surgery, and that this reduction also seems to be counteracted by physical activity[6]. Overall, the review authors wrote that there is still debate about the metabolic effect of suction-assisted lipectomy[6].
For eating habits after surgery, our article on diet recommendations after liposuction is a starting point for a conversation with your surgeon.
Two rat studies reached different conclusions about exercise and fat regain[3][7]. In rats that had partial removal of fat pads, and in sham-operated rats, six weeks of swimming training reduced carcass lipid content, food intake and fat-pad weights[3]. The authors concluded that exercise training after partial fat removal impaired the replenishment of adipose tissue and decreased body adiposity[3].
A second rat study, in animals fed a high-fat diet, used only a seven-day swimming program after lipectomy[7]. That short-term training improved insulin sensitivity but failed to prevent fat regain in the lipectomized animals[7]. In the same study, lipectomy in sedentary rats was followed by impaired glucose tolerance[7].
Ask your surgeon how much weight animal findings like these should carry in your own planning.
In a randomized trial, exercise training did not alter the liposuction-related changes in inflammation-related adipokines, which are signalling molecules secreted by fat tissue[8]. Thirty-six healthy normal-weight women had abdominal liposuction, and two months later eighteen were assigned to a four-month exercise program and eighteen remained untrained[8].
Blood levels of TNF-alpha, IL-6 and IL-10 were unchanged in both groups[8]. Six months after surgery, gene activity for TNF-alpha, IL-6 and IL-10 in abdominal and thigh fat under the skin had increased, while adiponectin gene activity and blood levels had decreased[8]. The authors concluded that these changes occurred in normal-weight women irrespective of exercise training[8].
Across the wider literature, a systematic review found that results on adiponectin and resistin levels after suction-assisted lipectomy are contradictory[6].
Exercise and liposuction remove fat in different ways: a review states that liposuction simply removes subcutaneous fat, while exercise has an important role in treatment, but with fat loss that is generalised[2]. The same review notes improved metabolic measures in exercising obese subjects, independent of weight loss[2].
Authors of a study on medium definition liposuction combined with abdominoplasty (removal of abdominal skin) write that not all patients who exercise regularly and follow a balanced diet will obtain a well-defined abdomen[9]. In that combined operation, 326 of 351 patients (93%) were rated as having good or excellent results at twelve months, and the overall complication rate was 4.8%[9].
In a randomized trial of 34 patients with non-alcoholic fatty liver disease and a body mass index of 30 to 40, both moderate aerobic exercise alone and aerobic exercise combined with focused ultrasound cavitation, a non-surgical device, significantly improved subcutaneous fat volume, visceral fat volume, body weight and waist circumference over three months[10]. The percentage improvements were higher in the group that also had the device treatment[10].
A systematic review of fourteen clinical studies of electromagnetic treatments for non-invasive body contouring found a mean reduction in fat thickness of 5.5 mm and judged the evidence for efficacy tenuous[11]. Almost all of those studies were authored by medical advisors for the device manufacturer[11].
A recent review describes lipedema treatment as conservative measures, including complete decongestive therapy, exercise and compression, plus surgical procedures such as tumescent liposuction[12]. An earlier review likewise lists compression, manual lymphatic drainage and exercise as conservative therapy, with liposuction as the surgical option, and states that there is no curative therapy[13].
In a single case of primary lymphoedema of the leg, a patient received complex decongestive therapy that included tailored exercises before and after liposuction[14]. Readers with lipedema can learn more in our article on treating lipedema with liposuction, and can ask their surgeon how exercise fits into their own plan.
A case report on abdominoplasty combined with liposuction notes that complications can occur with these operations, listing hematoma, seroma, infections, deep venous thrombosis and death among those encountered[15].
Another case report describes a 34-year-old woman who went to an emergency room with disturbance of urination and shortness of breath and was diagnosed with rhabdomyolysis with acute kidney injury after laser-assisted liposuction[16]. That report names repetitive exercises, trauma and crush injury as the major causes of rhabdomyolysis[16].
If you notice chest pain, shortness of breath, a rapidly growing swelling, fever, or a change in urination during your recovery, contact your surgeon or emergency services right away.
Bring these study findings to a board-certified surgeon and ask how they apply to you. Questions you might bring to your consultation include:
Ask your surgeon to set the timing for your own recovery. In one randomized trial, healthy normal-weight women began a four-month exercise program two months after small-volume abdominal liposuction[1].
In a randomized trial of thirty-six healthy normal-weight women, those who did not train after abdominal liposuction showed a significant 10% increase in visceral fat at six months compared with those who trained[1]. The authors concluded that physical activity effectively counteracted this compensatory increase[1].
The studies disagree. An older review states that the fat removed by liposuction is often rapidly replaced[2], while the randomized trial concluded that abdominal liposuction did not induce regrowth of fat but did trigger a compensatory increase in visceral fat[1].
Authors of a study on medium definition liposuction combined with abdominoplasty (removal of abdominal skin) write that not all patients who exercise regularly and follow a balanced diet will obtain a well-defined abdomen[9]. A review adds that exercise has an important role in treatment, but the fat loss it produces is generalised[2].