Liposuction & Longevity – After liposuction, does the fat come back?

Liposuction has solidly earned the position as number 1 cosmetic surgical procedure in the nation, and for good reason. It’s quick, it’s safe, and it’s permanent… isn’t it? Not necessarily according to a study published just last year.

The Numbers
Teri L. Hernandez, MD, Robert H. Eckel, MD, and colleagues from the University of Colorado, decided they wanted to try and answer the question by examining (a) whether fat came back after it was removed and if it did (b) where it took up residence. So they carried out a randomized controlled trial of liposuction in 32 non-obese healthy female patients with extra fat in the lower abdomen, hips or thighs. They published their results last year in Obesity.

Female were randomly assigned to one of two groups: 14 who underwent small-volume liposuction of the thighs within 2 to 4 weeks (average BMI 24 kg/m2), and 18 to a control group (average BMI 25 kg/m2) who did not have liposuction (but who were offered liposuction after the study’s end).

All the measurements were taken before liposuction of the thighs and again at 6 weeks, 6 months and 12 months afterwards. The women agreed not to change their eating or exercise habits, while they were enrolled in the study.

The researchers compared the measurements taken over the 12 months and found that after 6 weeks, the percentage body fat went down by 2.1% in the liposuction group and only 0.28% in the control group, demonstrating a significant difference between the women who had liposuction and those who did not. However, at 6 and 12 months, the gap closed between the two groups and the fat reappeared, but not in the thighs. It showed up in the abdominal area.

The question is, why?

Experts suggest that the human body "defends" its fat, so if you try to lose it, it will find a way to bring it back.

But women in the liposuction group were very happy with their results—they didn't like having the fat around their hips and thighs and just wanted it gone. And more than half the women in the control group chose to have the liposuction after the study completed, despite knowing the results.

As Dr. Hernandez explained to Medical News Today, "We must emphasize that liposuction surgery is not a weight loss procedure. Our research participants are wonderful women who sought to change their shape through liposuction. Despite fat returning, their cosmetic shape benefit was retained and they have been very happy with their surgery results."

Expert Opinion
But the study also has it’s critics, reports a recent article in trade publication Dermatology Times (DT) that aimed to determine if liposuction-seasoned dermatologists could corroborate these results.

Edward Lack, MD
38-Year Dermatologist Veteran
Chicago, Ill.

"It's ridiculous. It was a poorly done study with specious reasoning and extremely self-serving. They started out with the conclusion and then worked to prove their conclusion was right," Dr. Lack told DT.

"This study looked at what they call small-volume liposuction, which studies done over a 30-year period of time show do not alter metabolism and do not alter insulin resistance," he says. "Therefore, it's not relevant. They noted small changes, which easily are correlated to changes in lifestyle and also related to people getting older."

Robert C. Langdon, MD
16 Years’ Liposuction Experience
Guilford, Conn.

"As a problem, it's clinically insignificant," Dr. Langdon told DT. "I do liposuction and people don't come back a few years later saying the fat has all returned, so that's a mystery to me. The other thing, to my understanding, is that of the patients who underwent liposuction, a high percentage of them were happy with the results and would do it again.

"Liposuction isn't a weight-loss program. It's (for) specific problem areas, the outer or inner part of the thigh, and abdominal areas. Compared to the total fat load, you're actually doing this on a relatively small area. Even if patients get new fat elsewhere, they're getting it all over the place. It shouldn't be enough to be noticeable, unless you do very sensitive measurements like this study."

Anna Guanche, MD
8 Years’ Liposuction Experience
Calabasas, Calif.

"This question comes up all the time. What happens if you gain weight? You don't gain weight in the same localized area where we did liposuction, but you gain weight everywhere else because there are a finite number of fat cells. You can't get new fat cells. So that's nothing new," Dr. Guanche told DT.

"It's not that fat travels to find another spot, it's that your body wants to store fat energy somewhere, so it expands whatever cells are there, and those cells are all over the body."

Martin E. Salm, MD
25-Year Dermatologist Veteran
Stateline, Nev.

"People can still gain weight, and when they gain weight, it will go to a different location than it would not have gone before. If you remove all the fat cells out of one area, for example the abdomen, and then gain weight, that weight will accumulate in the other areas of the body," Dr. Salm said to DT.

"I don't think that's true, however, that virtually everyone experiences a return of fat within a year. It depends on the person. If they maintain a good diet and exercise and don't gain weight, they won't get those fat cells. Some people get to their optimal body fat composition, but they still have problem areas of fat like their love handles or saddlebags or little pooch on the lower abdomen, and that's where liposuction comes in."

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