Wednesday, May 4, 2011

Liposuction and Redistribution of Fat

Updated 3/2017-- photos and all links (except to my own posts) removed as many no longer active. 

Here’s the tweet I posted Sunday evening:
I've told pts this for years now>>> Liposuction Study Finds That Lost Fat Returns -
The New York Times article reports on a liposuction study published in the April issue of the journal Obesity (full reference below).   The NY Times article uses this photo as graphic illustration
and a quote from a plastic surgeon who says he is surprised.
Dr. Felmont Eaves III, a plastic surgeon in Charlotte, N.C., and president of the American Society for Aesthetic Plastic Surgery, said the study was “very well done,” and the results were surprising. He said he would mention it to his patients in the context of other information on liposuction.
I have told my patients for years to consider the fat cells in their body as drawers or storage bins.  If I take away some of the drawers and they continue to take in “fat” that needs to be stored, the body will put it somewhere.  If there are now fewer drawer options in the saddlebag or abdominal region, then where will it go?  Most likely the upper body, etc.
This article does more definitively define the answer to where it will be placed.
The study enrolled 32 healthy women (mean age 36) with disproportionate fat depots (lower abdomen, hips, or thighs) were enrolled and then randomly placed into either a small-volume liposuction group (n = 14, mean BMI: 24 ± 2 kg/m2) or control (n=18, mean BMI: 25 ± 2).  Participants agreed not to make lifestyle changes while enrolled.
Baseline body composition measurements included dual-energy X-ray absorptiometry (DXA) (a priori primary outcome), abdominal/limb circumferences, subcutaneous skinfold thickness, and magnetic resonance imaging (MRI) (torso/thighs).
The surgery group had their liposuction within 2-4 weeks of the baseline measurement.  Identical measurements were repeated at 6 weeks, 6 months, and 1 year later.
After 6 weeks, percent body fat (%BF) by DXA was decreased by 2.1% in the lipectomy group and by 0.28% in the control group (adjusted difference (AD): −1.82%; 95% confidence interval (CI): −2.79% to −0.85%; P = 0.0002).
This difference was smaller at 6 months, and by 1 year was no longer significant (0.59% (control) vs. −0.41% (lipectomy); AD: −1.00%; CI: −2.65 to 0.64; P = 0.23).
The fat (adipose tissue) reaccumulated differently across various sites. 
After 1 year the thigh region remained reduced, but fat (adipose tissue) reaccumulated in the abdominal region.   Following suction lipectomy, BF was restored and redistributed from the thigh to the abdomen.
I do not find this surprising.  Once the drawer is removed, it can not store items any longer.
If you only liposuction the lower abdomen (area below the umbilicus), those patients are likely to return with increased fat in the upper abdomen.  It needs to be keep in proportion.

Fat Redistribution Following Suction Lipectomy: Defense of Body Fat and Patterns of Restoration; Hernandez TL, Kittelson JM, Law CK, Ketch LL, Stob NR, Lindstrom RC, Scherzinger A, Stamm ER,  Eckel RH; Obesity, (7 April 2011); doi:10.1038/oby.2011.64


Anonymous said...

I like your analogy about the drawers - it is true! I had lipo on my upper arms in 1999. I had lipo on my flanks and abdomen in 2010. When I gain weight now, it goes to my thighs! I've never had saddlebags before, but I'm getting them now, it's crazy.

SeaSpray said...

I don't know anything about this, but have always thought it was great to be able to remove it ...although I'd be concerned about risks.

This is interesting and I am sure frustrating to people who've experienced the increase in other places.

Oh Ramona ...if only liposuction could suck *all* unwanted body fat out of everywhere without risk/side effects. Go in as if for a yearly physical... or a monthly hair appt, if necessary. :)

Cynthia Bailey MD said...

This is a great analogy to help people wrap their heads around the concept. People need to see this because they think lipo is the answer to their body shape 'issues'. Healthy diet, fitness and self acceptance still have an important place in all this.