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Dr. Barry Eppley

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Surgeon Dr. Barry Eppley

Posts Tagged ‘liposuction’

Kybella Injections vs. Liposuction Surgery

Sunday, February 21st, 2016


Kybella Double Chin Injections Indianapolis Dr Barry EppleyThe non-surgical treatment of fat has historically been difficult as external devices have a limited ability to reduce its thickness. This is particularly true in the ‘double chin’ deformity where excessive (under the chin) fat creates another roll of tissue like an extra chin. Liposuction of the submental/neck area is the gold standard by which the double chin problem is treated. (sometimes it is also helpful to do chin augmentation as well)

Kybella Injections Dr Barry Eppley IndianaolisWith the recent release of Kybella, an FDA-approved injectable drug that has been studied specifically for submental fat, the intriguing question is how this non-surgical injection compares to liposuction surgery. To best answer this question, one only has to know the predicate history of Kybella (Lipodissolve) and translate that prior experience to the present.

Kybella is deoxycholic acid which is a child sprung from its parent, Lipodissolve. Over a decade ago Lipodissolve,  a mixture of deoxycholic acid and phosphatidycholine, was a national sensation as a fat dissolving injection treatment. Having its origins in Europe and South America, it was brought to the U.S. with much fanfare. Lipodissolve clinics opened  up across the country providing such treatments until the FDA stepped in and ceased their operations as providing an untested and unregulated drug therapy. It was always suspected that the active agent in this mixture was the deoxycholic acid and not the phosphatidycholine. Kybella is the fully studied drug that proves this is true.

But the Lipodissolve experience can predict completely what one can expect for Kybella injections in the neck and how to compare it to liposuction surgery. This is just old history repeating itself. Kybella works by causing an inflammatory reaction that breaks down fat cell walls, allowing the release of their lipid content which is then absorbed. This will result in a predictable an profound amount of neck swelling. One essentially will look like a ‘bullfrog’ with the swelling. There is also a rather profound burning sensation that occurs in the first 30 to 60 minutes after the injections (the neck will feel really hot) but this subsides within a few hours. Thus one can expect some significant downtime with the swelling which will take one to two weeks to completely go away. While Kybella injections are non-surgical, patients should be aware that they should not have this treatment within a couple weeks of any major event.

Kybella Injections Indianapolis Dr Barry EppleyWhile the exact number of Kybella injection sessions may be needed, everyone will need more than one. Most patients will need at least two to four treatments, spaced 4 to 6 weeks apart to get maximal fat reduction.

When comparing Kybella to submental liposuction, there are some significant differences. Submental liposuction, if done alone, can be performed under local anesthesia with oral or IV sedation. It is more commonly done as part of other facial and body procedures in my practice which is then done under general anesthesia. But for the purposes of this discussion it shall be talked about as if it was done as a solitary procedure.

Submental liposuction certainly causes some swelling and bruising which can take up to six weeks to completely go away. (although the worst swelling is in the first seven to ten days) Liposuction in the neck is usually a one-time procedure although about 10% of patients may need a touch-up due to any residual remaining fat or asymmetry. (which can be done by Kybella injections if desired) The swelling after Kybella injections is usually much more than with liposuction. It is certainly far greater when one multiples it by the number of repeat Kybella injections that will be needed.

So how does one choose between Kybella injections or liposuction of the neck? In summary, liposuction produces a better result with less recovery but costs more and is an invasive procedure. Conversely, Kybella is non-surgical and costs less but has more recovery (repeated swelling) and produces less of a result. Every patient has to weigh their advantages and disadvantages and make the best decision for their own situation.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Mini Tummy Tuck with Liposuction

Tuesday, January 26th, 2016


Background: Pregnancy affects most women adversely from an abdominal standpoint. The expansion and stretching of the abdominal skin is most severely seen in its central aspect around the umbilicus. The peri-umbilical region is well known to develop radiating stretch marks, loose skin and be a reservoir for refractory fat collections.

For most women the amount of peri-umbilical deformity requires a full tummy tuck to adequately resolve. But for some women the amount of skin excess in the lower abdomen does not justify the long lower abdominal scar. Conversely, liposuction alone will make the area less full but will leave an irregular contour due to the skin excess. Skin with stretch marks has a dubious ability to shrink down smoothly after underlying fat removal.

For those women with an intermediate peri-umbilical abdominal problem, a strategy that combines both fat and skin removal makes the most sense. Aggressive liposuction can be supplemented by skin removal and tightening to lessen the risk of skin irregularities. A limited or mini tummy tuck an keep the lower abdominal incision very low with less scar length while creating the needed abdominal skin tightening.

Case Study: This 44 year-old female had a very large but discrete fat collection around her belly button. Given her body size and type, the amount of peri-umbilical tissue excess was disproportionate. She has reached her potential for what she could change by weight loss and exercise.

Mini Tummy Tuck with liposuction result front viewUnder general anesthesia, full abdominal and flank liposuction was initially performed. A total of 3.5 liters of liposuction aspirate was surprisingly obtained. This was not expected given her body size. A low mini tummy tuck was then performed with release of the umbilicus and allowing it to float downward and then reattached from the inside.

Mini Tummy Tuck with liposuction result obloique viewMini Tummy Tuck withu liposuction  result side viewHer six month results showed a completely flat abdomen with a much improved waistline shape. Her mini tummy tuck scar was low enough that it was situated below her underwear line.

For women that do not have enough excess tissues to warrant a full tummy tuck, combining overall liposuction with a smaller tummy tuck can be a good alternative. Some plastic surgeons feel that there is no good role for a mimi tummy tuck procedure as it does not produce enough of a result. While this may be true for many women who seek abdominal improvement, it clearly is not the case for all as this patient’s result demonstrates.


  1. Central abdominal peri-umbilical tissues distortions are common for many women after pregnancies.
  2. With loose stretched periumbilical skin, liposuction alone will produce an inadequate result.

3. Combining liposuction with slower skin removal and repositioning (mini tummy tuck) produces the best result in profound cases of peri-umbilical lipodystrophy.

Dr. Barry Eppley

Indianapolis, Indiana

Maximum Liposuction Fat Removal

Saturday, September 12th, 2015

Liposuction is one of the most common and successful body contouring procedures. Having now been around for almost 35 years in the U.S., it has undergone many evolutions and refinements in treatment strategies and in the equipment to do it. With widespread use of liposuction by many different practitioners and methods, complications from liposuction surgery were inevitable. While most of these complications are more aesthetic in nature, the most serious ones are of medical origin. Complications such as infection (necrotizing fasciitis), deep vein thrombosis, pulmonary emboli and death have all occurred and have led to a variety of preventative measures for their prevention.

Liposuction Fat Aspirate Dr Barry Eppley IndianapolisOne of the basic axioms of safety in liposuction surgery is based on the volume of fat removed. Large volume liposuction, generally defined as more than five liters of fat aspirate, has become a mainstay principle of decreasing serious liposuction complications. This concept has led numerous states and surgery facilities to institute a policy permitting a maximum limit of liposuction fat removal in a single surgical session. In many ways it has become one of the standards of care in liposuction surgery. This limitation of fat removal is a logical one as it is based on the concept of body trauma, fluid shifts and duration of the surgery procedure, all of which cause major body reactions to them.

In the September 2015 issue of the journal Plastic and Reconstructive Surgery, an article appeared entitled ‘Is There a Safe Lipoaspirate Volume? A Risk Assessment Model of Liposuction Volume as a Function of Body Mass Index’. In this paper the authors analyzed over 4,500 liposuction patients from a large plastic surgery database. They identified 69 out of 4,534 patients who developed a serious postoperative complication. Interestingly 97% of the large volume liposuction procedures were done in an outpatient setting. The amount of fat removed and the body mass index of the patients were found to be significant independent risk factors for complications. They found that liposuction volumes in excess of 100ml per unit of body mass index was a good predictor of complications. Their findings indicate that traditional liposuction volume thresholds do not accurately predict the risk of complications in any one patient. Looking at the volume of fat removal in the context of the patient’s physical measurements and body surface area is a more accurate way to establish an upper limit for an individual patient.

Patient deaths from liposuction over the years has led to restrictions being limited on the amount of liposuction fat aspirates. The most common maximum liposuction aspirate is that of 5,000 liters and is widely quoted. The Patient Safety Committee of the American Society of Plastic Surgeons has even adopted this number as an important safety marker. This study shows, however, that there were no differences between large volume liposuction (greater than 5,000 liters) vs. normovolemic liposuction (under 5,000 liters) with the exception of non-life threatening seroma rates.

body mass index for liposuctionCorrelating body mass index with liposuction aspirate appears to be a better predictor of the risk of potential complications rates. This would indicate that heavier patients can tolerate higher liposuction volumes than proportionately smaller patients. In other words, an increase in liposuction aspirate in patients with a low body mass index has a greater risk than a similar liposuction aspirate in a patient with a high body mass index. The use of liposuction volume aspirate greater than 100ml per unit of body mass provides plastic surgeons with an easy method to calculate a safety cutoff that is more predictive of the risk of postoperative complications. For example, a woman who is 5’5″ tall and weighs 165lbs should have a maximum liposuction aspirate of 2,750mls. Or one who is 5’7″ tall and weights 210 lbs could have a maximum liposuction aspirate volume of 3,290mls. These liposuction aspirate volumes are going to be influenced by how much tumescent fluid is initially infiltrated and may be slightly on the conservative side as a result.

Dr. Barry Eppley

Indianapolis, Indiana

The Importance of Skin Elasticity in Liposuction

Saturday, January 3rd, 2015


Liposuction is the ‘largest’ cosmetic procedure performed around the world if it is rated based on surface area alone. It is certainly by sheer numbers one of the top five aesthetic body procedures performed every year as shown by annual statistics. But the extent of the surface area it treats is what really distinguishes liposuction from any other plastic surgery where tissues are excised (e.g., tummy tuck)

But because it does not remove loose skin, the body contouring effects of liposuction rely upon a phenomenon created by the often large underlying surface area that it treats…skin retraction. Once some of the underlying fat is removed, there is actual skin excess. It is important that this skin shrink down to create an optimal contour reduction result. The shrinkage of the skin is primarily important to reflect the volume of tissue that has been removed. But it is secondarily important to help make the skin surface smooth.

Smartlipo Abdominal Liposuction result front view Dr Barry Eppley IndianapolisIt is the skin’s retractive ability that is important to a satisfying liposuction result. And this is often a physical characteristic patients overlook or hope that it won’t have a big impact on their result. Many times patients, understandably, want to avoid an excisional procedure like a tummy tuck or an arm lift to achieve a contour change. But a smaller contour that has a lot of skin irregularities and unevenness may be less appealing that a fuller contour that has a very smooth skin surface.

Smartlpo Abdominal Liposuction result side view Dr Barry Eppley IndianapolisSkin that does not respond well to the effects of liposuction is either damaged or aged. Women that have a lot of stretch marks around the belly button and lower abdomen is the classic example of lost skin elasticity. Older women, usually around age 60 and older, have skin that is thinner with almost equally poor retractive capability even if no stretch marks are present. Conversely men usually not have the same skin retraction problems, not because they do not get pregnant which helps, but because their skin is thicker and often has hair. (which ensures a greater number of elastic fibers)

When liposuction is done on skin of poor retraction potential, it is important that patients understand the trade-offs. Deflated looking skin is often the result. And while many new energy-based liposuction technologies exist, none of them have a magical ability to create a substantially improved retraction of the skin…despite how they marketed and promoted.

Dr. Barry Eppley

Indianapolis, Indiana

Liposuction and the Fat Redistribution Effect

Monday, June 9th, 2014


Abdominal and Flank Liposuction result Dr Barry Eppley front viewDespite the common performance of liposuction as part of many body contouring procedures, the long-term consequences of its effects on the body are not well understood. Various studies have indicated that liposuction can cause breast and upper body enlargement due to fat reaccumulation. Such findings fall in line with what is known as the fat homeostasis theory which states that the body has a certain amount of fat and will fight hard to maintain it in the face of surgical removal or weight loss.

In the Online First edition of the June 2014 issue of the Aesthetic Surgery Journal, an article was published entitled ‘No Increase in Female Breast Size or Fat Redistrbution to the Upper Body After Liposuction – A Prospective Controlled Photometric Study’. In this report, eighty-two women underwent cosmetic surgery consisting of liposuction or liposuction combined with a tummy tuck (one group was a control of 24 patients who had no liposuction), breast measurements were done from photographs and the groups compared. The results showed that there were no significant changes in mean body weight, breast size or upper body dimensions. Those women that had liposuction combined with a tummy tuck had a significant decrease in upper abdominal width.

This study provides data that runs contrary to the theory of fat redistribution with unchanged upper body dimensions. It is not a perfect study nor does it absolutely prove that it does not happen in that it does not follow the patients for years. But in the short-term, no immediate or rapid redevelopment of fat could be shown.

Flank Liposuction Dr Barry Eppley IndianapolisOne of the most common questions many patients ask considering liposuction is whether the fat will simply come back once it is removed. In essence, they are asking are the long-term results stable and will they enjoy many years of the benefits of the surgery. The traditional answer from most plastic surgeons is that as long as your weight is stable then the results will remain. This seems to make biologic sense and is still believed to be true.

Conversely the fat homeostasis theory also seems logical and runs counter to the weight stability theory after liposuction. This study combined with other contradictory studies keeps this issue unresolved. The answer is likely that both fat theories have some merit and is very patient dependent. But if patients really want to maintain their liposuction results the longest, rigid adherence to diet and exercise is still the best insurance.

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery’s Did You Know? Fat Cell Biology

Saturday, May 24th, 2014


Other than skin, fat is the most commonly manipulated tissue by plastic surgeons. Most people think of fat removal by liposuction when they think of plastic surgery by fat transplantation by injection is becoming increasingly popular. But when fat cells are removed or transplanted the questions are whether they will come back or do they survive and grow? The basic science of fat cell biology helps answer these questions.

Injectable Fat Grafting Indianapolis Dr EppleyFat cells are created during the last three months of pregnancy and during puberty and are influenced by the estrogen and testosterone hormones. The development of fat cells and their distribution are the same in male and females until puberty when the surge in hormones changes their bodily distributions. After puberty, fat cells do not generally replicate or are created (fat cell hyperplasia) and their number remains fairly stable for the rest of one’s life. One may get heavier or get bigger in certain body areas because fat cells gets bigger taking on excess calories. (fat cell hypertrophy) This is best illustrated as to what happens in the bariatric surgery patient where extreme amounts of weight loss occur…their fat cells merely get smaller but not less in number.

Liposuction removes fat cells but leaves many fat cells behind. No liposuction treated area removes all the fat cells. If one gains weight after liposuction, those remaining fat cells can get bigger. Thus one cal potentially wipe out any body contouring benefits from the procedure. When fat cells are transplanted, those that survive have the same characteristics from whence they came which is usually the stomach area. With weight gain those transplanted fat cells can get bigger or with weight loss those same fat cells can get smaller. Thus fat injected areas can grow or get smaller after transplantation.

Dr. Barry Eppley

Liposuction and Fat Injections for Treating Buttock Silicone Injection Complications

Sunday, April 13th, 2014


The desire for a larger and more shapely buttocks has led to a surge in the number of buttock augmentation procedures performed today. While fat injections and implants make up the legitimate surgical methods to increase buttock size, there is a significant black market industry of buttock augmentation by a variety of unapproved injectable filler materials. The most commonly uses of these materials is silicone oil of various grades…none of them approved for human use for buttock augmentation.

Silicone Buttock Injection Complications Dr Barry Eppley IndianapolisInjecting silicone oils into subcutaneous tissues is known to potentially cause adverse tissue reactions and problems. These can include hard lumps, cellulitis and abscesses, pigmentation changes in the overlying skin and chronic pain. As a result the black market buttock injection industry has created numerous patients with chronic buttock problems….known as gluteal silicone toxicosis. This can be a very difficult problem to treat since removing the silicone material dispersed throughout the buttocks is impossible without wide excision and major buttock deformity.

In the March 2014 issue of Aesthetic Plastic Surgery, an article addressing the treatment of gluteal toxicosis appeared entitled ‘ Liposuction and Lipofilling for Treatment of Symptomatic Silicone Toxicosis of the Gluteal Region’. In this paper, liposuction was evaluated as a treatment method for this problem to maintain good buttock aesthetics and to limit the risk of complications. Eight patients (seven women and one man with an average age of 36 years old) ) were treated with combined liposuction and fat injections over a three year period. After one year after surgery, the patient’s pain levels were  completely eliminated. No patients experienced any further infections or required ER visits or need for hospitalizations.

Indianapolis Buttock Fat Injections Dr Barry EppleyThis study series support that liposuction with immediate fat transfer is a safe treatment that preserves aesthetic appearance and reduces or eliminates pain for patients with gluteal silicone toxicosis. While the liposuction extraction undoubtably does not remove all of the silicone material, it does break up the scar tissue and painful lumps of silicone and fibrosis. It then replaced this with new fat that is interspersed amongst the broken up tissue areas, creating more healthy tissue areas.

One approach that this study did not evaluate and can be considered for treating silicone buttock injection complications is what role does the liposuction play in its treatment. Since it can not remove all of the silicone and may only remove just a fraction of it, its purpose may be nothing more than to break up the scar tissue and granulomas and provide space for the injected fat. Thus, using the liposuction instruments for tunneling and not necessarily extraction may be just as effective and could result in a greater buttock size than before the treatment.

Dr. Barry Eppley


Strategies for Successful Liposuction Outcomes

Sunday, March 2nd, 2014


Liposuction is the fourth most commonly performed aesthetic plastic surgery procedure in the U.S. as determined by the American Society of Plastic Surgeon’s annual Statistics in 2013. At over 200,000 procedures performed (this estimate is undoubtably low), there is a lot of fat being removed from the face to the ankles. What is unique about body liposuction in particular is the trauma that it induces on broad surface areas of the body.. This makes the issue of safety in liposuction of paramount importance.

Abdominal Liposuction Surgery Dr Barry Eppley IndianapolisThere are some basic principles in performing liposuction that can make for a successful and safe outcome. These include patient selection, intraoperative monitoring, fluid and drug management, contouring techniques and postoperative care.

Many liposuction problems start right at the initial consultation. Many patients that seek liposuction are pursuing it for the wrong reason. They see it as a weight loss method or have unrealistic expectations about what can be achieved. Some of these misinterpretations are created by the very advertising that some doctors do that drive patients in for consutations. Then there is the issue of long-term lifestyle changes, which if not done, may lead to an eventual re-accumulation of the removed fat.

Many liposuction procedures are done under general anesthesia to get the best result and for maximal patient comfort. The anesthesiologist provides fluid management, ensuring that enough intravenous fluid is given to maintain adequate blood pressure but not too much to create fluid overload. This is a delicate balance with the amount of tumescent fluid infused to safely perform liposuction and the amount of fat removed. Whether done under general anesthesia or not, it is also important to know how much lidocaine (and epinephrine) has been infused during tumescent infiltration and that is within safe dosages for the patient’s weight.

Liposuction (Fat Canister) Dr Barry Eppley IndianapolisContouring with liposuction is just as much an art as a science. While patients get focused  on the choice of liposuction technology, there are many other ‘simpler’ intraoperative techniques that are just if not more important. Small cannulas, closer access incisions, cross-tunneling and a bimanual touch technique can help to create a more even removal of fat beneath the skin. But when contour depressions are seen, it is best to try and manage them immediately. Sometimes it requires removal of fat surrounding the depression to smooth it out. But other times it requires the re-injection of some of the removed fat to fill out any contour irregularities.

The only thing that patients can really do after liposuction that could have some impact on recovery and outcome is the wearing of compression garments. The wearing of compression garments for the first 10 to 14 days after surgery can help control swelling and may have some mild shaping effect. Wearing them beyond that is more for comfirt than shaping. Adjunctive measures such as Vanquish and other non-invasive body contouring devices can help smooth out any residual contour irregularities.

Patient satisfaction after liposuction is highly driven by their preoperative expectations, both in their body shape and in the recovery process.

Dr. Barry Eppley

Indianapolis, Indiana

Six-Pack Abdominal Etching Liposuction

Saturday, February 15th, 2014


When it comes to the ‘abs’ most people think of having a six-pack. And many work hard to try and get it. But not many can for a variety of reasons…not working hard enough, too much abdominal fat from poor diet and not the right body type. Getting six-pack abs really comes down to genetics and hard work.

Abdominal Muscle Anatomy Dr Barry EppleyActually everyone already has a built-in six-pack, known as the abdominal inscriptions, which are part of the rectus abdominus muscles. The rectus abdominus muscles are a set of paired vertically oriented muscles that extend between the bottom of the rib cage and extend down into the pubic area. Throughout their vertical course, they are crossed by three fibrous bands called the tendinous inscriptions. They are usually three such horizontal crossings, one at the level of the belly button, one up high near the bottom of the rib cage below its central xiphoid process and a third one about halfway between the two.

These inscriptions cause indentations or lines across the muscle to appear as they extend about halfway into it. Regardless of your weight and abdominal size, everyone has these inscriptions. The trick is having a thin enough fat layer between them and the overlying skin for them to be seen on the outside.

Abdominal Etching Six Pack Surgery intraop Dr Barry Eppley IndianapolisFor those who diet correctly, exercises regularly, and do a lot of abdominal work but can’t get the cut abdominal look they desire or others who just want to take a shortcut, there is a way. A plastic surgery procedure known as ‘abdominal etching’ or ‘six-pack’ surgery can create it. While often described as ultra-sophisticated liposuction, it is really a form of linear liposuction. Rather than removing fat over a broad surface, fat is removed along a very specific linear lines where the tendinous inscriptions lie. One vertical line is made down the center representing the linea alba between the rectus abdominus muscles through an incision inside the bellybutton. Then the horizontal lines are made from small tiny incisions placed in the middle from which the lines can be made out to the sides.

As much fat as possible is removed between the skin and the tendinous inscriptions to create permanent indentations in a six-pack fashion. While there is an artistic side to how much fat to remove and the location of the lines, it is a relatively simple technique of small cannula liposuction done along straight lines.

Abdominal Etching result oblique view Dr Barry Eppley IndianapolisLike all liposuction, it takes months after surgery to see the final result as the underside of the skin contracts down to the muscle. Such lines will likely be permanent since the fat cells will not return to the indentation lines. However, the number of fat cells outside of the lines are greater in number and will get bigger should one gain weight. Thus abdominal weight gain may create an unnatural look after etching, creating the ‘waffle look’ with fat ballooning up between the lines. It behooves one to maintain a healthy lifestyle and exercise program afterwards.

The best candidates of abdominal etching are those men and women who are already fairly fit and lean. The thinner the abdominal fat layer the more the inscription lines will show.

Dr. Barry Eppley

Indianapolis, Indiana

Liposuction and Fat Cell Biology – Are The Results Maintained? Part 2

Sunday, February 2nd, 2014


Fat Cell Hormones Dr Barry Eppley IndianapolisFat cells are well known to release a large of cytokines (adipokines) that help regulate energy homeostasis and overall body fat mass. (leptin, tumor necrosis factor and many others) Leptin, for example, is a hormone produced by fat cells to help regulate body energy balance. Higher levels of leptin release favors energy burning rather than storage. Bigger fat cells release higher amounts of leptin than smaller fat cells which tell the brain to have one stop eating and burn more energy. But in the obese patient their brain is more resistant to this leptin message and is one reason they may continue to gain weight or can’t keep it off.

Conversely, smaller fat cells send out very low levels of leptin telling the brain to store energy rather than use it. This simplistic hormonal science would lend support to the fat cell homeostasis concept which in the liposuction patient could mean that removing large amounts of fat cells and mass, with resultant less circulating leptin, may be inadvertently inducing the body to try and put the fat back. However, whether the brain/body responds to fat cell number loss by increasing preadipocyte conversion and/or differentation in an attempt to maintain the fat mass it had is still a theoretical response.

While these fat cell behavior concepts seem straightforward and a bit contradictory, the variability of body type and fat mass must surely play a role in how these body fat responses are played out. If one divides body types into five main groups (lean, average, overweight, obese, extremely obese), it is clear that a change in body type is associated with a similar change in fat cellularity. (one who is obese has bigger fat cells than one who is lean and most likely has more fat cells as well) Research has clearly shown that obesity presents with different types of cell changes with severe obesity having increased numbers of fats as well as a fat cell size problem.

liposuction cosmetic surgeryThis would intuitively seem to change the dynamics of fat mass equilibrium in lean vs obese individuals even though their cell turnover rates may be the same. It just simply harder to keep fat off the more fat mass one has. This would also lend credence to why liposuction is not a weight loss method but a spot reduction technique. Liposuction just simply does not work well in overweight or the obese individual. Not because it often doesn’t make much of a visible difference (which it often won’t in an obese individual) but that the fat has a much greater propensity to hypertrophy or even be induced to make new cells due to the stimulation of the traumatic fat injury and loss. In essence, liposuction in obesity appears to be metabolically challenged or even doomed. As unfair as it may be, liposuction in leaner body types is not only more visibly rewarding but may be more sustainable long-term as well provided that a good energy balance is maintained.

While subcutaneous fat makes up about 80% of all body fat, it is suspected that it is not all the same. The fat around the abdomen and waistline is clearly more of a depot type fat than that of the neck or knees for example. (metabolic diversity) Fat accumulations occur in the abdomen either first or preferably in unfavorable energy balances. (the visceral intra-abdominal fat aside) Whether this is due to a greater number of fat cells per cm2 of tissue or a greater susceptibility to be stimulated for volume acquisition by increased receptors, or both, is not known. Such localized fat mass differences may account for why ‘liposuction may be more sustainable in some body areas than others once the cell numbers are decreased. For example, once the inner knees are reduced even in an obese patient, it is unusual to ever see much if any accumulation later. Certainly the same can not be said for subcutaneous abdominal fat removal.

In search of addressing the simple question of whether fat will return after liposuction…our current understanding of fat cell biology does not permit a clear biologic answer. That may not be satisfying to a prospective patient but is reflective of what we currently know. Current fat cell science suggests that:

Liposuction should not be viewed as a permanent or lifelong body contouring procedure. One may or may not get years of aesthetic benefit from localized removal of fat but the factors contributing to its long-term sustainability are not yet known.

It is sound biologic advice to maintain one’s weight after liposuction. This is the best way to prevent a subsequent increase in fat cell volume.

Liposuction works best in near weight appropriate individuals both in visible changes and in a greater likelihood of a sustained result. When a plastic surgeon tells a patient to lose some weight (or be within 20% of less of their ideal body weight) before being a good candidate for liposuction, that advice has some biologic merit and is in the patient’s best interest.

Obese individuals appear to be a biologic setup for a complete relapse for fat re-accumulation, most likely quicker than in a lean or weight appropriate individual.

Fat reaccumulation after liposuction, when and if it does occur, may develop from whence it was removed or may have tendency to occur elsewhere. This appears to vary by the individual. It is does not exclusively occur one way or the other and there is no scientific evidence that it does.

Dr. Barry Eppley

Indianapolis, Indiana


Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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