Liposuction remains the most effective method of instantaneous fat reduction. Studies and surveys have repeatedly shown that its initial effects are very visible and, as a result, has a high patient satisfaction rating. But well done long-term studies are lacking that evaluate what happens to the contours of the treated areas as well as other body fat sites.
But when fat is so dramatically removed, questions abound about this effect on both the treated and untreated body areas. Many unsupported beliefs exist such as that fat will never return to the treated area, fat will always return to the treated area and fat will just grow in other body area later negating the effects of the surgery. This latter statement is widely believed in the spirit of the so-called ‘fat homeostatic’ theory or fat redistribution concept.
This belief in fat redistribution was ‘confirmed’ by a published study last year that showed a small increase in arm and upper back fat one year after abdominal liposuction in women. This study was limited by the very small number of patients that were treated and was certainly criticized on that basis. But despite limited information, the belief that fat returns or appears elsewhere after liposuction persists.
The most definitive study to date on this topic appeared in the August 2012 issue of Plastic and Reconstructive Surgery entitled ‘ Photographic Measurements in 301 Cases of Liposuction and Abdominoplasty Reveal Fat Reduction without Redistribution’. In a prospective manner, over 300 patients from a single plastic surgeon’s practice undergoing liposuction and a tummy tuck were studied using measurements and standardized photos both before and at least 3 months after surgery. Upper body measurements were compared between women who underwent simultaneous breast surgery and a group of women that had breast surgery alone to determine whether fat redistribution occurs.
The study results show that the average weight change was just over 2 lbs after lower body liposuction and 4.5 lbs when combined with a tummy tuck. Liposuction was shown to reduce the circumferential width of the abdomen, thighs, knee and arm. To no surprise, width reduction of the abdomen and hips was more effectively achieved when liposuction was combined with a tummy tuck. There was no difference in upper body measurements when the body contouring patients were compared to women who only had cosmetic breast surgery alone. For those patients that were followed at one year and beyond (15% of study patients), there was no evidence of fat re-accumulation.
Despite the common belief that liposuction results may not be stable or that fat shifts around and accumulates elsewhere, this significant study provides evidence to the contrary. Liposuction results can be stable and upholds a preoperative advisory given by many plastic surgeons that weight control equals stability of liposuction results. But fat accumulating elsewhere because it was taken from one location has yet to be supported by high volume patient studies.
Dr. Barry Eppley
Indianapolis, Indiana