Liposuction is ideally used to reduce spot areas of fat excess in the trunk and neck. In a perfect world, it is done exclusively in patients that have maximized their weight loss through diet and exercise and are at or near their ideal body weight. In reality, not all liposuction patients fit these preoperative criteria. Some patients are looking for more circumferential abdominal and trunk reduction and may be looking for a jumpstart to continue with their lifestyle efforts. Maintenance of body contouring changes and fat reduction is also a concern for many liposuction patients.
Return of fat after liposuction, contrary to what patients would like to believe, is not rare. It is a myth that fat will not return to a body area that has been treated with liposuction, particularly in the trunk area. (abdomen, waistline, flank and back) In my Indianapolis plastic surgery practice, I tell patients that if you can keep your weight stable after liposuction then you will keep the fat from coming back. But if you gain significant weight (greater than 10 lbs), it has to go somewhere.
Managing or continuing with weight loss after liposuction surgery can be done with short-term weight loss medications. I do not prefer to use the typical metabolic-increasing medications that are all derivatives of phenteramine, such as Adipex. While they may be effective, they have more side effects and the risk of dependency. Safer and equally effective medications are Topamax and Zonegran.
Topamax is an anticonvulsant drug that is most well known in the treatment of migraines. It is really a sugar molecule (monosaccharide related to fructose) that has sulfa-like molecules attached. Topamax has a complex mechanism of action but why it works for weight loss is not precisely known. Weight loss is one of its known side effects and is how it has become known for that use. I usually start patients out on 25mg per day for a few weeks and then increase the dose up to 100mg per day. This is a very low dose compared to how it is used to treat other medical problems. Topamax should not be used in someone who has a known sulfa allergy. Side effects of note include cognitive issues (memory loss) and the formation of renal stones, although the low doses used do not make these a common problem. Patients should be drinking four to six glasses of water a day on any weight loss problem and this is also preventative for kidney stones.
Zonegran is another anticonvulsant drug that also has a sulfa molecule attached to it. Some refer to it as a new and improved Topamax. Sulfa allergies and concerns about the formation of kidney stones are similar. Zonegran is used by neurologists to treat nerve pain and the side effect of weight loss was observed, leading it to be become used for weight loss about five years ago. It is reported to be very effective for sweet cravings, pop drinking and binge eating. I have patients start off with one 25 to 50 mg pill, then increase the dose slowly up to 100 mg every other night for one week and then increase to one every night. The higher the dose, the more the appetite is suppressed.
Both Topamax and Zonegran provide a short-term medication use for continued weight loss after liposuction. Select patients are started on one or the other beginning three weeks after liposuction and given a three month treatment course. Thereafter their continued pharmacologic component of their weight loss program is turned over to a weight loss specialist. Lifestyle changes are an important element after surgery as is the required daily water intake.
This limited pharmacologic approach to augmenting the effects of continued weight loss after liposuction is very helpful for some patients. While plastic surgeons are not weight loss experts, and liposuction is not a weight loss method, body contouring and weight loss/maintenance are nonetheless often intertwined.
Dr. Barry Eppley
Indianapolis, Indiana