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The dark side of liposuction

Liposuction is a cosmetic surgery procedure that removes excess fat from different areas on the body, including thighs, buttocks, abdomen, upper arms and neck. It sculpts the body, making its contours more aesthetically appealing and eliminating unsightly pockets of fat.

The results of liposuction are virtually immediate and often dramatic. For a few thousand dollars, your excess thigh fat, or belly fat, or love handles can be gone tomorrow. Perhaps you donít have to skip ice cream or crispy fries after all. And if they end up on your thighs again, youíd just need to find a few more thousand smackers for another liposuction, right? Well, many people appear to think so -- almost half a million liposuctions are performed in the US each year. But it appears that there is no free lunch as far as liposuction is concerned -- or at least no free lunch that wonít go to your thighs or belly.

You probably think I am talking about the possible risks and side effects of surgery Ė after all liposuction is an invasive surgical procedure typically performed under general anesthesia (see our article on liposuction). While these are real concerns, serious side effects affect a relatively small percentage of people undergoing liposuction; most people are believed to get good results without any downside except for the expense.

But recent research indicates that liposuction also has a not-so-obvious downside affecting most if not all of the subjects. The fat comes back within about a year. The reason this effect was hard to spot sooner is that the "returning" fat seems to be distributed differently. For instance, the fat sucked out of a thigh would mainly "return" to the abdomen, upper arms, and shoulders.

This "return-of-the-living-fat" phenomenon was a subject of the study conducted by Dr. Teri Hernandez and colleagues at the University of Colorado and published in the journal Obesity in July 2011. The study involved healthy non-obese women with prominent fat deposits in thighs. The study was randomized (one of the indicators of good design), i.e. half of the women were randomly assigned to have liposuction (in thigh area), while others served as untreated controls. After the liposuction, as expected, the women who underwent liposuction had reduction in both the percentage of overall body fat and the amount of thigh fat. However, within a year, the percentage of body fat in the liposuction group approached the pre-treatment levels. Notably, in the liposuction group, thigh fat remained reduced after one year whereas fat in the abdominal area (and possibly elsewhere) modestly increased.

Dr. Felmont Eaves III, the president of the American Society for Aesthetic Plastic Surgery has called the results surprising (according to The New York Times). I have to stress that a single clinical study, even if properly conducted, is usually insufficient to firmly establish a medical fact. But assuming this phenomenon is real, I would not consider it particularly surprising. In fact, it is in line with the key principle of physiology called homeostasis.

Essentially, homeostasis is a proper balance of the organism's internal environment. To be able to function normally, the body needs its physiological parameters to be within a certain optimal range: the temperature should be about 37oC (98.6F), blood pressure about 120/80, blood sugar 70-120 mg/dl, and so forth. Homeostasis is a tendency of the system to maintain internal stability, which involves keeping dozens of physiological parameters within an optimal range. The body fat content is likely to be one of the key homeostatic parameters and is carefully balanced with related parameters, such as food intake and energy expenditure. If homeostasis is disrupted by liposuction, the body will likely attempt to restore the balance in some way. The question is: How?

The bodyís endocrine system appears to monitor the size of fat stores by sampling the bloodstream for hormones released by fat cells, most notably leptin. On the other hand, it does not seem to track the specific contribution of each body part to the level of leptin. If some of the thigh fat is gone, the endocrine system would "know" that some fat is missing but not the exact location of the lost fat. The likely upshot is that the body would attempt to restore its fat content by simply telling all the remaining fat depots to accumulate some extra fat. Besides, it is possible that liposuction destroys the connective tissue scaffolding required for growing new fat cells, which makes it harder for fat to return to the treated area. All in all, it is actually plausible rather than surprising that the sucked-out fat comes back but is distributed differently than before. Still, even a plausible single result needs to be confirmed by other studies.

Assuming future studies verify Dr. Hernandezís findings, what would this mean in practice for people considering liposuction? At a minimum, it would mean that liposuction should not be considered a tool for weight loss. Medical professionals generally do not recommend using liposuction for the purposes of weight loss anyway. And yet some people view liposuction as a backup weight loss plan. Dr. Hernandezís study points to the folly of such attitude.

What about the esthetic value of liposuction in the light of the return of the fat? Notably, after Dr. Hernandezís study had ended, the women who had liposuction were still happy with the results. They valued the improvement in the shape of their thighs. Furthermore, half of the women in the control group chose to have liposuction later on, fully aware of the study results. It appears that many women value liposuction as a body contouring procedure (rather than a weight loss tool) and may be willing to live with mild fat gain throughout the body for the sake of losing fat in a particular problem area. Thus, even if the results of Dr. Hernandezís study are fully validated by others, liposuction will likely retain its utility as a body contouring procedure -- albeit with a downside of mild compensatory fat gain in untreated areas.

So, if you still wish to consider liposuction, do it for the right reasons. Keep in mind that it cannot replace a trip to a gym or offset unhealthy eating habits.


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