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Liposuction: Making the Decision

Many people develop stubborn fatty deposits — like in the buttocks or upper thighs, or the so-called "love handles" — that are resistant to dieting and exercise. And although most people would admit to wanting to reshape their body in some way, not everyone makes an ideal liposuction candidate, says Daniel Morello, M.D., president of the American Society for Aesthetic Plastic Surgery. Morello stresses that liposuction is for body contouring, not weight reduction. "It is designed for removing localized areas of fatty tissues — not as a substitute for proper dietary management and exercise."

But what happens to the mildly to seriously overweight people who want and get liposuction? Sometimes after the surgery, these people may face yet another unwanted — and possibly unexpected — complication: the return of fatty deposits.

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But probably in other areas of the body, says C. Wayne Callaway, M.D., an associate clinical professor of medicine at George Washington University. Callaway, who is also an internist, endocrinologist, and obesity specialist in Washington, D.C., sees post-liposuction patients complaining of renewed accumulations of fat.

Animal studies have shown that if you remove significant amounts of fat from one area, body fat increases elsewhere, according to Callaway. "The signal is leptin, a hormone made in fat cells," he says. "The more fat you have, the more leptin is made...and if a large amount of fat is removed, there is a drop in leptin levels." In animal studies, this drop in leptin levels results in an increase in food intake and a decrease in activity until the leptin levels are up again, according to Callaway.

Callaway says that the people who have the most trouble after a liposuction procedure are the really obese who have had large amounts of fat removed. "They have a compensatory increase in new fat cells," Callaway says. "And fat goes to areas where there are still a lot of fat cells. So that means to the neck, above collar bones, and the upper abdomen."

Besides, he adds, abdominal obesity is controlled by a whole other set of signals, so that even after liposuction, the underlying causes for obesity remain. "Those causes are not addressed by taking out fat cells." He points out that, contrary to recent theories, "One can keep making new fat cells throughout life, so little can be gained by liposuction."

Liposuction for obese patients is "a prescription for disaster," according to Gerald Imber, M.D., a plastic surgeon in New York City and clinical assistant professor of plastic surgery at Cornell-Weill Medical College. The greater the volume of fat and tissue fluids, including plasma, that are sucked out, the greater the chance of severe dehydration and electrolyte imbalances.

"When you remove six, eight, or ten liters of mixed fat and water, you are courting disaster," he says. "Liposuction is not meant to change a size 16 to a size 8."

According to a consensus of the experts, the ideal liposuction candidate is a mature adult between the ages of 30 and 50 years old, male or female, in good health, who has dieted and exercised to lose unwanted pounds, with good skin tone, with a set of realistic expectations, and who wants a limited procedure for body contouring.

With Liposuction, Buyer Beware

Anyone considering liposuction should consider all the options, and consumers need to be very careful when selecting a doctor. The saying "caveat emptor" (buyer beware) has never been truer, says Morello. Liposuction sounds so deceptively simple, but in the hands of unskilled doctors, it poses a real threat to people's health, he adds. To complicate matters, anyone with a medical degree can perform liposuction, even with only the briefest weekend training period.

Fighting fat may be the number one battle for many Americans, but liposuction may not be the best weapon to win that slimmer, trimmer body.

Making the Decision About Liposuction

The American Society for Aesthetic Plastic Surgery, offers some guidelines for consumers considering liposuction:

  • Have realistic expectations. Liposuction is for body contouring, recommended for people who want to remove small amounts of fatty deposits. As a general rule, this means the mildly overweight who are within 30 percent of their ideal body weight.
  • Select a surgeon certified by the American Board of Plastic Surgery. Ask for verification in writing of the doctor's privileges to perform lipoplasty in an accredited acute care hospital. (Doctors may have privileges to perform other types of surgeries, but not necessarily liposuction.) If the doctor does the surgery in an office, ask for proof of the facility's accreditation.
  • Give an accurate medical history and be sure to report all medications you take, even dietary and herbal supplements.
  • Discuss the procedure thoroughly with your doctor, and make sure you understand the differences between the various types of liposuction. Ask questions. If your doctor can't answer them, or dismisses them as unimportant, find another doctor.
  • Understand which type of anesthesia is recommended and if that includes deep sedation, be sure that certified staff who have appropriate training will administer it.
  • Discuss pre- and post-operative care, and make sure you understand any possible risks.

Adapted from the November-December, 2000 issue of FDA Consumer

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