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Judith J. Wurtman, PhD

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Liposuction: The Fat Cells That Never Let Go

Posted: 05/04/11 01:07 PM ET

Since there is no magic pill that will make us thin, the next best thing seems to be sucking fat out of our bodies. No machine exists, yet, that passes a wand over our fat thighs, bellies and spare tire and vaporizes the offensive fat. Liposuction is about the best cosmetic surgery can offer, and its popularity attests to the effectiveness of the procedure in contouring bodies to our specifications, rather than the geography of our fat deposits.

But alas, liposuction has now been shown to be as impermanent as a quick weight-loss diet in keeping us thin. The New York Times recently described the results of a study published in the journal Obesity. Conducted last fall, the study revealed that that a year after liposuction removed fat, it came back. And horrors of horrors, it reappeared mostly in the upper abdomen, shoulders and triceps (the back of the arms).

The image is appalling and sounds like something out of a bad science fiction movie. The researchers explained that the fat did not appear again in the area from which it was removed because the fat cells there were destroyed. But, like water during a rainstorm seeking a dry creek to fill, the new fat being made by the body sought out fat cells in other parts of the body, often some distance away from the fat cells that had been sucked out. Presumably--and this is painful to contemplate--if one had liposuction in all the traditional areas where fat is usually deposited (and we all are familiar with those places), then the new fat might seek out fat cells in places where it normally doesn't go, including the face and head. "Fat head" might not just be a term of derision but also a description of new fat deposits.

Still, the study was misleading. The subtitle to the piece stated: "A study on liposuction confirms the patient's worst fears: that weight loss is temporary."

Weight loss? From liposuction? How much weight could one lose from liposuction? Three pounds, maybe five pounds? I doubt that any patient truly believes that suctioning out fat deposits from her thighs or belly is going to do anything more than sculpt her body into a shape she is pleased with. Does any woman regard liposuction as the answer to dropping from a size 14 to a size 4 in an afternoon?

Many people who opt for liposuction have already lost weight, dropped to an acceptable clothing size, watch what they eat and exercise regularly. They may trek to a liposuction specialist because, despite their best efforts, they don't like the way they look in a bikini.

However, the study does pose an important warning to people who may fail to maintain their weight loss after liposuction -- they erroneously believe they won't have to worry because their fat is gone forever.

According to the Dr. Rudolph Leibel, a medical researcher quoted in the article, fat cells are continuously made because the life span of a fat cell is about seven years. The new ones are just as eager to fill up with fat as the ones they have replaced. Some obesity researchers believe this may be why it is so hard to deviate from a set weight, no matter how many times we attempt to get thinner. Unless the ex-dieter is exceptionally vigilant about calorie consumption and maintaining a vigorous exercise schedule, weight will be regained and the fat cells filled once more.

Certainly numerous studies have discouraged us with the statistics on weight gain after the end of the diet. Reading them can lead to the decision to keep pre-diet clothes because they probably will, unfortunately, fit again.

So should people opting for liposuction be asked to sign a consent form agreeing not to be upset if, a year or so after the operation, fat appears in awkward places? Or should the operation be off-limits to anyone who has not been able to maintain an appropriate weight for, say, five years after the end of a diet? At the very least, the interested patient must be told that liposuction does not equal substantial weight loss, and that weight gain equals new fat deposits.

There is something else the article did not mention. People who resist the weight-loss process might feel that a fat-removing procedure gives them a head start on looking thinner. Knowing that the mirror will show sleeker thighs or a flatter tummy (after the swelling goes down) might motivate some to take on a long diet and commitment to exercise. Liposuction might be the push that gets them started, but they must be told that suctioning out fat does not remove the reasons they gained their weight or eliminate the reasons they may gain it again. Otherwise, they will be doomed to disappointment--and more fat.

 

Follow Judith J. Wurtman, PhD on Twitter: www.twitter.com/@stopmed_wt_gai

Since there is no magic pill that will make us thin, the next best thing seems to be sucking fat out of our bodies. No machine exists, yet, that passes a wand over our fat thighs, bellies and spare ti...
Since there is no magic pill that will make us thin, the next best thing seems to be sucking fat out of our bodies. No machine exists, yet, that passes a wand over our fat thighs, bellies and spare ti...
 
 
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03:51 PM on 05/19/2011
Great points! I'm the Medical Director for a laser liposuction facility, and our typical patient is already living a healthy lifestyle. We believe that it's important to communicate to our patients that the work isn't over when the procedure and recovery are complete. Keeping the body they want requires effort as well. We also don't measure the success of the procedure by pounds lost. As you said, this type of procedure is not intended to result in significant weight loss, but rather to sculpt certain problem areas. This is how we measure success: ar.gy/N4w Thanks for the article.
11:57 AM on 05/17/2011
Rather than getting lipo, it seems a better solution to long term fat loss is getting your mind in the right place and following a reduced calorie/fitness regimen.
As a psychotherapist, and avid fitness/health enthusiast, I know firsthand the benefits of mind body connection to fat loss. We have to get our mind-set in the right place before we can ever hope to achieve that ultimate body and optimum fitness for the long term.

After working with many clients in my therapy office, and teaching yoga and fitness classes, my partner, Demi Langford and I have developed a system of tools and secrets to help our clients align their minds and bodies to optimal fat loss.

Your mind is more powerful than any muscle in your body. We’ve all heard about what and how to eat and how to exercise. That’s essential information, for sure, BUT none of it will work, especially in the long term, unless your mind is in the right place.

Many Thanks,
Sunny Strasburg, MA, LMFTI
09:50 AM on 05/10/2011
I had liposuction of the abdomen about four years ago. My weight redistribution problem has pretty much ruined my looks. I wanted to counter a few things people have said: M Dwayne wrote that “weight gain is a result of behavioral issues”. While that’s true, in general, I don’t think that it's the case here. It is pretty well accepted among animal researchers that lipectomy (fat removal) results in compensatory weight gain in other areas. Additionally, the women in this study agreed to not change their lifestyle. When you write of the “lack of behavioral therapy”, you’re blaming the patient when the blame needs to be squarely on the procedure.
I'm glad someone wrote about informed consent, but even then, the language is not accurate. There have been many reports (I’m one of them) of an increased propensity to gain weight after the procedure. It’s like the body wants to hold onto as much fat as possible now that we’ve sucked some of it away. The statement implies that it's the patient's fault, not the procedure's.
Regarding the implausibility of this, the animal studies have repeatedly shown that fat depots increase after fat removal.
Nelson Montana, you are incorrect when you say that fat cells cannot multiply. That has been the conventional thinking, but the lipectomy animal studies have shown that the remaining fat can indeed multiply.
I doubt that this study will change things much. It’s sad.
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x men
06:03 PM on 05/06/2011
I am very slim. My secret? I eat breakfast at 7. A bowl of cereal with fruit, coffee and half a glass of fruit juice and a slice of cheese. Then I am hungry at 10:00 when I eat my lunch slowly: grilled turkey and cheese and a bag of chips. I have an apple around 2-3:00. Dinner is usually something like chicken and rice. I hate vegetables. I find a couple of tablespoons of ice-cream more than satisfies the ice cream urge.

Done!
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ruffmama
your ad here.....inquire within.
03:43 PM on 05/06/2011
well let me know when they figure out how to take it off my thighs and get it come back on my boobs! :D
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Michael Dayne
01:34 PM on 05/05/2011
Anyone who has done any research about liposuction knows that it is best suited for particular areas of fat repository, such as love handles, and is not a substitute for weightloss in general. Weight gain, or more appropriately, fat gain, in individuals is the result of behavioral issues that compel individuals to treat themselves in a less than optimum manner. Without appropriate behavioral therapy coupled with individually tailored diet and exercise programs designed to reduce body fat, there is simply no effective, permanent way to reduce.
01:28 PM on 05/05/2011
Why do we still call the necessary permanent changes in eating habits 'diet'? By definition dieting does not work in the long term: once we go back to soda refills and bacon-wrapped pork chops, our formerly decreased weight reacts accordingly. There is so much negative perception attached to giving up redundant calories! The secret to staying fit is that once you're tuned to your body, eating right feels best. The same mental hurdles apply to exercise - the right exercise routine makes you feel on top of the world good, while so many people struggle with the perception that exercising is torture. Usually it's a pile of excuses why they cannot exercise or eat right which somehow becomes a conclusion that exercising and eating right does not work. I find it hard to believe that people unjustly disappointed in the effect of adjusting exercising/eating habits and as a result turned to liposuction, would suddenly believe in the benefit of good eating habits and exercising once the operation is over.
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Sarah Trickey
love, luck and lollipops. Narf!
11:59 AM on 05/05/2011
Great article. I find it interesting that 'the fat comeback' would surprise anyone. Of course a nutritious diet and regular excercise are required for body maintenance. I am not one to run, I prefer walking and ashtanga yoga, which are perfect for me. I have difficulty keeping my weight 'up' and no problems whatsoever in losing, which might change when I reach age 40 in a few years though I won't hold my breath. I think education on what is nutritious and how to cook effectively, as well as self-experimentation regarding excercise would be far more effective than any surgery could possibly offer.
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Michael Dayne
01:37 PM on 05/05/2011
Sadly the diet industry produces so much media snake oil that it is hard for the average person to educate themselves to what actually works and what doesn't. As long as the Jenny Craigs, Weightwatchers and Nutrisystems of the diet world exist, people will continue to flock toward hopeless programs that exist only to make profits for the corporations behind them and offer little in the way of pertinent, cogent information on weightloss.
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bobclapp1936
10:48 AM on 05/05/2011
Nutrition and Exercise are the dynamic duo that can NOT be defeated.
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LINY01
Kind Thoughts lead to Kind Words
12:26 PM on 05/05/2011
Jack LaLanne said it best: Exercise is King and nutrition is Queen.
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bobclapp1936
01:04 PM on 05/05/2011
Right on!!
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Michael Dayne
01:38 PM on 05/05/2011
Without behavioral therapy, as well, most are doomed to regain any weight lost on a limited program of diet and exercise.
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bobclapp1936
02:15 PM on 05/05/2011
Be TRUE to the mirror and the scale and it's a piece of "cake" so to speak.
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EJD1208
wash your hands
10:29 AM on 05/05/2011
You have to eat right and work out...it has to be a lifestyle change. Sigh. Do as I say, not as I do. When I was 25 it was so easy to think that- fast forward a decade and a child and gets more difficult (less time, less energy). Those are my excuses.

I guess my #1 goal is to just not be a prisoner to my body. I want to be able to move and not be home bound due to illness brought on by obesity. I don't want to die at 55 of a heart attack or stroke. I also want to be in tune with my body, so if an illness does set in, I can be aware of it early on.

None of those things equate with being skinny. Being thin is unattractive if you're just all kind of saggy...
09:24 AM on 05/05/2011
There is no replacement of a healthy life style + some sport. It only requires lots of determination and strong will and that makes it such a hard pill for so many.
01:22 AM on 05/05/2011
There IS a proven, 3-step method of non-surgical weight loss.
R
U
N
04:23 AM on 05/05/2011
Actually if you are overweight rather walk, running is way to hard on your joints..
10:33 AM on 05/05/2011
I have degenerative arthritis that prevents me from running, but I get your point.
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Johnny Steps
I'd rather waltz than just walk through the forest
12:48 AM on 05/05/2011
Dr. Wurtman is correct in more ways than she realizes, because fat is not the only thing that comes back. If you think losing that 100 lbs and looking good get will get rid of your depression, anxiety, self loathing, insecurity, then you have no idea what you are in for.
03:28 AM on 05/05/2011
Losing 100 lbs may lead to more sex, in turn curing depression, anxiety, self loathing, insecurity ...
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Johnny Steps
I'd rather waltz than just walk through the forest
06:13 PM on 05/05/2011
I don't think sex can cure depression, perhaps the relationships and attention accompanying sex.
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TXfemmom
Grandma with eye on the future
12:32 AM on 05/05/2011
If people get lipo of the abdomen and certain areas, and then gain weight, it is going to go to the fat cells which remain.  That isn't any news.  The only lipo I would consider if the very refined and small amounts of fat destruction associated with laser use in which the cells are destroyed and the fat either slips out the small holes made for the instruments or is slowly absorbed.  It is particulary good on jowls and double chins and on necks.  The healing process also usually leads to tightening of the overlying skin.
 
I gave anesthesia for many liposuctions and sometimes they removed tremendous amounts of fat.  the ones which worked best were the ones where the person had a genetic pouch or area which wasn't huge, but made a big difference in appearance.  I had a friend who had unusual fat deposits on and around her knees and the back of her knees.  She had lipo done in a very conservative manner and it helped so much.  The entire amount of fat removed did not come to that much, but because the deposits were unusual and detracted from a very attractive person, it made a big difference for her.
 
One needs to understand that there are tremendous risks and tremendous complications which can and do occur with liposuction.  Be conservative folks, start with an area which will give you a lot of satisfaction and be noticeable, and then give it some time.  Just that one area can make enough of a difference to be very happy and then this kind of hump and bump thing in other areas is unlikely to occur.
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rosey7
11:06 PM on 05/04/2011
Well, a friend of mine had lipo and the fat came back as big breasts. Pretty funny!
03:47 AM on 05/05/2011
This is a woman we are talking about? :)
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rosey7
12:26 PM on 05/05/2011
spiromilhous, yes, it's a woman, but her breasts are cartoon big now and she needs a reduction.