The Biology of Fat and Liposuction

Fat is one of those topics that we hear too much about and want as little to do with as possible. Most people feel like they have a little or maybe a lot too much. For some, fat is a definite the enemy that makes the choice between what tastes good and one’s waistline a difficult one.

When thinking of fat, it is almost always perceived as this blob of yellow jelly-like stuff that just sits there without much purpose. This collection of extraneous lipids and carbohydrates appears as nothing more than a piggybank of kitchen and restaurant memories. The reality is quite the contrary, however, as fat is really a dynamic body tissue that is a lot more active than it looks. And it has different bodily functions than just being an annoyance.

Seeing patients daily who have chosen to finally battle their fat with plastic surgery, I get to hear a lot of personal stories and insights into how fat is perceived and what is believed to get rid of it.    Such experiences have prompted me to write a little mini-tutorial on one aspect of the biology of fat and body contouring.While fat may look the same throughout the body, it is actually quite different in structure. The size of fat globules, for instance, is quite different from that of the abdomen (big) versus that of the face or neck. (small) This is clearly evident when performing a tummy tuck versus a facelift. Because structure follows function in nature, it should be not surprise that the role of fat in the two places is different. Fat in the abdomen and waistline (men and women) and in the buttocks and thighs (just women) is depot fat. These are the primary storage areas and they offer a good central location with a lot of storage capacity. Fat in the extremities and the face and neck is largely insulating fat. Yes you can accumulate there but it is harder than storing it in your trunk regions.

This may be interesting biology but how is it relevant? While diet and exercise is a great first line of fat defense, it will not spot reduce any single area. And it does not work well on peripheral insulating fat areas. You can reduce tummy fat but it is virtually impossible to do the same with arm, neck or knee fat for example. And that flank or back fat is just about as stubborn. (it has smaller fat globules as well even though it is a trunk area) You can do all the crunches and twists that you want (and it is worth giving it a try first) but core fat reduction comes from overall weight loss. Spot or resistant fat reduction is most effectively reduced by liposuction, a focused fat removal method.

Will fat return after liposuction? The parallel question is will fat return after weight loss? Yes but the difference lies in what body areas are being treated. Depot fat site removal can return just like  that of weight loss. But peripheral or insulating fat site removal is much more difficult (not a primary depot site) and those results are more likely to persist over time.

Dr. Barry Eppley

Indianapolis Indiana