Will Fat Come Back To Body Areas Treated By Liposuction?

Q: Dr. Eppley, I am interested in liposuction of multiple body areas including the abdomen, love handles, thighs and knees. But I have a few questions that I hope you can answer for me.

1. As I age, if I gain a bit of weight (I’ve been within these same 20 pounds since I was a late teenager—I don’t intend to go out and purposely gain weight!), where will it go? One plastic surgeon told me since he’d “be removing all the fat cells” from under my breasts to my knees that the fat couldn’t return there, but would go to my bottom or my breasts. Now that we’re doubting most things he told us, can you please confirm or deny this?

2. Does doing this liposuction once mean I’ll need to do it again in years to come because it will look unnatural or lumpy when I’m 65, 75, etc? How will things “settle?” I guess I’m unsure of the “deconstruction” you’re doing and how naturally my body will function afterward (and years later as my life goes on).

3. I read your packet of information and wonder about revision surgery. I certainly know you can’t tell me I would never need it, but I do know you said I am a rare “good candidate” for his procedure. I’m hoping this fact significantly reduces the possibility for needing revision surgery. Your packet says roughly 15% of patients need it. I’m just curious where you think my risk for that lies (of course, I know there’s always at least a little risk).

4. Will the sudden removal of this fat have negative implications for my metabolism? Does fat secrete the hormone that controls metabolism? What happens if a lot of that fat is suddenly gone?

A: Your questions are all good ones about liposuction and many of them touch on the basic science of fat metabolism. While fat has been studied for over 100 years, it is still not a body tissue that is completely understood and it is more than just a blob of fat tissue that sits there only to accumulate excess calories. It is best thought of as a dynamic organ with complex metabolic and hormonal functions. How the removal of some body fat by liposuction affects its functions beyond a simple contour change is, again, incompletely understood. In answer to your questions:

Liposuction does not and can not remove all fat cells from any body area, that is an impossibility. Some fat cells (and probably more than just some) always remain in the liposuction treated area. There is just less fat cells than there were and that is why the body contour is less full or convex. If one does gain weight in the future, the treated area can change because the existing fat cells can accumulate more fat. (the cells get bigger) One can not grow more fat cells but the existing cells can themselves get bigger. Whether excess ‘calories’ will be prone to be deposited from whence it was removed or whether it goes elsewhere differs for each individual. Ultimately it has to somewhere so the long-term sustainability of a liposuction result is highly dependent on the stability of one’s weight.
The contour results from a liposuction procedure are generally fully known by three months after the procedure. This reflects the final external appearance of the evenness of the fat removed. It is not an issue where it continues to change or settle for years.
Being a good candidate for liposuction means that the quality of the overlying skin is good (has the ability to shrink down to a lesser contour after the procedure) and the fat is not too excessive that a good result can be obtained. Unfortunately being a great candidate for liposuction does not preclude the possibility of revisional surgery although it may make that risk less. Revisional surgery in liposuction is almost always done to even out any irregularities or asymmetries in the treated areas. In my experience, some small touch-ups may be desired in about 10% to 15% of all liposuction patients.
The amount of fat removed in liposuction is rarely ever enough to have any impact on one’s metabolism. If this were true, many diabetic patients would be treated by liposuction to lower or eliminate their insulin needs.

Dr. Barry Eppley

Indianapolis, Indiana