Liposuction does not permanently remove fat

Due to the increasing obsession with quick solutions to excess fat mass, liposuction has become one of the most popular cosmetic procedures.

And as far as simply removing large volumes of subcutaneous fat from one’s body, it just may be the most effective method – certainly, far superior to diet/exercise or bariatric surgery.

But there are a few catches.

As I have previously discussed, in contrast to losing weight via lifestyle modification or bariatric surgery, liposuction does not make an obese person healthier.  In fact, the removal of benign subcutaneous fat stores may actually make you worse off in terms of metabolic health.

Also, as I suggested in an earlier post, there was some very preliminary evidence suggesting that after the removal of fat from the buttocks, thighs, and abdomen, women see a compensatory increase in the fat deposition in other places – namely, their breasts. A 2-for-1 deal, if you will.

However, a hot-off-the-press study by Hernandez and colleagues suggests something less ideal than this scenario. Indeed, the authors found that a year after liposuction was performed the fat initially removed is basically all replaced, but not necessarily where you’d want it to go.

Specifically, while fat removed from the thighs and buttocks tended to stay ‘off’, abdominal fat increased to essentially compensate for any initial fat reduction (regardless of whether or not abdominal fat was removed during the procedure). There was a particularly significant growth of fat in the visceral depot.

So, essentially liposuction can permanently reduce fat stores in areas that may be beneficial to metabolic health (butt, hips and thighs) but increase fat stores in areas known to lead to metabolic problems (abdominal, specifically visceral fat).

Not good.

Finally, as was suggested by other studies, the women who underwent liposuction in the current study did not experience any metabolic benefits from the procedure.

To sum up, liposuction will:

1) not improve your health

2) not permanently reduce fat mass

3) redistribute body fat from good to bad areas of your body

Peter

Hernandez, T., Kittelson, J., Law, C., Ketch, L., Stob, N., Lindstrom, R., Scherzinger, A., Stamm, E., & Eckel, R. (2011). Fat Redistribution Following Suction Lipectomy: Defense of Body Fat and Patterns of Restoration Obesity DOI: 10.1038/oby.2011.64

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19 Responses to Liposuction does not permanently remove fat

  1. Dave Bridges says:

    What about the substantial improvements in insulin action and glucose homeostasis with bariatric surgery? I had thought that the improvements were first due to fat loss (like liposuction) followed by improvements in insulin sensitivity. I guess this means that bariatric surgery’s mechanisms must be independent of omental fat reductions.

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  2. Hi Dave,

    Good point. There is a very important distinction between the surgical removal of fat (taking out fat cells) and the reduction of fat through weight loss (reduction in the size of fat cells). Simply removing a bunch of fat cells does not make the remaining ones any more functional – in fact they may have to deal with a greater relative load of excess calories per given cell. On the other hand a negative energy balance (whether diet/exercise or bariatric surgery) will make all fat cells smaller and thus more metabolically functional. The latter scenario would improve insulin sensitivity while the former would not.

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    • David A. says:

      This is a terrific post that we will be sharing on our social media sites Peter. People seldom understand that storing fat is somewhat of an evolutionary necessity, that it can actually help regulate other aspects of body function (something we have written about as well). The elimination of fat cells could lead to the storage of fat in other, more dangerous areas of the body.

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  3. SurgPA says:

    Dave,

    Actually, the improvement in glucose homeostasis following *some* bariatric surgeries is unrelated to body fat. Following gastric bypass and sleeve gastrectomy (but not gastric banding aka LapBand) there is an overnight dramatic improvement in glucose levels. Patients who come to surgery on 2 oral agents +/- insulin frequently go home off-meds with normal glucose levels. They didn’t lose any fat overnight; current hypothesis is a neurohormonal mechanism involving grehlin. Interestingly, gastric banding does not yield the same overnight results; unlike the other two procedures, the surface area in contact with food is not dramatically reduced. The improvement in diabetic parameters with lap band is only seen after some element of weight loss.

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  9. Sarah says:

    Anecdotally I know this to be true. No lipo, but for sure had some fat removed with my excess skin (panniculectomy and abdominplasty in ’09 and thigh lipectomy in ’10) Watching the fat cells in my ARMS puff up and deflate with a few pounds on either side of my happy range was unexpected. Wish it was in my boobs! Alas.

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  10. WRG says:

    My neighbour died of a botched liposuction procedure. Too bad this kind of information was/is not more widely disseminated.

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  12. tom says:

    well that is surprising for me

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  14. Alex says:

    I agree that fat removed from one area will tend to redistribute to other areas. I also agree that visceral abdominal fat is correlated to worse long term health outcomes. However, this relationship is not cause and effect. No one has done a study to show that fat redistribution leads to worse health outcomes. This may be a chicken and egg phenomenon. Is it the propensity to build up visceral fat that leads to the worse health outcomes? Or is the lifestyle habits that lead to the visceral fat that cause the problem by coincidence rather than cause? So increased visceral fat redistribution caused by liposuction that does not change genetics or habits may or may not lead to a change in health outcomes. Patients should always modify their caloric intake and exercise to maintain and lower total body fat index after liposuction in order to avoid redistribution of fat.

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  18. Interesting article regarding liposuction. It is a good option for certain patients and the results can be long lasting. I always recommend to my patients that they follow a healthy lifestyle including eating the right foods and the right exercise program following their lipo procedure.

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