Is liposuction just an expensive short-term fix?

Welcome to today’s chat. Today we’ll be talking about liposuction with Dr. Seth Thaller, surgery professor at the University of Miami Medical School.

Unfortunately, Dr. Thaller is running a few minutes late, so feel free to submit your questions now, and we’ll plan to begin the chat around 12:45 p.m. Thanks for your patience.

Welcome once again to today’s chat. We’ve been joined by Dr. Thaller and we’re ready to take your questions.

Hi, I’m Bob LaMendola, health writer at the Sun Sentinel. Our subject today is liposuction.

Dr. Thaller, can you talk about the study that came out a few weeks ago saying that liposuction may not be a permanent solution. In that study, the fat returned from some of the patients. Can you explain a bit about that?

From reading the study from the journal article in my opinon on the surface the study appears extremely interesting and raises some interesting questions that will require more intensive examination with a larger study cohort. This is definitely an area that will require additional evaluation.

What the article speaks about is the redistributrion of fat. There is really nothing about weight. Ir says that the abdominal fat appears at one year to redistribute however there appears to be some improvement in the other areas investigated.

Liposuction should NEVER EVER be performed for weight control and should never supplant healthy lifestyle and diets. It is good for removal of localized deposits in appropriate surgical candidates with good skin turgor and in areas that are generally not amenable to weight loss such as thighs and saddle bags.

No area of cosmetic surgery is the monopoly for women. Men not only undergo liposuction but certainly other cosmetic procedures as well. One area of particular interest to males in liposuction for gynecomastia or enlarged male breasts.

This very well may be due to estrogens. We are actually looking at the effects of estrogens on aging and wound healing in opur basic science lab. Hormones have almost monumental effects on various physiologic processes

In males there may be a similiar hormonal effect on fat distribution

Florida for instance limits the quantities in an outpatient setting. This is really individualized depending on the overall patient status, medical conditons and needs. Yes sometimes it may require serial suction lipectomies. However, it should never be used in lieu of diet or healthy living.

Florida and maybe other states have restricted the amount of fat and liquid that can be removed in liposuction. That was because a few doctors were removing too much and people were having complications.

Suction lipectomy is thought by some in the general public as a routine and low risk procedure. This is not necessarily the case. All surgeries have inherent risks. First the patients should have these procedures performed by competent board certified plastic surgeons. Second they should approach the surgery with the same thought process of any other procedure and do the due diligence.

The case where it might be appropriate is a male with enlarged breasts or gynecomastia. In my opinion, other reason might be for recontsruction or specific indivisual needs. In general for purely cosmetic indicatons, I would be hesitatnt

That is a complex question. I think what is more important is knowing the accreditation status of the clinic and the credentials of your surgeon. I don’t believe you can generalize. Certainly when you are getting into high volume liposuction or there are overiding medical concerns, it might be more prudent to have your surgery within a hospital environment.

As an addendum, often the costs may be higher in a hospital. However, the first concern should always be patient safety. That is best determined by you and your plastic surgeon.

I am not sure that there is absolutely NO Down time with any procedure. I would certainly thoroughly investigate that claim.

This may be what that article is describing or it may be due to hormonal influences.

I personally have not seen that without a coincident weight gain

Maybe this is what the article found. I believe it said that fat returned when the person gained some weight back.

The article seems to state that the fat is redistributed to he abdomen from the thighs. However, it would appear that although the results to the abdomen were transitory @ one year, the thighs appeared to be improved at that point in time. In my own personal opinion, I have always approached liposuction of the abdomen with hesitation because there are generally a number of associated processes going on that need correction or to be addressed in rejuvenation of the abdominal area.

In general the article opens up many areas that require investigation and seems to be well contsructed since it is a perspective double blind study. However even the authors state that there is a small cohort requiring larger groups to investigate. The group is alos limited to pre menopausal females and there are other variables in he study that require closer observation.

No not really. Liposuction can be used in other anatomical areas other than the abdomen. This srudy only addresses a few regions and the redistribution is in the abdomen. The thighs seem to hold up. Perhaps in the future as we do further studies and get better data we may be able to redeefine the use of liposuction and where is is most efficient. So in summary, liposuction in the right individual with the correct expectations right body habitus and appropriate anaatomic needs is a very powerful surgical tool.

I’ll find that for you.

It is published in Obesity 2011. The exact information will be forthcoming

It was in the journal Obesity.

http://www.nature.com/oby/index.html

This should absolutely discussed during the informed consent. Anytime there is new information that gets into the literature, your surgeon has to analyze and discuss with you. More important is that you become an educated consumer and questions your surgeon with this information and have him explain to you

I can’t tell you exactly; however, some times researchers may advertise their needs. If you are near a medical school you might look into the website regarding information about potential studies. You might even mention to your plastic suregeon if that person is on a medical school faculty and may be aware of ongoing studies.

The study made the observation that the fat will come back unless the person changes their lifestyle, in terms of calorie intake and exercise. Does that suggest people should do that before they have the lipo?

Every one should consider the folloiwng before undergoing any cosmetic procedure. They should get to their optimum weight and size. So if theye will be losing weight they should optimize this. Another reality with liposuction is with massive weight loss liposuction might not be indicated because of the vast loss hanging skin. Once undergoing liposuction it is is imortant to mainitain this change towards a healthy lifestyle becuase if weight is gained the fat will certainly re-ccur and be redistributed.

What i mean is that at times a patient will come in for liposuction to improve the appearance of their abdomen. They may have had multiple pregancies massive weight loss etc. In these cases liposuction might be an adjunct but certainly will not address their concerns. These case might require instead tighetning up of te abdomenal muscles and excision of excess skin.

We have about 5 minutes left, so we can take another question or two…

Although in my opinion a good study and certainly a good strating of point for future investigations the study according to the authors had certain limitations. In particular:it was not designed for long term evaluation especially the overall metabolic and cardiovascular effects of the redistribution of fat to the abdominal regions nor could they fully clarify the actual mechanisms causing it. If uncovered they may even make liposuction an even more signficant procedures

I think our time is up. Thanks to everyone for participating. Dr. Thaller, any final thoughts?

I would recommend any one considering undergoing a liposuction procedure to look into possible plastic surgeons through the American Society of Plastic Surgeons website. These physicians have passed rigorous training and should be able to answer any of your questions.

That’s all the time we have for today. Thanks to everyone for participating, and a special thanks to Dr. Thaller for taking time out of his day to be with us.

A transcript of this chat will appear shortly on SunSentinel.com.