Dermatologists respond to results of study analyzing return of fat after liposuction

July 1, 2011

On Call wondered whether dermatologists who have been performing liposuction for decades have witnessed the phenomenon of fat returning to other parts of the body in their patients. Most of the doctors had more of an issue with the concept of the inevitability of the fat returning than with the location of its redistribution.

Key Points

Now, a study out of the University of Colorado contends that healthy women who have low-volume liposuction of the thighs and maintain the same lifestyle after surgery experience a return of the fat to other parts of the body within a year - primarily the abdomen but also the back and arms.

The researchers say that no study to date has looked at whether fat returned after liposuction, or where it returns. They contend that contrary to popular belief, liposuction results are not permanent, and that adipose tissue returns to its original level after surgical removal (although it may be redistributed). The study says that an undefined physiologic mechanism seems to restore "the surgically induced imbalance between adipose tissue and fat-free mass."

On Call wondered whether dermatologists who have been performing liposuction for 10, 20 and 30 years witnessed this phenomenon in their liposuction patients. In all reality, most of the doctors had more of an issue with the concept of the inevitability of the fat returning than with the location of its redistribution.

'Ridiculous' study

In Chicago, Edward Lack, M.D., a dermatologist for 38 years, was blunt in his assessment of the study.

"It's ridiculous. It was a poorly done study with specious reasoning and extremely self-serving. They started out with the conclusion and then worked to prove their conclusion was right," he says.

"This study looked at what they call small-volume liposuction, which studies done over a 30-year period of time show do not alter metabolism and do not alter insulin resistance," he says. "Therefore, it's not relevant. They noted small changes, which easily are correlated to changes in lifestyle and also related to people getting older."

Past-president of the American Academy of Cosmetic Surgery, Dr. Lack likened this study to one in the 1990s that cited lidocaine-overdose deaths. "We proved those patients had died of things like pulmonary embolisms because they were lying around in the hospital, but it took years to have that recognized," he says.

Clinical insignificance

Other dermatologists were a bit more restrained but no less skeptical about results they've never seen. Robert C. Langdon, M.D., of Guilford, Conn., has been doing liposuction for 16 years. He says it could be the way one looks at the study results, but it isn't something he considers to be an issue.

"As a problem, it's clinically insignificant," he says. "I do liposuction and people don't come back a few years later saying the fat has all returned, so that's a mystery to me. The other thing, to my understanding, is that of the patients who underwent liposuction, a high percentage of them were happy with the results and would do it again.

"Liposuction isn't a weight-loss program. It's (for) specific problem areas, the outer or inner part of the thigh, and abdominal areas. Compared to the total fat load, you're actually doing this on a relatively small area," Dr. Langdon says. "Even if patients get new fat elsewhere, they're getting it all over the place. It shouldn't be enough to be noticeable, unless you do very sensitive measurements like this study."