The recent article in the journal Obesity, April 2011, entitled “Fat Redistribution Following Suction Lipectomy: Defense of Body Fat and Patterns of Restoration” concludes that body fat becomes redistributed after liposuction. While the authors admit that one of the main limitations of their study is the small sample size of patients being only 14, the results bring up an important truth about the specific role of liposuction surgery. However, while I do and have always agreed about the concept of fat redistribution, I am concerned that the study may be sending the wrong message to prospective patients. That is, liposuction will necessarily cause you to become out of proportion.
For over 18 years I have specialized in liposuction and revision liposuction surgery and have performed this procedure on thousands of patients. Fifty percent of my surgeries today are revision to correct previously substandard results. Much of this involves properly reproportioning patients who have been thrown out of proportion by liposuction when the surgeon did not pay significant attention to only targeting areas of genetic disproportion. This involves a critical evaluation from head to toe by a surgeon who has a great eye for and understanding of what each patient needs to achieve proper balance, contour and proportion. There is no mention of how, if at all, these 14 patients were evaluated prior to surgery to make certain that liposuction was properly targeting disproportion.
Yes, fat cells are storage units that have no inherent intelligence. Their job is to store fat and the body will redistribute. The implication from this study is that it will necessarily store it in a displeasing way. But if the procedure is approached with proper judgment, artistry and technical precision a beautifully balanced, proportionate, well contoured happy patient will be the result.
It has always been my philosophy and experience that liposuction or liposculpture surgery is primarily a reproportioning procedure. It is a procedure to properly identify and target areas of genetically disproportionate storages of fat. Well done liposuction has the power to take a disproportionate patient (regardless of weight) and make them proportionate. Poorly done liposuction, without critical attention to balance and proportion has the unfortunate potential to throw a patient out of proportion. This has been and continues to be my clinical experience with the thousands of patients that I have followed. The results from the fourteen patients in the journal Obesity study are in support of my philosophy and experience. It is just that I question how this one investigator who performed the surgeries determined exactly where and how to target “disproportion” in these patients. Redistribution will take place, but were these patients possibly thrown out of proportion?
To further illustrate the importance of proper evaluation and the dangers of improper evaluation, there is a common almost universal trend that takes place in the initial consultation between a surgeon and a potential patient. As is the case with most cosmetic procedures, doctors ask the patient what they want to do. With liposuction surgery specifically, this is the first mistake. When I evaluate a patient for surgery, I never ask what they want to do. I critically evaluate them from head to toe and make a determination of what areas should be targeted with liposuction to create proper balance and proportion. At first, this may seem impolite and unconventional, but actually it comes from caring and the understanding that it is my job to achieve perfect proportion. The patient may be incorrect about what should be targeted. Unfortunately, what mostly goes on is that the patient says, “I want liposuction to my abdomen” then the surgeon just has the patient lift up their shirt and gives them a price to remove the fat. Well, maybe this patient is simply 25 pounds overweight, yet in proportion, and now the patient is thrown out of proportion. The surgeon has made a proportionate patient disproportionate by not properly evaluating first. This type of patient should never have had liposuction and should have been told to simply lose weight. On the other hand, a thin patient may be a perfect candidate if they have genetically disproportionate areas that don’t respond to diet and exercise. Those disproportionate, stubborn areas are the first to become fat and the last to slim down, if at all, precisely because there are disproportionately too many fat cells in those specific areas. Quite often these patients become too thin in other places in an effort to keep the disproportionate areas down. Properly targeted liposuction corrects the disproportion, and the patient now finds they can gain and lose weight in a more proportionate way (“redistribution”). It surprises me how difficult this concept is to grasp for most people but it is what I consistently and predictably see in my practice and what the recent study on redistribution supports. If a patient is overweight and also out of proportion, the role of liposuction is only to reduce the disproportion. Weight loss and the role of liposuction are two completely separate things. Ironically, this study appears in a journal entitled, Obesity. It is the patient’s responsibility to lose the weight. It is the surgeon’s responsibility to properly proportion the patient. I suggest that liposuction surgery should more accurately be termed “lipo-reproportioning.”
The study in the journal Obesity, although small, should be viewed as support of the powerful effects of the potential for fat redistribution from liposuction surgery. It should help convey that well done liposuction is a procedure that should be reserved for critically targeting genetic disproportion. It should bring awareness to the surgeon and patient regarding proper evaluation with respect to who is truly a candidate. Finally, it should stimulate additional studies to support the precise role of liposuction surgery as an important tool to create proper balance and proportion in the appropriate patient.
David M. Amron, M.D.
Liposculpture and Revision Liposculpture Surgery
Beverly Hills, CA