Jackson Hole, Wyo. — While liposuction can be among the most gratifying surgical procedures to perform because of its clear, quantifiable and long-lasting results, there are grey areas to this popular cosmetic option. Long-term success in liposuction hinges on the cosmetic surgeon's understanding of weight patterns and the role of diet and exercise, according to Naomi Lawrence, M.D., associate professor of medicine and division head, procedural dermatology, Cooper University Hospital, Marlton, N.J.
Dr. Lawrence, who lectured on liposuction do's and don'ts at the Cosmetic Bootcamp meeting here, said the procedure comes with risks of serious complications, and it requires that physicians have strong technical skills and trained support staffs. She adds that long-term success depends on physicians being able to separate the myths about weight loss from facts.
Who's a candidate? Who's not?"Patients often believe that if they could just be motivated to diet and exercise, they could lose the fat deposits on their outer thighs and flanks," Dr. Lawrence says.
The reality, according to Dr. Lawrence, is that 85 percent of dieters regain weight during a one- to three-year follow-up, and spot exercise does not reduce localized adiposity.
These are among the ideal candidates for liposuction, she tells Cosmetic Surgery Times.
"When performed on the right candidate — a person with stable weight — liposuction is the best way to reduce localized adiposity," Dr. Lawrence says.
Liposuction might also be the ideal approach for reducing the hanging stomach many women get after pregnancy, she says.
"It is a myth that these patients always need a tummy tuck," Dr. Lawrence says. "In fact, most women get excellent retraction with liposuction — even if they have stretch marks and poor skin tone."
Physicians experienced in liposuction are turning to the procedure to address areas which have traditionally not been considered ideal for liposuction, including for breast reduction and the post menopausal lumpy back.
"I consider liposuction as a breast reduction option because it is less invasive and carries less risk than traditional breast reduction surgery. With liposuction, there is also less need for nipple elevation," Dr. Lawrence explains. "The best candidates are women with fatty breasts, looking for a one- to two-cup size reduction."
Understanding weight cycling Before performing liposuction, cosmetic surgeons should first understand their patients' weight loss, weight gain histories, according to Dr. Lawrence.
"There are things doctors should know about the weight cycling phenomenon, which will help them to better choose their liposuction candidates," she says.
For example, frequent dieters tend to regain weight more than less frequent dieters. One study showed that being female, divorced, black and younger than 50 years old are predictors of attrition in weight loss programs.
There also are psychologic factors common among people who tend to regain weight, according to Dr. Lawrence. These include: failure to achieve weight goals and dissatisfaction with weight achieved; tendency to evaluate self worth in terms of weight and shape; lack of vigilance in regard to weight control; dichotomous thinking; and use of food to regulate mood.
"Behavior modification and exercise are the keys to successful weight loss and weight loss maintenance," Dr. Lawrence says.
A better diet Patients are more likely to lose weight and keep it off if they are on programs that offer a variety of low-fat food choices, manage their stress and can control their eating behavior, she says.
Diets too low in calories and fat slow the metabolism, starve dieters of energy and result in poor weight loss maintenance. High protein and fat diets that are low in carbohydrate consumption keep dieters better satiated and dieters tend to maintain their weight loss as long as they remain on the diet, according to Dr. Lawrence.
People who diet and exercise lose more weight, in general, than people who diet only or exercise only. And the higher the levels of physical activity, the more improved the weight loss, according to Dr. Lawrence.