Increasing body weight after liposuction profoundly diminishes the procedure’s outcome in predictable ways, according to Neil C. Goodman, M.D., who has been performing liposuction since 2004 and performed more than 5,000 office-based cases, all under local anesthesia, to date.
“The new fat must be restored in areas in the body where the fat storage patterns have been altered by the liposuction procedure, or in areas adjacent to or remote from the previously treated site,” says Dr. Goodman, who spoke yesterday during the “Profound Effect of Body Weight on Liposuction Outcomes” presentation at the American Academy of Cosmetic Surgery’s (AACS’s) 2017 annual scientific meeting in San Diego, Calif.
Dr. Goodman, who has offices in Palm Beach Gardens, Florida, and Mount Kisco, New York, says that he has learned a lot about liposuction outcomes, including how meaningless posted before and after photos are in many cases, unless body weights are also recorded.
If a patient gains weight after liposuction (and many do), the liposuction-treated area becomes lumpy and irregular, as fat cell clusters remaining in the fatty layer and also under the muscle and inside the body cavity are refilled. In areas adjacent to the previously treated area, more fat is stored so that the boundaries often become visible. Finally, areas remote from the site of treatment enlarge symmetrically, depending on the amount of fat to be stored. So, if the abdomen, waist and flanks undergo liposuction, then buttocks, breasts and other places predictably enlarge over time, he says.
These findings, Dr. Goodman says, can best be viewed in sequential photographs of liposuction patients before and at various times after their procedures, while body weights are recorded, with the most profound changes observed years after the initial treatment and after significant weight gain has occurred.
“What appears to be a very nice outcome after one to two months (before a patient has regained significant weight and after swelling has resolved) may be completely reversed by as little as a three- to five-pound weight gain in a small patient or a five- to 10-pound weight gain in a medium sized patient,” Dr. Goodman says. “These findings become even more apparent over many months or years with subsequent weight gain.”
Dr. Goodman’s top three tips for achieving ideal liposuction outcomes:
- Discuss these findings with patients, preoperatively, and have them acknowledge, in writing, that maintenance of the weight loss achieved through the liposuction procedure is essential to maintenance of their outcomes.
- Offer revision procedures for the liposuction areas or adjacent boundaries after four to six months for patients who approximately regain their preoperative weight, which is what is expected without diligent control of diet and exercise routines.
- Assist with dietary information and medication, if necessary, for those patients who become much larger than their preoperative weight.
Why is this important?
“Most prospective liposuction patients do not understand the intimate connection between the liposuction procedure and storage of new fat necessitated by subsequent weight gain. They also do not understand that unless they change their environmental routine that they are likely to return to their preoperative weight within a few months and gain additional weight over a number of years, and how this will alter their outcome,” Dr. Goodman says.
Disclosure: Dr. Goodman reports no relevant disclosures.