Weight-loss jabs may rule these days when it comes to banishing unwanted body fat – but liposuction remains one of the most popular cosmetic surgery procedures.
Liposuction is used to syphon off fat, usually from the tummy or thighs. But experts are warning that the procedure – which can cost between £3,000 to £10,000 – is not always the permanent fix for fat problems that some patients expect it to be. Indeed, it can lead to a build-up of fat in other areas where it is potentially far more harmful.
The procedure is usually performed under a general anaesthetic, with a high-pressure water jet, laser or ultrasound device used to break up the fat cells – a suction device clears everything out. Side-effects, though rare, can include haematomas (bleeding under the skin), uneven results leaving lumps (where fat has not been removed evenly) and blood clots.
The emerging concern is that patients may not realise the long-term risks of removing the fat cells – particularly if they later gain weight. That’s because the human body tightly regulates the number of fat cells it has. If a fat cell dies, it’s replaced with a new one but if it’s surgically removed then it isn’t. So if we subsequently gain weight, existing fat cells elsewhere on the body just get larger.
The procedure physically removes large numbers of fat cells and destroys the underlying support structure, so these fat cells don’t regrow in this area once they are removed.
However, the body then compensates for their loss by depositing more fat in the existing cells in other areas, so they get bigger.
‘When we remove fat with liposuction, that’s permanent because we are removing fat cells,’ says Nora Nugent, a consultant plastic surgeon at the Purity Bridge Clinic in Tunbridge Wells, and president of the British Association of Aesthetic Plastic Surgeons.
‘So if you later gain weight, the fat cells in other parts of the body get bigger. For example, if you had liposuction on your tummy and then gained weight the fat might build up on your thighs or hips.
Liposuction is used to syphon off fat, usually from the tummy or thighs. But experts are warning that the procedure is not always the permanent fix that some patients expect it to be
‘This is one reason why we always stress to patients that liposuction is not a weight-loss therapy – it’s a tool for body contouring.
‘There is a misconception that it’s a weight-loss procedure – in fact, an ideal candidate is someone who is a healthy weight but has unwanted fat in a particular area.’
What’s even more concerning than fat returning after liposuction is the risk that it gets stored as visceral fat – the type stored deep inside the abdomen close to vital organs such as the liver, pancreas and intestines.
Visceral fat plays a crucial role in protecting these organs against injury, but the body only needs a small amount. In excess, it starts to release hormones and inflammatory chemicals that raise the risk of type 2 diabetes, heart disease and high blood pressure.
Liposuction removes subcutaneous fat, which lies just beneath the skin, but it cannot access visceral fat. Even in patients who do not gain weight after liposuction, levels of visceral fat can increase, according to a 2012 study published in the Journal of Clinical Endocrinology & Metabolism.
It tracked 36 women of a healthy weight and found that, while the liposuction successfully removed their tummy fat, over the following six months they each saw a 10 per cent increase in visceral fat levels.
The Brazilian researchers said this was a ‘compensatory increase’ – a physiological response where the body stores fat around the internal organs when it detects there has been a sudden and marked decline in levels of subcutaneous fat. In other words, it conserves energy to ensure survival.
Professor Tunc Tiryaki, a consultant plastic surgeon at The Cadogan Clinic in London, says not everyone who has liposuction necessarily gains more visceral fat.
‘You don’t just gain visceral fat by gaining weight,’ he told Good Health. ‘It’s more to do with whether you already have underlying health issues, such as type 2 diabetes or insulin resistance [a forerunner to type 2 diabetes].
‘In these people, fat is more likely to accumulate in the visceral area.’
The Brazil study did have some good news, however – women who exercised daily in the four months after liposuction saw no increase in their visceral fat levels.
Ms Nugent says the key to avoiding further fat problems is to ensure you don’t gain significant weight after liposuction.
‘If you do, the fat has to go somewhere,’ she says.
And for all its popularity, liposuction should not be thought of as a minor procedure, she adds.
‘It’s a safe treatment but patients still need to think of it as surgery.
‘It may only involve small incisions – no more than 1cm long – but people don’t realise how much work is involved under the surface.’
