Demand for body contouring procedures is on the rise and increasingly so in patients with already fit/athletic bodies who have stubborn localized areas of fat or who desire a more defined/contoured aesthetic. Surgical removal by liposuction is still the gold standard for fat reduction and allows for fat harvesting and transfer to improve body disproportion such as a flat or sagging buttocks (Figure 1), or breasts, or poorly sized/defined chest, shoulders, biceps (Figure 2) or calves. So-called “Brazilian butt lifting” and “abdominal etching” procedures are becoming more widespread and popular. In my practice these are known as “high definition” or “superficial liposuction” procedures (Figure 3). That said, liposculpting is gaining popularity and excellent results can be obtained with very few complications when performed meticulously with skill and artistry by a well-trained surgeon.
FIGURE 1. Patient shown before and 2 weeks after fat transfer to the buttocks.
FIGURE 2. Patient shown before and 2 weeks after fat transfer to the chest, shoulders and biceps.
FIGURE 3. Patient shown before and 3 weeks after high-definition liposuction of the abdominals, flank and back.
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'Interesting' Side Effects
Common complications from skin surgery such as infection, dehiscence, and scarring, are uncommon with surgical body contouring procedures. After many years of performing hundreds body shaping procedures it isn’t uncommon for me to have complaints of “interesting” side effects from surgical body contouring procedures such as a change in menstruation, sexual hypersensitivity or body hair growth.
One patient in a recent realself.com post was curious to know if hunger can increase after a liposuction procedure. Surprisingly, this may be true and have validity, but not a result of the procedure. It may be an indirect effect on the body’s metabolism after large volume fat removal/full body contouring. Here’s why:
Hormones and Fat Stores
The human body is born with a genetically determined number of fat cells, and this number rarely changes in the course of our lifetime. The cells can increase in size (hypertrophy) with poor diet or exercise or a dysfunctional metabolism. In a condition known as lipedema, the cell number (hyperplasia) and cell size can both increase over the course of a person’s lifetime, predisposing them to other consequences such as fat disproportion causing pain, swelling and functional disability such as joint disease. In this condition, certain herbal/holistic medications have shown benefit, including Selenium for its anti-inflammatory activity and Butcher’s broom, which has also been shown to improve lymphatic pumping/function. Both are utilized by Dr. Karen Herbst in her endocrinology practice for patients with fat disorders and are a recommendation for my patients after liposuction procedures, signifying the importance of alternative supplementation in healing and tissue metabolism.
To continue, after liposuction surgery, the body’s total number of fat cells are permanently decreased, leaving a smaller total number of cells to be influenced by internal and external factors. Although these factors and their integrate associations are not fully defined, there is a significant amount of research ongoing to determine the connection between fat cells, metabolism, hunger and appetite. It is known that leptin is a master hormone in the body helping to regulate the energy balance by inhibiting hunger through the hypothalamus. Leptin is opposed by the actions of the hormone ghrelin, also known as the “hunger hormone.” In obesity, a decreased sensitivity to leptin occurs, resulting in an inability to detect satiety despite high energy stores, thus impact on hunger and fat gain. Nonetheless, in humans, many instances are seen where leptin dissociates from the strict role of communicating nutritional status between body and brain and no longer correlates with body fat levels such as decreased levels seen during short-term fasting, increased levels during perceived emotional stress, and reduced levels during extreme physical exercise, to name a few. Thus, more research is needed on this hormone’s complete influence on fat stores and internal body metabolism.
Mulling Metabolism
Knowing that there is a physiological connection between fat cell number and size and body metabolism, can liposuction itself influence weight loss? I have a number of patients who have reported a significant weight loss after liposuction surgery with little change to their diet and exercise routines. However, the majority of my patients seem to get increased motivation post-procedure that impacts their physical change. They go to the extreme of diet and exercise so that their 6- and 12-month follow-up visits are more impressive than could have been predicted by procedure results alone.
FIGURE 4. Patient shown before and 3 months after liposculpting of the abdominals, flanks and back. Theoretically, if the number of fat cells are permanently decreased after liposuction surgery, there should be less available leptin to inhibit hunger and the appetite should increase. Although this is only speculation, and the intricacies of internal metabolism is much more great than a simple feedback loop, it is an interesting concept as to why significant body changes can be observed well beyond the initial surgical procedure (Figure 4). In my practice I have rarely seen what has been documented in the literature of fat gain in other non-treated areas, likely because the majority of my patients use the liposuction procedure as a life-changing event to compliment their diet, exercise and supplementation.
What can we learn from this post?
What can we learn from this post?
Liposuction results may not be as short-lived as we had thought. I have my patients utilize this post-procedural “hunger” (or metabolic change) to their advantage by referring them to a nutritionist/anti-aging physician that can help with dietary plans and supplementation. Referrals to personal trainers and body workers (for yoga, pilates, TABATA, etc.) starting 10 to 14 days after the procedure to increase muscle toning, further stimulate the body’s metabolism, and help with skin retraction/tightening. All of my patients receive radiofrequency treatments (Velashape 3 and/or Venus Legacy) post-procedure to improve tissue health and metabolism, decrease swelling and increase further fat loss and skin tightening. Overall, lipocontouring can be very dramatic and satisfying if an integrative approach is used that incorporates nutritional supplementation, hormonal evaluation and implementation of exercise and diet.
Jason Emer, M.D., is a board-certified and fellowship-trained general, cosmetic and procedural dermatologist who is passionate about advancing safe and effective treatments in the field of cosmetic dermatology and laser surgery. Dr. Emer’s expertise and interests include the full range of general dermatological conditions, novel therapeutics, cosmetic face and body treatments, including aging skin, veins, body sculpting, fat harvesting and fat transfer.
