Liposuction Research

Read some interesting research papers on liposuction via the following links:

  1. This is Dr Jeffrey Klein’s seminal and epochal paper from 1987. From this paper and the thinking therein developed office-based liposuction under local anaesthetic as we know it now nearly 30 years later. Click here.
  2. Can liposuction reduce your risk of heart disease? If diet ‘n’ exercising off 5kg of fat can significantly reduce cardiovascular risk, will liposuctioning away 5kg of fat do the same? This important paper from the New England Journal of Medicine, published in 2004, sought to answer this question, and the answer is, sadly, “no”. Liposuction doesn’t seem to improve your insulin sensitivity nor any cardiac risk factors. Pity. Click here.
  3. This 2004 paper published in “Cytotherapy” first demonstrated that stem cells could be derived from fat via liposuction. Stem cell technology promises much in terms of future therapeutics, and until this paper came out it was assumed that stem cells would have to come from embryos. Click here.
  4. This older paper (1994) from Plastic and Reconstructive Surgery (PRS) was one of the first to demonstrate the efficacy of liposuction as a technique for breast reduction (admittedly, in these cases, in combination with mammaplasty. That’s surgeons for you). Click here.
  5. This enormously important paper from Dermatological Surgery in 1995 reports on the complications experienced by a total of 15,336 liposuction patients treated by 66 different dermatological surgeons. And the news was: no serious complications in any of them! At the time, office-based liposuction under local anaesthesia was relatively new, and its safety level unpublicised – this paper put paid to any doubts. Click here.
  6. Here’s Dr Jeffrey Klein reporting in 1990 in The Journal of Dermatologic Surgery and Oncology that under his tumescent techniques (see first paper, above) lignocaine can be safely administered in doses of up to 35mg/kg. This was revolutionary at the time, but subsequent research (see next paper) put the limit even higher, at 55mg/kg. Still, it’s an historic paper. Click here.
  7. And this is the paper, from Dermatological Surgery in 1996, demonstrating the safety of tumescent technique lignocaine doses of up to 55mg/kg. Now nearly 20 years later, this data remains standard. Click here.
  8. When does a liposuctionist know he or she has removed enough fat? I’ve often observed that as the subcutaneous fat layer becomes empty of fat, the liposuction cannula will start to draw air in through the incision. This creates a stertorous sound, as one would expect. It never occurred to me that the observation would be worth writing up in a surgical journal, but a Dr van der Lei did, and published his thoughts in the journal Plastic and Reconstructive Surgery in February 2014, dubbing the sound the “Swine Sign”. Click here.
  9. This brief overview of the evolution of liposuction, published in August last year in “Anaplastology”, touches on the extent to which superfluous but marketable “technology” has complicated contemporary liposuction without bringing actual proven benefits to patients. It observes a general trend of return to straightforward liposuction. I concur with this view. Click here.
  10. Is neck liposuction trivial? In the larger scheme of things, does a fatty or swollen neck matter as compared to, say, the management of cancer? Some cancer surgeons think it matters. The management of head and neck cancer will sometimes leave the patient with lymphoedema, or a fatty swelling, of the neck. This study examines the outcomes of performing neck liposuction on such patients: ” Submental liposuction improves the appearance and quality of life for head and neck cancer patients suffering from posttreatment lymphedema by way of improving their self-perception and self-confidence.Click here.
  11. This is a review article published under the auspices the American “National Institutes of Health” a US federal government body of high repute.The object is to review without fear or favour a range of devices currently available that would assist too improve the outcome of liposuction, or compete with liposuction in the management of unwanted subcutaneous body fat. Typical of articles of this sort, and of textbook chapters covering the same material, there is an uncritical reliance on studies produced by the manufacturers of such devices. All the devices are reportedly good, there is no suggestion any one device might be better than another, and the authors seem to have little or no personal experience with any of the devices. Thus we are left with a catalogue of manufacturers’ claims for their products. But there is nothing here that would convince me to bet my liposuction patients on any one of these devices. Click here.
  12. What do you do about man-boobs: liposuction or surgical excision? Nine surgeons, reporting on 733 patients over a 20-year period (1990 – 2010), published their enormous study in the prestigious “Annals of Plastic Surgery” in September 2014. Liposuction for gynaecomastia (“man-boobs”) was unheard-of back in 1990, and these surgeons would have offered all their gynaecomastia patients surgery as the only option back then. But what happened thereafter? Here is their own conclusion…..
    The increase in the number of liposuction patients was reflected in our study because it was associated with superior esthetic results and few complications.” Superior esthetic results and few complications. That’s what liposuction offers for men with man-boobs. Click here.
  13. This article from “Aesthetic Plastic Surgery” June 2014 describes the benefits of relatively wide undermining when performing neck liposuction under local anaesthesia. Funny thing is: that’s how I thought it was always *meant* to be done. My undermining goes to the mandibular margin and the sternomastoids. The lateral skin contraction this produces means that the anterior skin result will be smoother. Having said that, I’ve been in theatre observing surgeons whose neck liposuction was much less extensive and arguably perfunctory, when performed in combination with a facelift. In such instances the neck liposuction might be seen as merely ancillary to the main game, being the excisional surgery. Certainly, to get best results from neck liposuction undermining should be wide and the treatment performed thoroughly. Good to see these authors agreeing. Click here.
  14. Dr Jeffrey Klein was the liposuction pioneer of office-based tumescent technique liposuction, but his approach was soon confirmed and expanded upon by others. This historical paper from 1988 by Dr Patrick Lillis describes the author’s experience starting with the Klein technique and taking it further with what were then considered bigger anaesthetic doses and more substantial treatments – all achieved safely. Click here.
  15. It’s all very well for this author or that author to describe that liposuction is safe – but what about safety across large numbers of doctors doing large numbers of treatments? This important 2002 paper from Dermatological Surgery surveys 267 dermatological surgeons who had performed over 66,000 liposuction treatments. These doctors reported a serious complication rate of 0.67 per 1000 cases. This is a complication rate significantly lower than that seen in hospital treatments, and reflects real world experience with office-based liposuction. Click here.
  16. What about the skin? If you remove the fat, will the skin be loose? In this 1992 paper liposuction pioneer (another one, I know) Dr Marco Gasparotti describes the contraction and smoothing that occurs after liposuction has been performed superficially under skin. His fundings concur with our general experience – that liposuction is associated with a useful degree of skin tightening. Click here
  17. In Paper #2 above I related that liposuction did not improve metabolic parameters such as insulin sensitivity, as reported in 2004. But in this paper a study of 6 liposuction patients compared with 6 controls *did* find improvement in glucose levels and uric acid levels and insulin sensitivity following liposuction, so what is going on? Here, the follow-up measures of blood sugar, etc, were performed only 21-28 days after surgery – too soon to know the ongoing effect of liposuction. On the other hand, Paper #2 above measured the blood sugar levels etc 3+months after surgery – more likely to reflect the ongoing state of affairs. Goes to show the importance of reading the fine print of medical research papers.
  18. This Italian paper, nonetheless published by the British Association of Plastic Surgeons in 2004, takes another look at whether liposuction improves health. Thirty patients underwent liposuction of an average of 3 litres of fat, and were then placed on a diet in order that they kept off the 3 litres of fat that had been removed. Six months later it was found that their glucose levels and insulin levels and a variety of inflammatory mediators were all improved, apparenlty due to the liposuction. So what is going on here, in contrast to the other papers I have quoted? The key thing is that the patients were “advised” to stick to a diet after the liposuction. We don’t know whether it was the liposuction or the dieting (or the combination) that did the trick. Food for thought.
  19. This 2001 paper by Giese et al published in “Plastic and Reconstructive Surgery” has a look, as well, at the “is liposuction good for you?” question. Interestingly, amongst the 17 participants, there was a tendency to continue to lose weight *after* the liposuction. And, lo and behold, metabolic parameters were improved at the end of the study period. Looking at all these papers together, it seems that papers reporting maintenance of weight loss after liposuction also report health benefits, but those that don’t, don’t.
  20. Then in 2008, Mohammed et al published a study in “Obesity” journal purporting to demonstrate that large volume liposuction did not produce health benefits in the long term even when weight remains at the lower level. However, this paper studies only seven participants: very difficult to demonstrate statistically significant results when the study is so small. Further, there’s no control group, We don’t know whether the participants are better off than they would have been had they not had liposuction. Further, the participants demonstrate and increase in visceral adipose tissue over the course of the study period (having initially fallen), so although their weights did not change their fat composition did. Overall, this is too small a study to tell us much.It seems to me that liposuction, by itself, doesn’t bring about substantial changes in blood pressure and blood glucose, etc, *but if* liposuction treatment can prompt a patient to *then* exercise as well, and look after themselves with their new trimmer body, *then* the combination of liposuction and exercise brings benefits. Now, the obvious rejoiner is: can’t you achieve that with exercise alone? Perhaps you can, perhaps you can. I absolutely encourage all patients to exercise, and have done for 30 years. But, like all doctors the world over, I have not been able to change patients behaviour as much as I would have liked in this regard. So, in practical terms, *if* a patient is unlikely to actually lose weight and keep that weight off unaided, and *if* liposuction might prompt in them a new attitude and new behaviour, *then* its worth while from a metabolic perspective.
  21. Smelly armpits? That’s called “osmidrosis”, and this 2001 paper by Tsai and Lin in Derm Surg tells us liposuction to your armpits combined with some curettage under the armpit skin will substantially reduce smelly armpits in most patients. Thought you’d like to know.
  22. What do other surgeons think about treating smelly armpits with liposuction? This 2004 paper by Perng et al in “Plastic and Reconstructive Surgery” reports a series of 134 patients who underwent liposuction (alone) for smelly armpits. He reported that liposuction is much safer than open surgery for this condition but not always as effective. On balance, worth the bet. (Would have been better had he treated the patients with liposuction *and* curettage, like Dr Tsai).
  23. Another positive report of liposuction reducing smelly armpits: this 2006 paper by Lee et al in Derm Surg tells us about their success with a scraping liposuction cannlua called a Fatemi cannula. 39 of the 40 treated armpits got a good or excellent result.
  24. Trust the Brazilians to produce an excellent review on the topic of treating smelly armpits, in very good English, fully available on the internet. Published in December 2014, in goes into great detail about how to perform this procedure with textbook clarity.
  25. Australians contribute to the literature as well. Retired cosmetic surgeon Dr Mark Goyen was published in 2002 in Dermatological Surgery on the quality-of-life benefits of liposuction. I quote him: ” A large proportion of patients experienced positive lifestyle outcomes from the procedure: 80.5% were more confident, 74.8% noted an increase in self-esteem, and 87% were more comfortable in clothes.” You can therefore be fairly certain that the decision to proceed with liposuction will be a correct one.
  26. Dr Goyen is not the only author to have looked at this question scientifically. In 2006 a couple of American plastic surgeons published this review in Plastic and Reconstructive Surgery. Whilst the levels of satisfaction they report are positive and reassuring, I must say they are not as good as those reported by Dr Goyen (with whom I did some of my training). I suspect that this is because the plastic surgeon authors of this article likely performed their liposuctions under general anaesthetic, with what would be considered inadequate patient preparation when treating under local anaesthetic alone. Treating under local anaesthetic leads to shorter recovery times and less analgesic requirement.
  27. What is lipedema? Read about it here. Some articles say it is rare, others claim up to 11% of women suffer from it. You might call it very very severe cellulite. And it turns out that patients who have their lipedema treated by liposuction are very very much satisfied with the improvement they expereince in quality of life, according to this 2006 German paper published in the Journal of Cutaneous Medicine and Surgery. Twenty eight patients were studied and their outcomes assessed an average of 12 months after their procedures. Results: ” All showed great improvement, with normalization of body proportions. Additionally, spontaneous pain, sensitivity to pressure, and bruising either disappeared completely or improved markedly. Other than minor swelling for a few days, no complications could be observed following surgery. All patients reported a tremendous increase in their quality of life. Physical therapy had to be continued to a much lower degree.” Now, having said that, it isn’t clear to me whether some of these patients *also* underwent skin-reduction surgery. Nonetheless, a “tremendous increase in their quality of life” is something very much worth noting.
  28. This is another quality-of-result retrospective study, but this time covers 39 different organisations covering 688 different cases. Much larger than the study in paper 26 above. Authored by William Hanke and William Coleman (amongst others), and published in Dermatological Surgery in 2004, the pre-eminent international reputation of these two doctors gives this study extra “cred”. Amongst their conclusions the following is noted: ” Seventy-five percent of the patients reported no discomfort during their procedures. Of the 59% of patients who responded to a 6-month postoperative survey, 91% were positive about their decision to have liposuction (rating of 4 or 5 on a scale of 1–5) and 84% had high levels (4 or 5 on a scale of 1–5) of overall satisfaction with the procedure.” This would seem to be a higher satisfaction rating than that found by the plastic surgeons who wrote paper 26 above, but this is, again, consistent with Drs Hanke and Coleman performing their liposuctions under local anaesthetic – a superior method.
  29. Why would a plastic surgeon want to write up a paper on breast liposuction when the plastic surgeon’s standard approach is open surgical breast reduction? Because liposuction of the breast usually gives a superior result. So writes plastic surgeon Dr Lawrence Gray in Plastic and Reconstructive Surgery back in 2001 . Certainly in older patients with inevitably fatty breasts, liposuction can give not just acceptable results but spectacular results, in my own experience.
  30. This is another review of the safety of liposuction. In 2008 in Dermatological Surgery, a Dr Habbema reviewed his 3240 cases (that’s a LOT of liposuction) and found his patients had experienced no complications requiring hospitalisation. He reported that just nine patients had complications requiring further action (whatever that may entail, without hospitalisation). This is an outstanding record.
  31. Still on the topic of safety in cosmetic surgery, this large literature review in Dermatological Surgery in 2005 sought to reconcile discrepancies in published data on safety pertaining to various standard cosmetic surgical procedures. It found that the safety of liposuction, especially performed under local anaesthetic in provate rooms, was confirmed, but that more significant risks were associated with abdominoplasty (tummy tuck) and in-hospital care, especially when associated with general anaesthetic and prolonged surgeries. Cosmetic surgery is always about a trade-off. The decision is relatively easy when it comes to liposuction, but not so easy with abdominoplasty.
  32. Perhaps the best that can be known today on the topic of whether liposuction is good for health might be found in the chapter on “Liposuction and obesity” chapter 33, in the 2014-published book ” Handbook of Obesity: Clinical Applications, Fourth Edition Volume 2” edited by Bray and Bouchard. This chapter is worth reading through for those who are interested, but its conclusion is inconclusive: a number of studies support the notion that liposuction may be good for yoru health, and a number of others do not. As I suggested above, they also postulate that the best thing liposuction may achieve is a change in attitude and lifestyle, as a newly-thinned patient seeks to make the most of their liposcution investment and their new shape by working at the gym.
  33. This Brazilian article from The Journal of Clinical Endocrinology and Metabolism, volume 97 issue 7 (2012) cites a study of 36 liposuction patients who were divided (after surgery) into an exercising group and a non-exercising group. It was found that the non-exercising group put on weight after the liposuction, especially into visceral fat, and that this regain did not occur in the exercsing group. Whilst this might seem a predictable and obvious outcome, it was important to measure the effects. Once again, the onus is placed on the patient to ensure they work to keep their weight down at the level achieved by their liposuction.
  34. Would you rather a tummy tuck? The famed journal Plastic and Reconstructive Surgery is ordinarily a touch biased in favour of the procedures commonly performed by plastic surgeons, such as abdominoplasty, whereas Dermatological Surgery is more often pro-dermatologist and pro-minimalist in approach. So it is welcome to see the April 2015 PRS journal publish a study comparing the safety of liposuction versus liposuction+abdominoplasty. This article found that adding abdominoplasty to a liposuction treatment was associated with an over 5x higher risk of major complication. It *also* found that office-based procedures, such as we perform at Peach, are safer that hospital-based procedures.The study looked at over 31,000 procedures, and found that when liposuction was performed on its own the “serious complication” rate was 0.7%. But when liposuction was combined with abdominoplasty the serious complication rate rose to 3.8% and went even higher, to 12%, when combined with abdominoplasty *and* another procedure such as a breast procedure all at the same time. The commoner reported such complications were bleeding, infection, and DVT. Another independent predictor of complication was having the procedure performed in a hospital as opposed to an office, presumably related to higher infection risk and general anaesthetic risk.
  35. Another study published in Plastic and Reconstructive Surgery April 2012 looked at a series of 360 patients who underwent either liposuction to the abdomen, or lipoabdominoplasty (combined liposuction and abdominoplasty), or abdominoplasty alone. It found that liposuction patients recovered more rapidly than the other patients, and that their pain levels were lower. It also found that in combining the three groups 85.8% of patients reported improved self-esteem and 69.6 reported improved quality of life following the procedure. Result ratings were high for all groups and higher for abdominoplasty groups than for the liposuction-alone group.
  36. This review article in the European Review for Medical and Pharmacological Sciences in 2012 presents a fairly long and comprehensive review of the subject of liposuction, starting as a historical review and then moving into a comparison of the different techniques. I include it here as something some patients may like to access but I should add that it makes a number of claims with which I would take issue as being inconsistent with the literature and inconsistent with my own experience which cannot be dismissed as inconsiderable. Nonetheless the simple facts of history presented are interesting and the rough sketch of different techniques provide food for thought. Patients familiar with the way O work will note differences between my approach at that advocated here – I am keen to discuss any questions that may consequently arise in the minds of anyone reading this article.
  37. Another little historical article. I’m not sure what Dr Pinto hopes to achieve with this quite brief description of the history of liposuction – too brief to be of didactic value and too broad in scope to give adequate attention to any specific aspect of the topic. However, towards the end he gives his game away – he doesn’t like all the marketing of gizmos that purport to advance the art and science of liposuction but really merely blur the science and commercialise the art. Like myself, Dr Pinto recognizes that certain current technologies associated with liposuction do nothing to advance the results obtained by the patient but merely add bells and whistles to make the process more marketable. And like Dr Pinto I applaud the current return to simple pump-assisted liposuction, as it offers the safest treatment currently possible.

If in doubt, you lose nothing by opting for liposuction-alone when dealing with a bigger belly. Its safer than abdominoplasty, cheaper, and with much less scarring. Furthermore, if the contraction you get after liposuction doesn’t bring your belly up to scratch, there’s no reason why you can’t thence opt for an abdominoplasty at a later date.

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