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Dear Doctor Why Can’t Liposuction Remove All of My Excess Weight

by David C. Voellinger, MD, FACS, FASMBS, DABOM

Fall 2021

Liposuction is popular and has been performed in the United States since the early 1980s after beginning in France. It’s the most common cosmetic procedure performed with more than 300,000 performed in 2020. The advertisements are everywhere. So, can you just have all of your fat removed and get rid of weight issues and medical problems? Unfortunately, it doesn’t work that way.

What is Liposuction?

Liposuction is a cosmetic procedure for body shaping or contouring. It is used to immediately remove small pockets of fat in particular areas of your body that tend to “hold on” to fat despite your best efforts at diet and exercise. These areas include:

• Abdomen
• Flank (love handles)
• Hips
• Thighs
• Buttocks
• Chest
• Arms
• Under your chin

Most commonly, the fat is removed by making a small cut; then inserting a hollow tube (cannula) under the skin; then injecting a solution that separates the fat cells, numbs the nerves and constricts the blood vessels; and finally using vacuum suction to remove the fat cells.
Only a small amount of fat can be removed in one sitting due to the risk of complications—no more than six to eight pounds or three to four liters. If more than that is taken, the below risks can increase:

• Bleeding
• Fluid collections
• Infection
• Blood clots
• Fat embolism (fat clumps in the blood that go to the lung)
• Shock (major fluid shifts causing damage to organs like the kidneys, lungs and heart)

The best candidates for liposuction are patients who are less than 30% above their ideal weight (overweight), have good elastic skin, have a normal immune system and have no major medical issues such as heart disease, diabetes or poor circulation.
If you want to target particular areas of your body to improve your body shape and maintain a stable weight, go for it.

What Liposuction Isn’t

Liposuction is not a weight-loss procedure. Only small amounts of weight can be removed during liposuction due to risks from the procedure. Only fat under the skin can be removed by liposuction, not the internal fat that surrounds our organs and is more important in obesity-related medical problems.

Even though the amount of fat cells is decreased by liposuction, small amounts of weight gain can cause other fat cells to grow, and large amounts of weight gain can cause new fat cells to form. Patients affected by obesity undergoing liposuction have a poorer cosmetic result and a higher risk of complications from the procedure.

Patients who are greater than 30% above their ideal weight (with obesity) are not good candidates for liposuction. Sometimes, people affected by obesity:

• Are older with less elastic skin
• Have major medical issues
• Have an immune disease or are taking immune suppressing medications
• Have frequent weight changes

What is the Best Way to Remove My Excess Weight?

If you want to remove as much of your excess weight as possible, then focus on managing your lifestyle. Make slow, steady improvements by eating a healthy, low-sugar diet, drinking a lot of water, exercising regularly, managing stress, changing bad habits and getting plenty of sleep.

It is not immediate fat removal like liposuction, but your fat cells will reduce in size–and not just the ones under your skin, but the ones all over your body. Not only will your body shape improve, but so will your obesity-related medical issues and your quality of life. You will be healthier and live longer.

Weight-loss medications can help by reducing hunger and cravings and making you feel more full. If you have obesity with medical problems related to your weight, then bariatric surgery could also help. Talk to your primary care physician, your bariatrician or your bariatric surgeon about your options.


About the Author
David C. Voellinger, MD, FACS, FASMBS, DABOM, is a bariatric surgeon who is double-boarded in General Surgery and Bariatric Medicine. He completed his surgical residency at the University of Alabama Birmingham and his fellowship at Mt Sinai Medical Center in New York. He is currently the lead physician for Novant Health Bariatric Solutions Charlotte, the Medical Director for the Novant Health Bariatric Center and Chief of Staff at Presbyterian Medical Center in Charlotte, NC. Dr. Voellinger specializes exclusively in minimally invasive bariatric surgeries, including vertical sleeve gastrectomy, gastric bypass, duodenal switch, adjustable gastric banding, and revisional bariatric surgery.

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