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It’s BAAACK: Weight Gain after Lipo

By Pamela Peeke, MD, FACP, MPHMay 03, 2011
From the WebMD Archives

A number of years ago, when Oprah’s infamous rapid weight loss liquid diet sent legions of folks off to gulp down gooey drinks, I met a woman I’ll never forget. She’d dropped 90 pounds over a short period of time downing 600 calories a day of some pricey fluid concoction. Here’s the catch. She’d done it three times for a total of 270 pounds worth of yoyo’ing. Talk about a pain in the wallet as well as wracking her mind and body.

She’d come to see me one year after her final go at it. During that time, she’d endured extensive liposuction and skin tightening procedures throughout her body to “neaten up” after this significant weight removal. The problem — she gained the weight back. In those days, there was almost no mention of the need for lifestyle change to support and sustain any weight reduction.

When she opened her patient gown, I was saddened to see railroad tracks of stretched scarring, which I had expected. What was unusual were her fat deposits. Since many of the fat cells had been removed from around her belly, the newly gained fat was now being laid down in strange places — her upper body, arms, trunk, back, breasts. She felt like a freak, with lumps and bumps pouching out around her overstretched scars. It just broke my heart. Happily, at long last, she’d finally learned her lesson and embarked on the long road back to recover her mind and body.

As liposuction became more popular, I continued to notice the same phenomenon in those people who’d regained weight after the procedure. In fact, it was so common that I warned people ahead of time — “If you want to do liposuction, don’t regain the weight.”

Now, a new study by Drs. Teri L. Hernandez and Robert H. Eckel of the University of Colorado has shed light on what my colleagues and I have noted for years. The researchers performed lipo (removing a pound of fat underneath the skin) on the thighs and abdomens of 36 non-obese women in their 30′s who were told not to change their lifestyle habits. They were compared to a control group of women who never received the lipo. It took about a year for the fat to come back. Where did it return on the body? The lipo’d thighs did not pick up new fat. However, the lipo’d abdomen did show regain, primarily in the upper abdomen (including below the skin or subcutaneous as well as inside the belly), the shoulders and triceps (batwing) part of the arms. So what’s going on here?

Here’s a little Fat Cell 101. Typically, a fat cell lifespan is seven years. When it dies, it grows another one to replace it. Fat cell scientists believe that the body keeps track of its fat cell supply as well as the amount of fat in each cell, compensating for any fat loss by growing new fat cells in other areas.

Lipo demolishes the delicate fishnet matrix under the skin that holds the fat cells together. Therefore, when fat is regained, it can’t accumulate where there are no new fat cells, so it’s laid down in other places where new fat cells are waiting to fill up. Why didn’t the thighs pick up new fat? It’s felt that the subcutaneous fishnet scaffolding supporting the thigh fat cells may be more fragile than the ab fat, and thus may sustain more permanent damage, making fat cell growth and deposits less possible. The jury’s out on that, so hold on for more studies to answer this question.

What’s the take home lesson for you?

Lipo Does Not Remove Toxic Fat: The only fat that can ever be lipo’d is the fat that lies directly underneath the skin. The most that can be lipo’d safely is no more than 2-3 pounds of fat. Toxic Fat, or excessive intra-abdominal fat associated with heart disease and diabetes, can never be lipo’d since it lies deep inside the abdomen below the abdominal muscle. The only way to reduce that fat load to normal levels is through healthy lifestyle choices. One troubling finding from this study is that part of the fat regain occurred inside the abdomen. So, you get abdominal lipo, then regain the weight and some of it now goes inside the belly. This is a bad scenario. If you have Toxic Fat right now (measure your belly size across the belly button, women should be less than 35″, men less than 40″), then you need to change up your lifestyle and rein in your belly fat. If you’re thinking about lipo, remember that if you regain the weight you’ll probably be adding more inside your belly. Come on, everyone. Get that healthy lifestyle going right now and avoid this gain and regain cycle altogether.

Stay Vigilant: When you shed fat with healthy nutrition and physical activity your fat cells do not disappear. They become deflated balloons. The fat has been used for energy as you stop eating excessively, as well as fuel for exercise. Staying vigilant with your new healthier lifestyle is imperative. Once you go mindless and begin to overeat or stop your physical activity, those fat cells are just sitting there waiting to fill up once again. That’s why it’s so easy to regain weight. And, that’s also why the fat is usually regained in the same spots. Vigilance is critical. That doesn’t mean you obsess all day. It just means you need to monitor yourself within a safe range of eating and activity to achieve your goal or sustain your success.

Consult an Expert: If you feel you want to do lipo, you should book an appointment with no less than two board certified plastic surgeons. You need to listen to different assessments about your unique situation. Any credible surgeon will need to assess your psychological expectations and your baseline mental status regarding body image. The surgeon also needs to know that you have a healthy lifestyle foundation in place. They don’t want to see weight regain any more than you do. Some will require you to have kept the weight off for a period of time indicating that you are living a healthy lifestyle. Spend time thinking about any surgical procedure, as this most definitely involves mind and body.

Lipo Without a Healthy Lifestyle is a Loser: If you elect to do lipo (with or without skin tightening) after a healthy weight removal that had left you with skin hang and uneven lumpiness, then keep in mind that to avoid the regain and redistribution problem, you must live a healthy lifestyle. If the women in the study had been told to improve their exercise and eating habits, their chance of regain would have been significantly lessened. At the end of the day, lipo can never substitute for a life of healthy mental, nutritional and physical activity choices.

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