Here we are talking about subcutaneous (as opposed to visceral) fat, mainly I would like a professional opinion about these questions: -does the number of subcutaneous fat cells increases over time and in which circumstances? -do the cells have (as some people claim) a MINIMUM, finite size, after which they cannot shrink further no matter the amount of diet and exercises, and the only way to get rid of a resulting flabby pouch belly (panniculus?) is by abdominoplasty? -people usually refer to this problem as an "excess abdominal skin", but is it really just skin? The skin should be max -3 mm thick, and the remaining layers bellow are just the subcutaneous fat cells...are there any other tissues or structures beside these cells which give the flabby look seen in patients diagnosed with "subcutaneous fat after weight loss" problem? Thanks
Do Adipocytes Have Minimum Volume and Diameter?
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Do adipocyte sites have minimal volume?
You ask a very interesting and complex question. I think most of us on this form as plastic surgeons are long beyond their years of biochemistry and focus more on the clinical aspects of what we do. But going a bit back in time here's my take on your answers.
Until puberty there is evidence that your body can create new fat cells which it can fill with fat. After puberty the number of fat cells remain stable, but they can get larger or smaller depending upon your caloric intake. There is some evidence that if people become morbidly obese they can create new fat cells even after puberty.
In my opinion there is likely a minimum finite size for fat cells, but if you lost enough weight to get to that point you probably would not need liposuction. It would be very difficult to get to that point, somewhat like starvation. It would not be healthy as well.
With respect to excess abdominal skin, yes, a pannus is a combination of skin and fat together. But if you lost weight further or even liposuction a droopy pannus while the amount of fat would decrease the loose skin would not likely retract and you would still want to remove the excess skin to make the abdomen look better.
The layers of tissue that contribute to the pannus are mainly the skin and the fat cells but there are also layers of fibrous tissue known as superficial fascia.
All of these layers are removed in abdominoplasty.
I hope I was able to answer your question.
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Fat cell metabolism
Fat cells do shrink to their lowest volume with weight loss and if the skin above it has lost its elasticity then it does not matter how thin the fat cell becomes. I know this because when I operate on really thin pateints for other reasons, I know what that fat looks like and it looks weak and thin..so what really matters is the skin elasticity. So the answer to your question is not about the adipocyte volume as much as it pertains to the skin elasticity. This is the key element in my opinion. I hope this helps.
South Shore Plastic Surgery
Pannus and Fat Cell Size
The pannus contains fat and skin, but the tummy tuck is necessary to remove the laxity of the skin tissue. Liposuction can reduce fat cell numbers and exercise and diet can reduce fat cell volume, but skin is an entirely different entity and will persist within the pannus after either of these. Kenneth Hughes, MD Los Angeles, CA
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