Does Lipo Fat Really Return in Other Places?

The study released in the NY Times yesterday seems to indicate that there's a pretty good chance lipo fat will come back in other areas of the body after a year.

Have you seen results like this with your patients? Is this only if a patient is not actively maintaining their weight after lipo? - Makenzie @ RealSelf

Doctor Answers 14

For Best Results, One Needs To Lose Weight Aftter Liposuction

The patients in this study weighed on average 150 lbs. before liposuction and had 3000 cc (about 6 lbs.) of fat removed from the abdomen, flanks, and thighs.  One year later they weighed on average 149 lbs.  The patients’ measurements in the waist and thighs were improved, after the liposuction so they looked better.  MRI analysis showed that there was increased fat in the deeper areas of the abdomen and other areas of the body.  In other words they looked better in the areas of liposuction.  The fat did not recollect there.  The problem is that energy expenditures, food intake, and weight were stable.  Therefore, the body expanded fat in other areas.
This study shows the result of a single session of liposuction removing about six pounds of fat, and a look at these patients one year later.  The total body weight was essentially the same and the one pound difference was not statistically different.  Fat accumulated in other areas, but not in he areas liposuctioned.
For optimal results I would wish the patients had dieted to a new, better weight of 144 pounds which is the amount lost with liposuction.  I believe with this weight, they would maintain their looks, plus would not accumulate deep fat or fat in other areas.After lipo it is best to lose some weight.   

Marin Plastic Surgeon
5.0 out of 5 stars 19 reviews

Weight gain after liposuction

The areas of fat concentration tend to be abdominal in aging men, hips & thighs in aging women & buttocks in certain races as those individuals age.  The age at which this occurs varies from person to person.  Changes in metabolism & fat deposition can also occur more quickly such as after childbirth. It is easier to lose fat from areas in which your body tends to not concentrate fat. The fat doesn't go to one place & then another as in first, second etc.. It goes all over but more of it is stored in specific areas & it is mobilized from other areas more easily. This could be interpreted as last on first off. That is why spot reduction exercises do not work & why you cannot shift fat concentration from one area of the body
to another. This also explains why fad diets do not work.

If you gain weight after liposuction and store this as fat the increased amount of fat is stored in those areas where your body tends to concentrate fat. This is usually the areas that were liposuctioned. However, if the total number of fat cells was significantly reduced the next storage area in line will get a greater percentage of the stored fat than it otherwise would have. A greater percentage is removed if the fat appearance is due to larger fat cells and less if it is due to a greater number of fat cells. That is because the fat has to be stored within cells it can't be stored on its own outside of the cells.

I have never seen a patient put on large amounts of excess fat in un liposuctioned areas in preference to the liposuctioned areas for the reasons described above and because my liposuction removal tends to be conservative. The areas liposuctioned most frequently are the areas where an individual innately tends to concentrate fat. This does not change after liposuction & obviously every fat cell in an area is not removed by liposuction.

As you alluded to in your post all plastic surgery requires work on the patient's part to maintain their results whether that be exercise, dieting, skin care or anything else.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 2 reviews

Liposuction fat coing back somewhere else

Liposuction in one area generally does not make the fat come back in other areas.  However if the patient gains weight, fat will go elsewhere.

That means if 5 pounds were taken off in surgery, and you have gained 5 pounds since the surgery, you have actually gained 10 pounds since the surgery.

If liposuction is aggressively done in one area, this tendency will be worse.

So liposuction patients should maintain a healthy body and not gain weight after their surgery.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 178 reviews

Fat redistribution after liposuction

Liposuction does NOT cause a redistribution of fat!  Rather, if patients gain weight after liposuction, it may accumulate in other areas, especially since liposuction removes fat cells in the areas that are treated.  Regardless, liposuction is not a weight loss procedure, but a contouring procedure.  The goal is to maintain the investment you have made, watch what you eat, and exercise regularly after the procedure.  

B. Aviva Preminger, MD
New York Plastic Surgeon
5.0 out of 5 stars 5 reviews

Fat in treated areas

The procedure re-contours the body by reducing the number of cells. This is permanent. If one does gain a significant amount of weight, however, the cells that do remain can enlarge diminishing the benefits. Overall contour, however, remains improved.

Jerome Edelstein, MD
Toronto Plastic Surgeon
5.0 out of 5 stars 179 reviews

Weight gain after liposuction

Liposuction permanently removes some, but not all, of the fat cells from the area in which the surgery is done.  If one gains weight after surgery, the fat can go into the remaining cells to some degree, and is also distributed in other body areas in the remaining non-operated sites. 

It is not the procedure of having liposuction that makes one gain weight.  If you adapt to your new body size, you should realize that you need less calories to support less of your fat now that you've had liposuction. But the average daily calories you consumed and the amount of exercise you did, and in turn, the calories burnt off from this exercise, prior to liposuction, created a net amount of calories that had maintained the fat you had prior to the surgery. Now that there is less fat, you need less calories. So if you eat more, or exercise less you will start having a positive energy balance and you will create fat for this energy store.  The fat has to be stored somewhere and it will go to different sites, including some in the area of liposuction.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 38 reviews

"The Migrating Fat" theory of Liposuction Vindicated - NOT

As you know, through the centuries there were a LOT of "factual" books printed which were convinced the Earth was flat, that our arteries carried Air (hence the origin of their name) instead of blood, that applying searing hot irons cures some incurable diseases (according to The Father of Medicine - Hippocrates - "What drugs will not cure, the knife will; what the knife will not cure, the cautery will; what the cautery will not cure must be considered incurable"), that ingesting poisonous Calomel (Mercury chloride) (all the rage during Revolutionary and Civil War America), cupping and leeches were beneficial to our health and the list of medical idiocies and scientic "facts" can fill stadiums. They were NOT true.

The most honest presentation of ever evolving medical knowledge was delivered by Dr. Sir William Osler, Professor of Medicine at Johns Hopkins when he told his stidents ""Gentlemen, I have a confession to make - half of what we have taught you is in error; and furthermore we cannot tell you which half it is.”

How about some REAL Facts?

FACT 1 - Liposuction PERMANENTLY removed anything which goes into the sterile stainless steel cannula. Ones that fat is removed from an area, it is gone. (To quote Monty Python, that fat has "passed on, is no more, has ceased to be, is expired and gone to meet its maker, it's bereft of life, it rests in peace, it's pushing up the daisies, its metabolic processes are now history, it as kicked the bucket, it shuffled off its mortal coil, it has run down the curtain and joined the bleedin' choir invisibile").
FACT 2 - Unless the fat has be surgically transferred / grafted to other parts of the body, it does NOT have the magical transformational ability to make its way from the suction canister across the room back into other parts of the patient.

FACT 3 - The REAL truth which this rather simplistic study does not address is the challenge posed by our individual physiologies AND "The Get Out Of Jail - ALL You Can Eat" Card Psychology seen in many body contouring patients.

Fat is a very sophisticated microscopic storage room. In times of caloric drought (decreased eating, massive caloric expenditures exercising / farming etc) , fat cells will be empty. BUT - the CAPACITY of filling up will be retained. In times increased caloric intake which are not matched by a corresponding or higher burning of calories, the excess calories will be deposited in our fat storage units AS DETERMINED BY HORMONAL FACTORS (men - centrally, Women - Thighs, buttocks, arms etc).

Unfortunately, some people think that Liposuction comes with an invisible Kevlar jacket-like immunity to the consequences of over-eating and under-exercising - "The Get Out Of Jail - ALL You Can Eat" Card. Now that the areas which previously bothered them have been nicely smoothed down, many lose sight of the importance of watching their diet.

As they incease their caloric intakes, the excess calories can no longer be deposited in the areas which were liposuctioned. But - this does not mean that the billions of fat cells elsewhere in the body will not open their little doors to this caloric transgression. They do and they fill up. As a result, other areas of fat fill up and GIVE THE IMPRESSION that the fat "MOVED" there.  

Going back to previously accepted (sometimes enforced "facts") - If you are watching the skies at night, you will see the moon and stars circling our Earth. It is therefore easy to assume as millions have done that the Earth is at the center of the universe. This was Church (Ptolomeic) doctrine and considered FACT for centuries: MANY were persecuted (Copernicus, Galileo Galilei) or burned at the stake for saying otherwise.

The SAME "Lying Eyes" phenomenon is clearly in play here and in this rather fact-challenged article published by the New York Times as a clear swipe to Plaqstic Surgery.

If you have properly done liposuction AND watch your diet - you will NOT be a victim of the "shifting, transmutating fat". Chuck it to a MODERN version of other foolish "facts" / urban legends.

Peter A. Aldea, MD
Memphis, Tennessee

Peter A. Aldea, MD
Memphis Plastic Surgeon
4.9 out of 5 stars 109 reviews

The body cannot regenerate fat cells.

When patients undergo liposuction, fat cells are removed from problem areas.These fat cells are removed permanently because your body doesn’t have the ability to regenerate new fat cells.

After liposuction, it’s important for patients to maintain a healthy lifestyle and avoid significant fluctuations in their weight.When patients ingest significant calories, they will be stored as fat.Accumulation of fat will occur in areas where the fat cells have not been previously removed.Under these circumstances, patients may gain weight in areas that have not undergone liposuction.

It’s, therefore, important to realize that liposuction is not a stand-alone procedure.The success rate for liposuction is dependent upon adopting a healthy lifestyle.When liposuction is performed in combination with appropriate lifestyle changes, results are excellent, and levels of patient satisfaction are high as well.

Richard J. Bruneteau, MD
Omaha Plastic Surgeon
4.9 out of 5 stars 194 reviews

Permanent Fat Removal?

Thank you for the question.

Fat cells that are gone (for example removed with liposuction surgery) are gone forever.  However, if a patient gains weight the fat cells that remain in the area treated with liposuction and in areas that were not treated will grow.  Do your best to maintain a healthy weight  after your procedure.

I hope this helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,499 reviews

Return of lipo fat after liposuction

When fat is removed from a specific area it typically does not return.  Your fat cell increase and decrease in size with weight changes.  That said if you gain weight significantly after liposuction you will typically gain it in other areas first.  The ideal patient is one who eats healthy and exercises regularly to maintain or improve their result.

Roger J. Friedman, MD
Bethesda Plastic Surgeon
5.0 out of 5 stars 8 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.