Can surgical liposuction actually make you gain weight? Is non-surgical liposculpture better?
The benefits of losing weight are well documented for people who are overweight or obese: a much-reduced risk of heart disease, stroke, diabetes, cancers, and chronic pain conditions to name but a few.
But the way we look is so intrinsically linked with our emotions and psychology that even after successful weight loss, many people seek help to ‘perfect’ and maintain their results. Liposuction and laser fat reduction are procedures forming just part of a multi-million pound cosmetic industry to help people lose weight quicker, to sculpt fat loss in particular areas of the body, and to achieve an ‘ideal’ shape.
Surgical fat removal
Of the several surgical liposculpture techniques used to remove fat from the body, suction-assisted lipectomy – more commonly known as ‘liposuction’ – is perhaps the best known. This clinical procedure, which usually takes place under general anaesthetic, involves physically breaking up fat tissue, then inserting a tube under the skin to suck the loose, excess fat cells from the body.
Unlike bariatric weight loss surgery, It’s not a ‘quick fix’ for drastic weight loss, but can be used on smaller areas of the body like the chin, stomach, buttocks, hips or thighs to improve the appearance of fatty areas that have a tendency to resist slimming through diet and exercise.
The results achievable from liposuction are usually effective and long lasting – but as a relatively major and invasive fat reduction operation, there are certain liposuction risks and side effects to consider.
Immediately after the operation, and for several weeks afterwards, patients wear an elasticated compression corset to help reduce swelling and bruising – but this doesn’t eliminate swelling and bruising completely. In fact, it’s quite likely, and the results of liposuction can take some time to become apparent.
It is also common to experience numbness of the skin, scarring from the incisions, fluid leaking from the entry wounds, and inflammation. Bleeding, blood clots, allergic reactions and infections requiring antibiotic treatment are not uncommon.
Does liposuction make you hungrier?
Another reported side effect, which has recently been the subject of several clinical studies, is the notion that surgically removing fat cells in this way can actually increase a person’s appetite.
If this is the case, having liposuction could cause a patient to overeat and regain weight – exactly the opposite of the desired effect! But why would this happen, and is there any truth in it?
Fat cells and the ‘hunger hormones’
It’s all to do with an under-appreciated property of fat cells – they do not just store excess fat, they also produce a hormone called leptin.
Leptin is the body’s “satiety hormone” and works antagonistically with its opposite hormone ghrelin, the “hunger hormone”. When the body detects that it is getting low on energy, ghrelin is released to make us feel hungry, so we eat to replace our energy levels. Leptin, on the other hand, is produced when we have eaten enough to replenish our energy levels, thus ‘switching off’ the effects of ghrelin and causing us to feel full.
When large numbers of fat cells are removed from the body in a procedure like surgical liposuction, the body’s ability to produce leptin is therefore reduced. In fact, several clinical studies have confirmed that post-operative leptin levels are significantly lower in people who have had liposuction (e.g. 1–3).
The concern is that if we do not have enough fat cells to produce enough leptin, then the “hunger hormone” ghrelin stays switched on, and we continue to feel hungry even when we have consumed enough calories for our needs. This can lead to over-eating and weight gain. Not the ideal situation for someone who has just spent thousands of pounds on cosmetic surgery!
Does liposuction merely swap one type of fat for another?
As an aside, some studies also suggest that while liposuction removes the ‘flabby’ subcutaneous fat from beneath the skin, unless one is very physically active, the body can respond by producing more visceral fat – the harder type of fat that surrounds our internal organs4. Consequently, and contrary to what one might expect, this type of fat reduction appears to have no overall effect on reducing cardiovascular disease risk5.
Surgical liposuction vs. non-surgical fat reduction
According to the most recent statistics from the British Association of Aesthetic Plastic Surgeons (BAAPS)6, 3218 people in the UK underwent a surgical liposuction procedure in 2016. Surprisingly, however – given that the side effects of liposuction have always been there and remain the same – this figure was down over 40% on figures from the previous year.
There are many possible reasons for this downturn in the number of liposuction procedures – the emergence of ‘real’ celebrity role models who actively shun cosmetic surgery and embrace a larger size, the economic recession and even Brexit have all been suggested as contributory factors.
The number of non-surgical liposculpture procedures, however, is on the rise. Are people starting to shun surgical liposuction in favour of these less invasive methods?
Non-surgical liposculpture: how it works
Previously viewed by some as a cheaper, less effective alternative to surgical liposuction, the technology used for non-surgical liposculpture has greatly improved in recent years. In fact, many now consider that the results achievable with non-surgical fat removal are on a par with the surgical equivalent.
Non-surgical fat reduction is not an alternative to weight loss surgery, but like liposuction, can help to sculpt and smooth out stubborn areas of fat.
‘Fat freezing’, also known as ‘CoolSculpting’, is one method of non-surgical fat reduction that exploits the tendency of fat cells to freeze at warmer temperatures than the surrounding tissues. In CoolSculpting, cold pads are applied to the skin at a temperature that freezes and destroys fat cells completely, while the surrounding skin and tissue remains unaffected. Reported side effects include inflammation and stinging pain, which can be extreme in approximately 10% of people, and numbness and swelling can last for 2–3 weeks after treatment.
Laser fat reduction
Laser fat reduction techniques, like Xero Lipo, use pads containing small lasers that are applied to the surface of the skin for a few minutes at a time. These lasers emit concentrated rays of red light at the specific wavelength of 658 nanometers – this is the precise wavelength needed to ‘biostimulate’ (vibrate) components in the subcutaneous fat cells (those found underneath the skin).
Two key things happen when this wavelength is applied:
1) The fat molecules themselves break down into their constituent parts (fatty acids and glycerol), and;
2) Tiny yet temporary pores (holes) appear in the membrane of each fat cell. These pores allow the fatty acids and glycerol to leak out of the cell where they had been stored.
When the lasers are removed from the skin, or switched off, the molecular vibrations stop, the cellular pores close up, and the fat cells return to normal – albeit with one key difference: they have much less fat inside them.
The leaked fatty acids and glycerol are then made available to the body to be used as fuel; in order words, we burn them for our calorie needs and convert them to harmless carbon dioxide and water, which is finally breathed out of the body.
To accelerate this process, the second step in Xero treatment is to apply neuromuscular stimulation to the target area to enhance fat metabolism, and strengthen and tone the muscles in the target area. Finally, radiofrequency is applied to tighten the skin. All three technologies work in synergy to eliminate fat, and sculpt, tone and firm the target area to reshape the body.
Benefits of Xero Lipo
Being a non-surgical fat reduction procedure, there are clear benefits to Xero Lipo over surgery. Xero lipo requires no anaesthetic, thus operation-related liposuction risks are eliminated. Some people describe the laser as ‘warming’, the neuromuscular stimulation as ‘intense but not painful’, and the radiofrequency as ‘like a hot massage’. Unlike surgical liposuction or ‘fat freezing’ there is no inflammation, swelling, numbness or pain, so the patient can return to normal activity immediately.
Xero Lipo will not increase hunger
Another advantage over surgical liposuction, and indeed over fat freezing methods like CoolSculpting, is that Xero Lipo makes fat cells smaller by removing the fat molecules inside them, rather than destroying and removing the fat cells themselves. Therefore, the cells can still produce enough leptin to properly regulate hunger.
Combined with all the other advantages of laser fat removal over surgery – including the fact that it is much less expensive! – perhaps treatments like Xero Lipo will soon replace surgical liposuction altogether.
1. Talisman et al. Aesthetic Plast Surg. 2001;25(4):262–5
2. Geliebter et al. J Diabetes Obes. 2015;2(4):1–7
3. Crahay et al. Ann Chir Plast Esthet. 2016;61(4):270–86
4. Benatti et al. J Clin Endocrinol Metab. 2012;97(7):2388–95
5. Danilla et al. J Plast Reconstr Aesthet Surg. 2013;66(11):1557–63
6. ConsultingRoom.com [Internet]. 2016 BAAPS: Cosmetic surgical procedures dipped below 31,000 in 2016m [accessed 2017 Mar 03]. Available from: http://www.consultingroom.com/Services/Cosmetic-Surgery-Stats/2016+BAAPS:+Cosmetic+surgical+procedures+dipped+below+31,000+in+2016.