Archive for May, 2011

Dr Comins and Dr Wolf would like to congratulate Dr Paul Cronin, Dr Paul Charlsen, Dr Andy Weber and Dr Josh Berkowitz (more…)

Following the recent articles in the national press over the past week in regards to fat redistribution following Liposuction procedures there has been growing unecessary concern regarding this.

The Private Clinic always welcomes new and relevant medical studies so when we heard about the below recent study, led by Dr Teri Hernandez and Dr Robert Eckel of the University of Colorado, we were keen to explore it further.

The paper looks into the potential unwanted side effects following Liposuction. As fat treatments are such a large and very successful part of our business at The Private Clinic we were eager to investigate the paper in detail.  Here, we collated Dr Mike Comins and Dr Dennis Wolf comments on the study.

We congratulate the authors of their publication of this recent paper as it is hugely important that studies such as these continue to be published and challenge cosmetic medicine.  The paper makes extremely interesting reading however we feel it has been taken slightly out of context by the press. Several newspapers have already published articles on the subject in relation to this medical paper and also on previous theories of adipose redistribution post-liposuction.  To date there have not been many sound and accurate studies on this topic.

Our initial observations were drawn to the small quantity of patients that were observed in the study; 14 were treated and 18 were used for control group (patients not treated for comparison) 32 in total.  With such a small number of people being studied it is not really possible for the results to be truly representative of all patients treated with Liposuction and the authors do acknowledge this. Furthermore prior to any patients being treated with Liposuction they were all measured, weighed and fat percentage accessed. Interestingly, the group chosen to have the Liposuction treatment weighed significantly less then the control group (6 Kg on average which is nearly 10% of their total body weight). However, all patients in both the control group and the Liposuction group had similar fat percentage measurements. So although the Liposuction group weighed much less on average, they had the same fat amount including the arms as the heavier control group – hence you could argue that the Liposuction patients were already prone to store fat on their arms.  

Further analysis revealed that the 14 patients who had Liposuction had some or all of the following areas treated, flanks (hips), thighs and lower abdomen. It’s not clear as to what area of the thighs were treated, but it is clear that only the abdomen below the navel was treated. Although some of our clients have a very defined upper abdomen and just a small-localized area of lower abdominal fat, this is unusual. With VASER^® and Microcannula Liposuction we rarely recommend just treating the abdominal fat just below the naval as this may leave disproportionate sizes of upper and lower abdomen thus we treat mostly upper and lower abdomen in one session.  This is especially true for mid and hi def VASER^® where it is essential to treat the entire front torso. It is therefore not unexpected that some fat may accumulate in the untreated upper abdominal area.

This studies revealed that the Liposuction group had increased fat redistribution on their arms one year after the treatment which initially presents the most surprising results due to what we already understand about fat cells (adipocytes) and the way they behave in response to age, genetics and hormones. From a physiological point of view it is unlikely that fat would deposit itself in the same position (i.e. arms) in every patient that has Liposuction, especially if multiple and different areas are treated.

In the thousands of patients we have personally treated and the hundreds of thousands of patients having had Liposuction worldwide in the last 20 years, this has certainly not been an obvious concern or trend for patients to grow significant disproportionate fat on their arms. The conclusion reached in the study was that patients saw a fat increase by 1.02%, therefore being such a small amount it would be very unlikely to be obviously noticeable or of concern. Interestingly, as reported in a national newspaper, the patients in the study who had Liposuction were very satisfied with the overall results, furthermore the majority of the control group (the patients not treated in the trial) decided to have Liposuction after the trial finished.

The study also has to consider the possibility that the pre liposuction patients treated, that they may be already prone to store fat on their arms as well as their lower abdomen, thighs and hips. At The Private Clinic whether a Vaser or Microcannula technique is used, we will highlight to patients that if there is an area more prone to put weight on than the areas treated, it may well accumulate more fat as a result of the lipo treatment. In these cases we recommend either treating all the areas, or if the patient would only like their desired areas treated then we would recommend a post treatment exercise regime focusing on the untreated prone areas or not having any treatment at all.

This study has revealed some interesting observations although it is in line with our current ideas of fat and fat redistribution. Nonetheless Dr Wolf and Dr Comins feel it prudent to conduct a clinical audit and will shortly start measuring patients’ arm fat before and after treatment, using skin fold calipers, and we look forward to sharing our findings on hundreds of patients as opposed to just 14.

Whilst it would be inappropriate to undermine these new findings completely, a proper power analysis would probably indicate that a larger cohort of patients would need to be studied to give an accurate reflection of post-liposuction effects.

We think we can be assured that Tumescent Liposuction whether used on its own or with VASER^® has consistently been one of the most popular cosmetic medical treatments for over 20 years. As a general rule any cosmetic treatment resulting in frequent complications or unsuccessful outcomes tend to lose recognition very quickly and quite rightly so. Our figures in fact show that year-on-year our fat treatments have become more popular with both our patients and medical staff, this would not be the case if patients were developing a significant amount of obvious fat redistribution on areas such as the arms.

Its important to remember, the types of fat treatments we offer at The Private Clinic, whether it be VASER^® Lipo-Contouring or Tumescent Microcannula, that they should never be seen as weight loss treatment, but rather a compliment to, or a motivation to a healthy general lifestyle.

 Notes

The study: ‘Fat Redistribution Following Suction Lipectomy: Defense of Body Fat and Patterns of Restoration

Teri L. Hernandez1,2, John M. Kittelson3, Christopher K. Law4, Lawrence L. Ketch5, Nicole R. Stob1, Rachel C. Lindstrom1, Ann Scherzinger6, Elizabeth R. Stamm6 and Robert H. Eckel1

No randomized studies in humans have examined whether fat returns after removal or where it returns. We undertook a prospective, randomized-controlled trial of suction lipectomy in nonobese women to determine if adipose tissue (AT) is defended and if so, the anatomic pattern of redistribution. Healthy women with disproportionate AT depots (lower abdomen, hips, or thighs) were enrolled. Baseline body composition measurements included dual-energy X-ray absorptiometry (DXA) (a priori primary outcome), abdominal/li Fat Redistribution mb circumferences, subcutaneous skinfold thickness, and magnetic resonance imaging (MRI) (torso/thighs). Participants (n = 32; 36 ± 1 year) were randomized to small- volume liposuction (n = 14, mean BMI: 24 ± 2 kg/m2) or control (n=18, mean BMI: 25 ± 2) following baseline. Surgery group participants underwent liposuction within 2–4 weeks. Identical measurements were repeated at 6 weeks, 6 months, and 1 year later. Participants agreed not to make lifestyle changes while enrolled. Between-group differences were adjusted for baseline level of the outcome variable. After 6 weeks, percent body fat (%BF) by DXA was decreased by 2.1% in the lipectomy group and by 0.28% in the control group (adjusted difference (AD): −1.82%; 95% confidence interval (CI): −2.79% to −0.85%; P = 0.0002). This difference was smaller at 6 months, and by 1 year was no longer significant (0.59% (control) vs. −0.41% (lipectomy); AD: −1.00%; CI: −2.65 to 0.64; P = 0.23). AT reaccumulated differently across various sites. After 1 year the thigh region remained reduced (0.77% (control) vs. −1.83% (lipectomy); AD: −2.59%; CI: −3.91 to −1.28; P = 0.0001), but AT reaccumulated in the abdominal region (0.64% (control) vs. 0.42% (lipectomy); AD: −0.22; CI: −2.35 to 1.91; P = 0.84). Following suction lipectomy, BF was restored and redistributed from the thigh to the abdomen.