At the beginning of my practice, I systematically refused obese patients who consulted me for liposuction and recommended that they lose weight. The small number who succeeded in this challenge could benefit from liposuction. But I quickly realized the inconsistency and changed my strategy.
After significant weight loss, liposuction became much more difficult. For example, if you take two patients weighing 150 pounds (68 kg), one of whom previously weighed 180 pounds (81 kg), the liposuction for the latter will be much more challenging due to a higher proportion of fibrous tissue. Here is the explanation resulting from my clinical observations. When losing weight, fat cells empty, but their number does not decrease; worse still, the fibrous proportion of fatty tissues increases. This makes the procedure more laborious, as the tissues become much more pasty, harder to penetrate with the cannula, and the fat becomes less easy to remove. Sometimes it feels like the cannula slides through the tissues without extracting fat.
Moreover, the aesthetic results will be less impressive in such cases, as very often, the skin will have lost its elasticity during weight loss and will retract less effectively, resulting in a less beautiful final outcome. If we need to perform liposuction on a patient who yo-yos with their weight, losing and gaining kilos, the best time for the procedure will be when the yo-yo is at its highest.
Many surgeons still believe the opposite, but according to my experience and supported by eminent specialists, including Dr. Klein, the inventor of tumescence, this opinion is well-founded. “The aesthetic results of liposuction in a former obese patient tend to be less impressive than those of the same liposuction in a patient operated at their maximum weight,” Klein states in his book Tumescent Technique on page 264.
I now have no objection to performing liposuction on moderately obese patients, especially those who have lost weight multiple times and regained it afterward. I become their lifeline, and believe me, this role suits me very well. Let’s not forget that the goal of liposuction is to make people happier, not only morphologically but also psychologically (self-esteem, depression, clothing, quality of life), hygienically as well (fat apron, chafing thighs), and in terms of the patient’s overall health. A small excess of fat harms beauty, while a large excess harms health.
One day, after treating a case of a very prominent abdomen, the patient, upon standing up after the procedure, started crying and said, “This is the first time in 10 years that I can touch my pubis!” Did this patient’s life change? In just one hour, she became herself again. Is there a weight limit beyond which liposuction is not recommended? Of course, for safety reasons alone, liposuction is not performed on any patient with a body mass index (BMI) over 40. Sometimes, after liposuction in an obese patient, we witness an extraordinary weight loss of 20 to 25 pounds (10 to 12 kg) with or without dieting. Some patients claim they did not follow a diet and lost this weight naturally and effortlessly. Other times, they confirm they followed a diet, but the motivation was so strong due to the liposuction and the boost they received that the weight loss occurred smoothly, almost painlessly. The relationship with their body and health was then completely transformed.
We have already discussed an effect on weight loss thanks to liposuction. I find the expression very appropriate. In French, we could use the expression “boost effect.” In an obese person, liposuction must be performed with great caution and done in stages, as the surgical risks are greater, among other things, we monitor respiratory complications.
Rather than attempting two massive liposuctions of 4 liters each, we could propose three liposuctions of 2 to 3 liters, with about two months of recovery between each. This is not systematic, as each request must be judged on a case-by-case basis.
Local anesthesia by tumescence will be even more indicated as an obese patient will tolerate general anesthesia less well than a thin person. Before concluding this chapter, which allows us to address the most current questions, I would like to mention two recent studies that support liposuction in obese patients. First, it has already been mentioned that men over 40 with belly fat (visceral fat) are twenty times more at risk of heart disease than thin men. According to these researchers, the location of body fat is more important than excess weight, up to a certain point, of course. Thus, saddlebags would have virtually no health consequences.
In simpler terms, this information shows us that to live longer, it is better to resemble a pear than an apple, regardless of our gender. You will understand that apple means a big belly, while pear refers to overly plump buttocks and thighs. For obesity localized to the abdomen, liposuction will be a weapon of choice, acting precisely on the cause of excess weight, whereas a weight loss cure cannot be targeted in any way. The yo-yo effect demonstrates this: so much unnecessary effort for people who only have one life to live.
While studying these conditions, another troubling fact about weight loss was reported this time by researchers from Laval University. These in-depth analyses demonstrate that even though the generally accepted opinion among doctors is that losing weight is very beneficial for the health of obese people, weight loss, by burning fat, releases several toxic products into the blood that had accumulated in adipose tissue.
Trapped in fat, these substances were inert and therefore not actively harmful to health, but once released into the blood, PCBs, pesticides, and other organochlorine compounds become real poisons.
Still in the same study from Laval University, nineteen toxic substances were detected, increasing by 30% in the blood of subjects undergoing a weight loss diet.
Obviously, the studies are too recent to determine if these substances can cause diseases, but one thing is certain, yo-yoing with weight no longer seems as harmless as we once thought. It is reassuring to note that during liposuction, all these toxic substances, rather than entering the bloodstream and risking causing damage that we cannot yet quantify, are suctioned by the cannula and subsequently incinerated.
I see another advantage of resorting to liposuction, and moreover, with liposuction, there is no yo-yo effect, the removed fat cells never return. Indeed, the removed fatty tissue is gone forever. I conclude this chapter with a striking example of psychological change thanks to liposuction. A 19-year-old girl, obese (figure 33), who could no longer lose weight, had become, in response to her multiple frustrations and inner discomfort, almost impossible to live with for her parents: pregnancy at 16, school dropout, indiscipline, rudeness, and so on…
In desperation, they came to see me for a consultation. We planned four successive liposuctions, with recovery time between each: trunk, thighs, buttocks, arms. She then lost 25 pounds (11 kg), and her body slimmed down, her character changed: she experienced a true resurrection. Her parents told me they had never made a better investment, as they love their daughter and gave her a gift commensurate with their desire to see her happy, finally.
