Consumer Reports: Targeted Slimming

The following is an article from Consumer Reports magazine.

More than 478,000 Americans underwent liposuction in 2004 up 24 percent from the year before making it the nation’s most often performed cosmetic surgery. And it’s not being done just on parts of the body that are usually considered problematic. New technologies and thinner instruments let surgeons siphon fat cells from increasingly small areas, such as the knees, “cankles” (calves plus ankles), and even the neck, chin, and cheeks. But liposuction is costly and not without risks. Here’s what you should know about it.

What to Expect

Liposuction, or lipoplasty, involves using a thin, vacuum powered tube called a cannula to remove fat through small incisions. The amount can range from the equivalent of two pats of butter taken from the chin to 40 plus cups of fat from tummy, thighs, and buttocks. One method (with the BRAND NAMES Lysonix and Vaser) uses ultrasound energy to dissolve fat before it’s sucked out. Proponents say the technique reduces pain and bruising, but studies haven’t established that. About 90 percent of liposuction surgeries are performed on women.

A single procedure can remove millions of fat cells, and once they’re out, they’re out. But if you gain weight later, you’ll just store it somewhere else. “You can’t predict in any one person where it’s going to go,” says Gerald Pitman, M.D., a plastic surgeon in New York and author of “Liposuction and Aesthetic Surgery.” In the best case scenario, he says, “if they gain the weight back that was taken off, now it’s distributed normally through the rest of the body, so it’s not as noticeable.”

The operation is painful in a couple of ways. Expect bruising and swelling that can last several weeks and numbness in the treated area that may last longer. You may have to wear compression garments for several weeks after surgery.
Risks include infection, bleeding, pulmonary embolism, and complications from anesthesia (usually local for small areas, general for large or multisite procedures). Other possible side effects include asymmetry, uneven contour, and, very rarely, permanent weakness in the treated area.

The surgery will also pinch you in the wallet. It costs anywhere from $2,000 to $6,000. Insurance companies generally do not pay for it.

What Not to Expect

Liposuction does not improve overall health. That’s possible only if you LOSE WEIGHT through diet and exercise or with bariatric surgery.

In a study published in June 2004 in The New England Journal of Medicine, researchers used liposuction to remove lots of ABDOMINAL FAT from 15 obese women. Although the patients were 20 to 22 pounds lighter after the operation, it had no significant bearing on their metabolic risk factors for heart attack and stroke, namely blood pressure, cholesterol, blood sugar, and insulin levels.

One possible explanation: Liposuction removes some fat cells, but it doesn’t shrink those that remain. It’s not the number of fat cells in your body that affects cardiovascular risk, but the amount of fat stored in them. The bigger the cells, the greater the risk. Scientists theorize that the key to the health benefits of weight loss may lie in “negative energy balance,” or taking in fewer calories than you expend, which seems to shrink fat cells. What’s more, the fat removed by liposuction is just below the skin, not the fat around internal organs, which is more likely to pose health risks.

How To Choose

The ideal candidate for liposuction is in good health and of normal or near normal weight, with excess fat concentrated in a certain spot that hasn’t disappeared with diet or exercise. No formal guidelines prohibit liposuction on heavier people, but an advisory published in 2004 by the American Society of Plastic Surgeons warns of risks for obese individuals (especially those with a body mass index of 40 or higher), who are more susceptible to complications from surgery in general.

For The Best Results:

Find a qualified practitioner.

Look for certification from the American Board of Plastic Surgery, which ensures post medical school training in surgery and plastic surgery. Web sites for the American Society for Aesthetic Plastic Surgery (www and the American Society of Plastic Surgeons ( list board certified practitioners.

Ask for evidence

Examine pictures of the surgeon’s work.

Avoid Injections

Liposuction is the only fat removal procedure that is currently approved in the U.S. Steer clear of doctors who offer the reputed fat dissolving injection Lipostabil (phosphatidyicholine), which is used abroad but has not been approved for use in the U.S. Studies have not proved its safety or efficacy.