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2-Jul-04 7:00 PM  CST  

Liposuction and Metabolism: Does the body change after Liposuction? 

Lipogenesis and Lipoplasty Meeting

Hosted at Baylor Department of Plastic Surgery, June 16, 2001

 

Henry A. Mentz, M.D., FACS, FICS

 

Introduction

  • Materials and Methods
  • Results
  • Discussion
  • Conclusion

Maximum Fat
Aspirate Volumes

1980

1985

1990

1995               

  1,500 cc

  2,000 cc

  4,000 cc

22,000 cc

 

Fat Cell Number

  • Born with 5 x 109 cells
  • Adult with 5 x 1010 cells

Total Fat Cells Removed

 

5-50% ?

 

An Enlarging Total Fat Mass Increases

  • Sympathetic activity
  • Metabolic rates
  • Fat cell lipolysis
  • Free fatty acid flux in hepatic circulation
  • Pancreatic insulin secretion
  • Insulin resistance
  • Hepatic synthesis of VLDL, TG, ApoB
  • Hepatic TG lipase
  • Serum TG
  • Cholesterol ester to adipose tissue
  • Vasoconstriction
  • Cardiac output
  • Renal Na reabsorption
  • Blood pressure
  • Aromatization of steroids
  • Free testosterone

 An Enlarging Total Fat Mass Decreases

  • Hepatic glucose uptake
  • Skeletal muscle glucose uptake
  • Insulin antilipolytic effect
  • Hepatic insulin extraction
  • SHgb
  • Serum HDL

Footnote:  Fat Distribution, 1987 Claude Bouchard

 

Surgical Removal of Fat

  • May affect feeding behavior
  • May affect glucose insulin metabolism
  • May affect weight

Will the removal of fat cells affect any metabolic system?

 

Introduction

Materials and Methods

  • Results
  • Discussion
  • Conclusion

Patient Selection

  • 19 consecutive hospital-based patients scheduled for liposuction.
  • 2 patients had the procedure twice.

Measured Data

  • Changes in serum lipids
  • Changes in weight and BMI
  • Changes in exercise habits
  • Changes in dietary habits

Pre- Postoperative IntervalRange

 

Mean

10-40 weeks

 

27 weeks

 

Serum Lipid Test

  • 8 hours NPO
  • Olympus AU 5000
  • Photospectometry

 Serum Lipid

  • Total Cholesterol
  • LDL Cholesterol
  • HDL Cholesterol
  • Triglycerides
  • Cholesterol/HDL ratio

 Patient Profile

Nutritional Counseling

  • All patients received nutritiona counseling postop by a licensed dietitian.
  • At-risk patients received a fullassessment with recommendations and educational materials.

 Introduction

Materials and Methods

Results

Discussion

Conclusion

 

Results

19 consecutive patients

Hospital based

General anesthesia

Tumescent technique

Fat Volume Removed

Changes in Weight & BMI

 

Have patients changed their exercise habits?

                                      8                    improved

                                    10                    unchanged

                                      1                    digressed

 

Have patients changed their dietary habits?

                                      7                    improved

                                    10                    unchanged

                                      2                    worse/digressed

 

Changes in Cholesterol

Changes in LDL

Changes in HDL

Changes in Ratio

Changes in Triglycerides

 

95% of the
fat cell mass
is triglyceride

 

Introduction

Materials and Methods

Results

Discussion

Conclusion

% Body Fat
Over Time

Changes After Liposuction

Cholesterol

LDL

HDL

Triglycerides

Chol/HDL

  +12.5               6%

  +10.1               7%

     -2.0               5%

  +25.2             23% 

    +0.7             13%   

Changes After Liposuction

Weight      (-) 3.43 kg

Diet                          8 improved   

                                                  1 digressed

                                                10 Unchanged

Exercise        7 improved

                                                  2 digressed

                                                10 unchanged

 

 

Conclusion

 

Suggestions For Study

  • Larger study
  • More specific patient selection
  • Account for dietary, weight, and exercise changes
  • Sequential serum studies
  • Measure for fat necrosis

 Total Fat Cell

  • 30% may be very small diameter
  • Represents <1% of total fat volume
  • May be recruitment after existing large cells have reached a critical size
  • Site-to-site variation in cell size
  • Adiposity is a function of hypertrophy

“LIPOSTAT”

-- more related to individual fat cell size, not total fat mass

 

Exercise

  • Increased HDL cholesterol
  • Easier to diet


Effects of FAT NECROSIS on lipid metabolism

 

May need to evaluate weight changes with large volume liposuction

 

Effects of EXERCISE on lipid metabolism

 

Effects of DIET on lipid metabolism

 

Diet

  • Decreased LDL and total cholesterol
  • Decreased triglyceride
  • Increased HDL Fat Necrosis
  • Increased triglyceride

 Conclusion

 

OBESITY

  • Higher serum triglycerides, total andLDL cholesterol
  • Lower HDL cholesterol
  • Higher blood pressure
  • Glucose/insulin metabolism disturbances
  • Increased cancer and mortality risks

 Excess Calories

  • 70% of excess calories are stored as fat
  • Connected to free fatty acids in the liver
  • Stored as triglyceride in fat cells

 Lipids

  • Cholesterol
  • Triglycerides
  • Phospholipids
  • Free fatty acids

 FAT CELL

  • 3-10 x 1010 total body cells
  • Storage .001 - 1 ug of triglycerides
  • Can increase 1000 x in volume
  • Can increase 100 x in surface
  • 95% triglyceride

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For additional information on this Medical Research article, please contact:

Henry Mentz, MD, FACS, FICS / The Aesthetic Center For Plastic Surgery
(877) 707-2277

Source: Dr. Mentz
http://www.drmentz.com

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