Liposuction is a cosmetic procedure that removes fat deposits from specific areas of the body through suction. It is one of the most popular cosmetic surgeries performed today. However, liposuction is not intended as a weight loss procedure and has limited effectiveness on people who are morbidly obese.
What is morbid obesity?
Morbid obesity is defined as having a body mass index (BMI) of 40 or higher. BMI is calculated by dividing weight in kilograms by height in meters squared. A BMI of 30-39.9 is considered obese, while 40 and above is morbidly obese.
At this level of obesity, excess weight starts to take a serious toll on health. Risks include high blood pressure, heart disease, type 2 diabetes, stroke, sleep apnea, gallstones, osteoarthritis, and certain cancers. Morbid obesity reduces life expectancy.
Limitations of liposuction for the morbidly obese
Liposuction is not an effective weight loss method for the morbidly obese for several reasons:
- Liposuction only removes between 3-6 pounds of fat per treatment area. This amount is insignificant compared to the excess fat stores of someone morbidly obese.
- Fat removal is limited to selected areas like the abdomen, thighs, hips, flanks, back, arms, neck, etc. Liposuction cannot eliminate visceral fat around organs or evenly remove fat from the entire body.
- The human body compensates for fat removal by putting fat back into treated areas within a year. The morbidly obese regain fat rapidly after liposuction.
- Liposuction risks are higher with morbid obesity, including adverse reactions to anesthesia, bleeding, infection, embolism, puncture injuries, and unsatisfactory contour results.
- The costs of multiple liposuction sessions required to see a noticeable change are extremely high. Health insurance does not cover liposuction costs for the morbidly obese.
Amount of fat removed by liposuction
| Liposuction Treatment Area | Amount of Fat Removed Per Session |
|---|---|
| Abdomen | Up to 5 pounds |
| Back | Up to 3 pounds |
| Hips/outer thighs | Up to 3 pounds |
| Inner thighs | Up to 3 pounds |
| Knees | Up to 2 pounds |
| Upper arms | Up to 3 pounds |
| Neck/chin | Up to 2 pounds |
As shown in the table, the maximum amount of fat removed in one liposuction session is about 5 pounds per treatment area. Morbidly obese patients have 50-100 pounds or more of excess fat. Multiple procedures over time would be required to make a visible difference.
Health risks of liposuction for the morbidly obese
Because liposuction is an invasive surgical procedure, risks are higher for morbidly obese patients:
- Adverse reactions to anesthesia – Obese patients are at greater risk of complications from general anesthesia or intravenous sedation used in liposuction including problems breathing, blood clots, drug reactions, stroke, and heart attack.
- Excessive bleeding – Morbid obesity leads to greater bleeding during and after liposuction. This can require blood transfusions.
- Infection – The obese have higher rates of infection following liposuction surgery.
- Fat embolism – Fat globules can break away and enter the bloodstream, blocking blood flow to lungs and brain.
- Puncture injuries – The cannula used during liposuction can puncture internal organs in morbidly obese patients more easily.
- Contour irregularities – Removal of huge fat volumes can lead to a wavy, lumpy, or sagging appearance of the skin.
These risks mean liposuction is not usually recommended for patients who are morbidly obese. The benefits do not outweigh the potential complications.
Alternative fat reduction procedures
Instead of liposuction, some alternative fat reduction procedures may be better options for a morbidly obese patient including:
- Laser-assisted liposuction – Uses laser energy to break down fat cells before suction. May result in less bleeding and swelling.
- Ultrasound-assisted liposuction – Uses ultrasonic energy to liquefy fat before removal. May better treat fibrous areas.
- Power-assisted liposuction – A powered cannula is used to pull fat out with less surgeon effort.
- Radiofrequency liposuction – Radio wave energy is applied through the skin to melt fat cells.
- Cryolipolysis – Applies cold temperatures to freeze and destroy fat cells without surgery.
- Low-level laser therapy – Reduces fat layer thickness by delivering light energy to fat cells.
However, while these techniques are less invasive, they still cannot remove huge volumes of fat required for substantial weight loss in the morbidly obese. Only small areas can be treated at one time.
Weight loss methods for the morbidly obese
For morbid obesity, liposuction should not be the first choice. Comprehensive lifestyle changes should be explored first, including:
- Adopting healthy eating habits with calorie restriction
- Increasing physical activity and exercise
- Addressing psychological issues contributing to overeating
- Joining weight management programs for education and peer support
- Trying prescription diet pills under medical supervision
If these methods fail to induce sufficient weight loss, bariatric surgery is considered the treatment of choice for morbid obesity:
- Gastric bypass – Reduces stomach size and reroutes the small intestine to reduce calorie absorption.
- Adjustable gastric banding – An inflatable band placed around the upper stomach limits food intake.
- Sleeve gastrectomy – Removes a portion of the stomach to decrease volume and appetite.
- Duodenal switch – Decreases stomach size and causes malabsorption of calories and nutrients.
These weight loss surgeries produce much more dramatic and sustained fat reduction compared to liposuction. They can enable obese patients to lose 50-75% of excess weight within 1-2 years.
Should one consider liposuction after bariatric surgery?
In some cases, liposuction may be considered as a follow-up to bariatric surgery for morbid obesity.
Advantages include:
- Removing fat deposits that remain even after major weight loss
- Improving body contour in areas with sagging skin like the abdomen
- Supporting continued motivation to keep weight off
However, waiting 12-18 months after bariatric surgery is advised before considering liposuction. This allows the individual to fully recover, become stable at their new lower weight, and show that they can maintain new lifestyle habits.
Liposuction can then sculpt problem areas that remain disproportionate even after major weight loss from gastric bypass or other procedures. But it still should not be viewed as an initial weight loss method by the morbidly obese.
The bottom line
While liposuction is the most popular form of fat reduction surgery, it has severe limitations for patients who have extreme obesity. The maximum amount of fat removed is fairly small, risks are higher, and the costs quickly become prohibitive.
For substantial fat loss in cases of morbid obesity, comprehensive lifestyle changes should first be exhausted. Bariatric surgery like gastric bypass or gastric sleeve can produce much greater weight reduction when needed.
Liposuction may have a role only after significant weight loss from bariatric surgery to address localized areas of fat that remain disproportionate. But even after major weight loss, liposuction cannot be expected to deliver the massive fat reduction a morbidly obese patient desires. Appropriate diet and exercise remains essential for long-term health and maintaining normal weight.
