Early Metabolic Changes and Its Considerations after Liposuction

PURPOSE: Advanced techniques now make it possible to remove considerable amounts of subcutaneous adipose tissue more safely with minimum blood loss. However, few have analyzed the metabolic consequences of liposuction. The purpose of this study was to identify the early effects of the surgical removal of subcutaneous fat on metabolic changes in patients who have undergone liposuction. METHODS: Nineteen patients were evaluated from June 2005 to December 2005. Preoperative body weight, serums levels of lipids, apolipoprotein A1, dehydroepiandrosterone(DHEA), uric acid, insulin, and glucose were evaluated. Insulin resistance was determined using the homeostasis model assessment of insulin resistance (HOMA-IR), which is based on fasting glucose and insulin concentrations. All of these data were remeasured in 1 and 4 weeks postoperatively. Tumescent fluid was infiltrated using the superwet technique. The liposuction device used was a Liposlim(R) power-assisted unit. RESULTS: Average volumes of infiltrate and aspirate were 3,268mL and 2,892mL, respectively. Results in 1 week postoperatively demonstrated a significant difference in high-density lipoprotein(HDL) cholesterol, apolipoprotein A1, insulin, and HOMA-IR levels. However, all values were within normal limits and returned to baseline in 4 weeks postoperatively. CONCLUSION: This study provides little to support the presumed therapeutic effect of liposuction. And, it is unclear whether liposuction can prevent or be used to treat the metabolic complications of obesity. However, the results of the present study lead us to believe that liposuction is a metabolically safe procedure.

Clinical Experiences and Considerations of Large-Volume Liposuction

A review of recent reports showed that many surgeons define large-volume liposuction as the removal of over 5000ml of total aspirate. However, no clinical reports of single procedures in Korean involving aspirate volume of 5000 ml or greater have been presented. From May 2002 to December 2004, 59 patients with age averaging 31.2 years old underwent large-volume liposuction. Liposuction was performed using the superwet technique and a Lipomatic(R) vibropneumatic system. Clinical data, which included; body weight changes and BMIs at a postoperative 2 months, hemoglobin and hematocrit at a postoperative 2 days, operative time, and volume of infiltrate and aspirate, were evaluated. The average volumes of infiltrate and aspirate were 6916.7+/-1665.8ml and 6549.6+/-1787.2ml, respectively. Mean patient weight had decreased from 62.96+/-14.21 to 58.61+/-13.43kg with an average weight loss of 4.35kg, and mean body mass index from 23.84+/-3.91 to 22.17+/-3.70kg/m2 with an average drop of 1.67kg/m2; equivalent to a fall in weight per liter of aspirated volume of 0.66+/-0.09kg/L. Falls in hemoglobin and hematocrit per liter of aspirate volume were 0.46+/-0.07g/dl/L and 1.70+/-0.35%/L, respectively. Mean operative time per liter of aspirate was 39.6+/-2.1min/L. Complications were palpable skin irregularity in 5 patients; hyperpigmentation scars occurred in 5 patients; 2 of the heaviest women required blood transfusions; and 1 patient experienced prolonged edema. One major complication of subclinical fat embolism occurred. Cosmetic results were generally good. In conclusion, if patients are properly selected and fluid resuscitations are performed adequately, single stage liposuction involving aspirations of greater than 5000ml can be undertaken safely in Korean.