Lipoplasty: Weight Loss and Large Volume Lipoplasty
New York, NY (January 18, 2002) — New data suggest that large volume lipoplasty (LVL) can produce dramatic weight loss and significant, and possibly long-lasting health benefits, when performed using the strictest patient selection criteria, in an accredited surgical setting and with close monitoring. Yet most plastic surgeons remain concerned about the potential risks of LVL. In the current issue of Aesthetic Surgery Journal (ASJ), the peer-reviewed publication of the American Society for Aesthetic Plastic Surgery (ASAPS), Sharon Giese, MD, and co-authors discuss their 1-year findings on the results of LVL in 14 overweight women.
Lipoplasty (liposuction) is the most popular cosmetic surgical procedure, according to ASAPS' national statistics, up 113% since 1997, and totaling 376,633 procedures in 2000. Lipoplasty is generally recommended for patients at or close to their ideal body weight who desire "contouring" of diet- and exercise-resistant fatty tissue. While a few surgeons successfully perform large volume fat removal (defined in the study as removal of 5 liters or more of fat aspirate), most plastic surgeons prefer to avoid the increased risk believed to be associated with LVL.
In outlining the factors for success and safety in LVL, Dr. Giese and her co-authors name patient selection as the single most important factor. They contend that LVL may be appropriate for individuals classified as "medically overweight," but emphasize that it is not for those who are "medically obese" (more than 50 pounds over their ideal weight). Appropriate candidates must be in excellent health. Absolute contraindications for LVL are multiple medical problems, eating disorders, and unstable weight in the past year (greater than 10-pound fluctuation), alcoholism, or drug abuse; based on these factors alone, the number of suitable candidates for this procedure is small.
In addition, candidates must be willing to lose some weight before surgery and maintain their weight loss following LVL, says Dr. Giese. "Maintenance and additional weight loss can be achieved only with a healthy lifestyle. The exciting finding of our study is that results at 10 to 21 months after LVL showed that the improvements in body weight, systolic blood pressure and fasting insulin levels observed at 4 months after the procedure were largely sustained in our study group," she says. Dr. Giese maintains that the benefits of LVL in reducing weight and improving overweight patients' cardiovascular risk profile make the procedure worth considering as a possible weight loss treatment. And, she says, "All patients who were pre-diabetic are now normal."
But Charles Hughes, MD, chair of the ASAPS' Body Contouring Committee, urges caution. "The safety of lipoplasty has increased dramatically since 1998, presumably because plastic surgeons have taken a more conservative approach to performing the procedure by tightening patient selection criteria and generally removing smaller volumes of fat," says Dr. Hughes. "Dr. Giese and her co-authors have outlined possible expansion of the use of lipoplasty in clearly defined and limited circumstances, and for a select group of healthy patients who are within 50 pounds of their ideal body weight. Neither this study, nor any other research that I know, advocates lipoplasty as a treatment for obesity."
Dr. Hughes, who authored the ASJ article published in May 2001 reporting results of a major survey on lipoplasty safety, says Dr. Giese's study involves a very small number of patients, and similar results would need to be obtained from a much larger group, with a longer follow up time, in order to validate the reported health benefits. "As far as I know, this is the only study of LVL that has measured the sustained impact on systolic blood pressure and insulin levels," adds Dr. Hughes.
It is the position of the American Society for Aesthetic Plastic Surgery (ASAPS) that patient safety is the most important consideration in any cosmetic surgery procedure. ASAPS recommends that lipoplasty be performed by an American Board of Plastic Surgery certified physician and only in an accredited surgical facility. "LVL, in particular, requires extensive experience in lipoplasty procedures," says Dr. Hughes. "The surgeon and assisting medical personnel must have broad knowledge and experience in anesthesia and fluid management. Postoperative monitoring of the LVL patients must be vigilant. Patients must be thoroughly informed of the possibility of increased risk associated with large volume fat removal."
With the strictest patient selection and in the hands of a qualified plastic surgeon trained in the proper technique, LVL may prove to be a valuable tool for reducing some of the co-morbid conditions associated with being overweight. Most plastic surgeons, however, do not advocate lipoplasty, including large volume lipoplasty, as a safe and effective method for significant weight reduction.
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The American Society for Aesthetic Plastic Surgery (ASAPS), is recognized as the world’s leading organization devoted entirely to aesthetic plastic surgery and cosmetic medicine of the face and body. ASAPS is comprised of over 2,600 Plastic Surgeons; active members are certified by the American Board of Plastic Surgery (USA) or by the Royal College of Physicians and Surgeons of Canada and have extensive training in the complete spectrum of surgical and non-surgical aesthetic procedures. International active members are certified by equivalent boards of their respective countries. All members worldwide adhere to a strict Code of Ethics and must meet stringent membership requirements.
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