Liposuction Info: Fat Cells and Your Anatomy
Liposuction is about the removal of fat from the layers under the skin. To understand liposuction or fat removal in general, you must first understand the skin, body fat and the structure of fat cells.
The skin is not just a covering for the rest of the body, it is our body's largest organ. The skin does not just keep our insides in and the outside out. It is the first line of the body's immune defense against infectious organisms. It helps keep our body from dehydrating, helps keep us at the right temperature, serves as an organ of sensation (touch), protects us from ultraviolet radiation, and synthesizes vitamin D from sunlight.
There are basically three layers to the skin, the epidermis on top, the dermis just below that, and below that is the hypodermis or subcutis layer. The epidermis is primarily made of dead skin cells that form a protective layer. It is also where the melanocytes, the color cells of the skin, are found. These cells are continually flaking off the top and being replaced from the bottom.
The dermis is where you find the hair follicles, the nerves that perform the sense of touch, and the sweat and oil glands, among other structures.
The top two layers of skin do important things, but in terms of liposuction, we are concerned more with the hypodermis. The hypodermis is where the subcutaneous layer of fat resides. Although the body stores fat in a few other places, such as in the abdominal cavity around the internal organs there, the hypodermis is where the body stores about 50% of its fat. This fat serves as padding, insulation, and as energy storage.
Fat Structure and Fat Cells
Fat, also called adipose tissue, is important. You may hate it and despise its effects on your thighs and abdomen, but you need it! Your body has about 25 to 30 billion fat cells (adipocytes). Without fat, you would freeze to death in weather that was anything less than warm, have no energy stores, and have to eat constantly. If you did anything at all that expended energy, your body would have to start burning muscle tissue to create that energy. Without body fat, you would be uncomfortable sitting or laying down because your bones would have no padding.
A fat cell's job is to store the chemicals called lipids that provide energy for the body. This energy comes from the food you eat. It is stored as fat in the fat cells. Actually, saying fat is stored makes it sounds like an individual fat cell sits on your hip holding the fat until whenever. Instead, fat is continuously being put into and taken out of each fat cell. It is when that balance of what is put into storage and what is used goes out of whack that you either lose weight or gain it. If you eat too much and use too little energy, the fat builds up.
Fat Location and Distribution: Subcutaneous and Visceral Fat
There are three levels of fat in the body: two layers of subcutaneous fat (the deep layer and the superficial layer) and a third is known as visceral fat, the fat that is within the abdominal cavity and around the organs.
The deep subcutaneous fat layer is the one that is commonly removed in liposuction. The superficial fatty tissue, which is less commonly removed, can also be suctioned out in liposuction. The superficial and deep subcutaneous layers are separated by a membrane called fascia. There are also membranes within the layers of fat that separate fat into pockets.
The superficial subcutaneous fat layer is denser than the deep layer and is tightly packed with nerves and blood vessels. This fat layer is the location of the dreaded cellulite, which is caused by tight bands of connective tissue that squeeze portions of the fat cells and cause the bumpy irregularities on the skin. Please see our Cellulite Therapy Section for more information.
Liposuction in the superficial layer must be done carefully so as not to damage the functional components of the skin. This damage can result in visible permanent irregularities, discolorations, and possible death to that section of skin (skin necrosis).
The visceral fat layer is the deepest area of fat (sometimes called intra-abdominal fat). This fatty tissue surrounds and covers the intestines and other organs within the abdomen.
Fat is deposited in the body in two basic patterns. Gynoid refers to fat accumulation in the lower abdomen, lateral thighs, hips, and buttocks giving a “pear shape.” Android refers to accumulation of fat in the upper abdomen and flanks giving an “apple shape.” Most women have a gynoid distribution of fat and most men have an android distribution, but this is certainly not a hard and fast rule.
Excess amounts of visceral fat can be quite prominent in many people who are carrying a lot of weight and have an android (apple-shaped) body shape. This is the classic “beer belly,” although beer certainly isn't the only culprit. Proper diet and exercise is essential in controlling the amount of visceral fat. However, hormonal disorders or fluctuations can lead to the formation of a lot of visceral fat and a protruding abdomen, as can some medications such as protease inhibitors that are used to treat HIV and AIDS.
The percentage of fat in the body and where it is located varies somewhat from person to person and depends on hormones such as insulin, testosterone, and estrogen. The one thing you should know about fat is that once puberty is over, the number of fat cells you have is the number you have forever, unless you become extremely obese. Your fat cells only multiply if you reach 200% of your ideal body weight. Whether you are thin or fat, you have the same number of fat cells. They just shrink or plump up. Fat cells can expand enormously.
Liposuction removes some fat cells. They are gone for good once they have been sucked out. But this does not mean that if you overindulge and underexercise that the fat cells that remain will not expand and undo the effects of the surgery.
Diet Tips and Exercise to Decrease Fat as The Liposuction Alternative
Let me stress that liposuction is not a quick or easy means to lose weight. I repeat: Liposuction should not be used to reduce your weight or thought of as an overnight remedy to get rid of large amounts of body fat. The best and healthiest way to lose weight is with a combination of diet and exercise.
An ideal candidate for liposuction should eat a healthy diet, exercise regularly, and have a steady and healthy body weight. However, if that describes you and you've tried mightily and just can't seem to rid yourself of that “pinch an inch” section on your tummy, saddlebags, or elsewhere, liposuction might help.
Liposuction has given many people a jumpstart to increase their activity and improve their diet to improve their physique. It can give you the jumpstart you need to looking better and making healthy changes in your behavior. If you feel good about yourself, you take better care of yourself. Liposuction can help motivate you.
But in the mean time, you have to look at your behavior: if you aren't eating what you should (or not in the quantities that you should) and aren't at least walking around the block once a week, you have to know that this isn't healthy. It's not all about looking good, it's about feeling good, too. Your body can't function well when it's all out of whack so at least try to help it run smoothly.
Proper diet and exercise will increase your metabolism and improve the way your body functions. Diet can help keep your cholesterol levels and blood sugar under control. Regular exercise can do those things and also boosts your cardiovascular health, helps regulate moods, and helps build strong bones. A good diet and regular exercise may even prolong your life.
Unhealthy habitswhich includes eating the wrong foods, eating the right foods in excess, drinking excessively, and smokingwill put your body through the ringer. Saddlebags, "love handles", and excess poundage will be the least of your worries if you live that way. The best way to create a wholesome diet for you is to meet with a nutritionist or registered dietician. But I know not all of us, including me, want to pay or can afford to pay someone to tell us how we should eat.
The good news is that there are countless books, websites, support forums, and organizations that can help you with eating healthier. The bad news is that often these sources contradict each other and confuse the heck out of everyone. Find what works for you. You should be able to tell by how you feel, how you perform and how you look if a diet works for you.
Some suggestions for you for healthy dieting:
Watch your sugar intake: Eating pies, candies, cakes, and desserts in general, which have high amounts of sugar, can really pack on the lbs. Sugar also stresses your body by creating high insulin spikes that must be quickly balance out in your blood sugar levels.
Watch your refined carbohydrate intake: If all your carbohydrates are in the form of white processed flour, pasta, white bread, and even white rice, you have removed almost all of the essential fiber and vitamins. These products increase your insulin levels and increase your waistline.
Watch your starches and natural sugars: Foods like potatoes, carrots and corn are high in starches and/or sugars and can cause you to expand. You may think they are friendly vegetables but especially when they are eaten in excess, they're not. By sugar, I mean maple syrup, honey, and other "natural" forms of sugar. It's not so much the calories, it's the glycemic index. There are several sugar alternatives I use such as Splenda, isomalt, stevia and others. I don't personally like to consume such as aspartame, maltitol, and lactitol.
Decrease your intake of sodas and other sugary drinks: Again, the problem is the sugar. America lives off of sugar. Think of how many sodas or sugary beverages you drink daily and add up those calories.
Not all fat is bad fat. Fats found naturally in foods should be taken in moderation. The body needs fat to survive and depriving it will throw your entire body chemistry off. I am not talking about potato chip fat or Ben and Jerry's fat. I am talking about avocado, olive oil, nut oils, fish oils, lean meatsthat kind of fat.
The important fact is that you shouldn't go out and get liposuction and start eating all the bad things all over again thinking you won't gain weight. You will gain weight. Liposuction does not give you a license for many return trips to the gourmet buffet at Bellagio in Las Vegas or the nearest Krispy Kreme.
Don't get me wrong, I cheat every once in a while and sometimes much more than once in a while, but I don't eat every "forbidden food" consistently. I love food, but I know I can't keep eating and eating without paying for it eventually. I eat healthy and "reward" my self sometimes.
Exercise is also very important. You should get at least 30 minutes of cardiovascular exercise, the exercise that gets your heart pumping a bit harder, several times a week. You don't need expensive machinery or a gym membership. A brisk walk will do this. Again, you have to burn off more calories than you take in to lose weight. Exercise has the advantage of building strong bones, which is a good thing.
When Body Fat Stems from a Heath Issue
Many underlying health conditions can contribute to weight gain. Thyroid problems are one of the top reasons for a slow metabolism and an inability to burn fat efficiently. My thyroid is slow, as is my mother's. Staying thin is a battle.
Aging may be an issue in weight gain, but not all older people have problems with fat gain. Eating the wrong foods can cause imbalances in hormones such as insulin. Too much insulin can alter your hormonal outputs and decrease your ability to burn fat efficiently.
Medications can also alter your body's fat storage and fat burning ability or affect appetite. Hormone supplements, including birth control, can be a big cause in female-specific area weight gain. Hips, lower abdomen and thighsas well as the breastsbecome fattier and the mammary glands enlarge in the breasts in many women after they start using hormonal birth control products.
Hormone replacement therapy for menopause can also cause weight problems. Estrogen can cause weight gain in the hips, lower abdomen, pubic mound, and thighs, as well.
Protease Inhibitors used to treat HIV and AIDS tend to disrupt fat distribution, giving users a potbelly ("the protease paunch") as well as a fat pad on the nape of the neck (sometimes called a "buffalo hump"). However, some physicians believe this is not fat build up, but formation of dense scar tissue that is formed in those sites or a dense form of fatty tissue rather than scar tissue or normal adipose tissue. A "buffalo hump" can be removed with liposuction or surgical excision, but removing the visceral fat in the paunch is risky and very rarely performed. But some of the paunch is subcutaneous fat and is easily removed with normal liposuction.
Some antipsychotic drugs cause weight gain as well. Luckily, the first stage of treatment is when the weight gain seems to occur for most people. Usually after the body adjusts, the weight gain levels off as well. If you are on antipsychotic medications and have noticed weight gain, consider changing your diet under the supervision of your physician.
Oral corticosteroids (prednisone, prednisone, and methylprednisolone) can cause fat distribution abnormalities as well. They also are known to increase your appetite. Protruding abdomens and rounded faces (a ‘moon face”) are a known side effect of steroid use. Corticosteroids are used in treating many disorders, including lupus and rheumatoid arthritis.
Cushing's syndrome or disease is caused by an adenoma of the pituitary gland. It too can cause a protuberant abdomen and a buffalo hump. As with corticosteroid use, Cushing's syndrome can lead to a moon face. People with Cushing's usually have an "apple" shaped body due to weight carried in the midsection.
But whatever the cause, it is important to know that visceral fat is dangerous to remove, either through liposuction or any other type of surgery. Furthermore, if you have any kind of preexisting medical disorder or even the possibility of one, you should discuss it with your primary care physician and any specialists you see if you are considering liposuction or other fat extraction. Liposuction is very serious surgery. All risks and possibilities should be known before you can make an informed choice.
But don't feel guilty for thinking about liposuction if it makes you happy. Life is too short to worry about or be ashamed of making yourself happy. As long as you are making healthy choices and not hurting anyone, go for it! You just have to know the risks and be well informed.
George John Bitar, MD
Larry Lickstein, MD
Bitar Cosmetic Surgery Institute
3023 Hamaker Court
Fairfax, VA 22031
George John Bitar, MD
Larry Lickstein, MD
Bitar Cosmetic Surgery Institute
8650 Sudley Road
Manassas, VA 20110
Michael J. Olding, MD, FACS
George Washington University Hospital
2150 Pennsylvania Avenue
Washington DC, DC 20037