Plastic surgery in case of obesity without weight loss

The human body is covered with fat and skin. Fat is essential to life. It fulfils several functions: insulation against the cold, energy storage, shock absorption, etc. Certain scientific data must be examined first in order to understand how surgical excess fat removal "works":

 The two fat layers and how their cells work (metabolism)

The body (or its outer envelope) consists of two very different layers of fat.

• The outer layer (just below the skin):

  Lines the entire body. The cells that form it have limited capacity for storage and easily release absorbed fat. This layer is therefore highly responsive to dieting.

• The deep layer:

  A genuine organ of storage. This layer only exists in certain parts of the body, as in the thighs (forming the famous ‘saddle bags’). The cells in this layer are avid and store fat five times faster than the cells in the outer layer. By contrast, under ordinary conditions, the cells are designed to keep their fat. This explains why the body changes shape over time. Fat is in fact gradually accumulated in favour of weight variations and does not go away. Dieting has little or no effect on this skin layer.

The number of fat cells in both layers is determined during early childhood and does not change later.

All surgical fat removal is therefore definitive, explaining the effectiveness of the liposuction technique.

 Fat distribution in the body

Fat distribution in the body is genetically and hormonally programmed.

• Genetics:

  Every person has an individual capacity for fat storage. We know that at one and the same food intake level, some will lose weight and others keep their weight stable, while a third group will actually gain weight. Genetics also explain why certain women have excess fat on the thighs ("saddle bags") and others do not.

• Hormones:

  Generally speaking, men and women do not store fat in the same areas of the body. We refer to android and gynoid obesity. Android obesity is more preponderant among men, although it can also be found in some women. The fat storage area is located in the upper part of the body and the lower extremities are always slim. This is reversed in gynoid obesity. Localized fat accumulations are located from the hips down. When the upper half of the body is slim, dieting is less effective. It may lead to weight loss in the upper part of the body and practically no changes in the lower. The difference between the upper and lower body is therefore aggravated.

 Surgery

• Liposuction: fat removal under well-toned skin

  This is the only solution given that dieting has no effect on localized obesity of the lower body. Developed 20 years ago by Dr YG. ILLOUZ, this technique has become the most frequently practised plastic surgery procedure in the world. Its success can be explained by its results:

  Spectacular results: it is possible to easily remove up to 10 litres of fat and to move down by one to three clothes sizes. No visible scars. Scars are only a few millimetres in length and are concealed within skin folds. Liposuction in the ‘saddle bag’ area of the thighs is performed through a small incision in a buttock fold, which will later become nearly invisible.

  

• The results are definitive. The answer to the most frequently asked patient question "Does it come back?" is simple. If all storage cells are removed at a given site, it is theoretically impossible. Recurrence may become a problem when all cells have not been removed and in case of significant and uncontrolled weight gain.

  The problem of liposuction lies not with recurrence but rather with the skin. Will the skin properly retract? Does it still have sufficient elasticity to avoid a rippling effect on the surface?

  In preoperative consultation, the surgeon assesses skin quality and warns the patient of the risk of excess skin.
  The possible ‘rippling’ effect on the skin surface is not a contra-indication. Usually patients undergo this procedure because they want to wear certain clothing again…
  For example, the reduction in volume, which is always very significant, may enable the patient to wear jeans again.

  As regards skin problems, surgeons are greatly aided by new techniques.

  Two points have undergone major changes:

  • The diameter of cannulas:

    In the first days of liposuction, the cannulas measured 10 to 12 mm and destroyed the fibre tissue causing skin retraction.
    To date, the commonly used cannulas measure 3 and 4 mm.
    The procedure is longer but it is a lot less traumatizing.

  • Superficial liposuction:

    As suggested by the name, not only the deep fat layer but also the superficial layer is removed by suction with very fine cannulas in order to create a second layer of scar tissue that further facilitates skin retraction.

    Areas for treatment: nearly all parts of the body can be treated by liposuction. However, there are about 20 most commonly treated areas.

    

  • Skin and fat removal:

    When the excess skin is not well-toned and elastic, it must be removed in addition to the fat.

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