The authors conducted a small but important study with 11 patients who had 5 or more of liposuction and found that the serum lipid profile measurements all improved. From Sharon Giese’s excellent work on large-volume liposuction patient’s it is clear that removing a significant amount of body fat by any means will beneficially modulate the metabolic parameters [1,2].

As the authors indicate, diet and exercise are the preferred method for losing weight, but there are a number of patients who have tried every method, motivation, and system but are unable to lose weight. Liposuction should be considered as one of those methods whereby substantial amounts of weight can be lost. When Illouz first described the blunt technique, he was careful to not present it as a weight reduction method, but as a safe means for the treatment of figure faults. Some controversy and questions about the maximum amount that can be taken at one time remain. We have removed as much as 50 pounds (more than 25 l) at one time, from an otherwise healthy young patient for whom liposuction was limited to a single area (i.e., abdomen and flanks). In addition, we have done serial liposuction, in which we took a maximum safe amount at one time, waited 6 weeks or so, removed another maximum safe amount and repeated this .procedure several times [3].

Such methods do not approach the intraperitoneal and mesenteric fat deposits which can be immense, but they certainly can remove nearly all the subcutaneous fat. Because we do all these on an outpatient basis with the patient under valium and ketamine dissociative anesthesia [4], we see no contraindication to repeated sessions and do not know what the limits would be. It is clear that removing large amounts of subcutaneous fat improves several metabolic parameters. Liposuction is the most frequently requested and most often performed plastic surgery procedure in the world, but it still may be the least well studied. Everyone who is performing large-volume liposuction should be measuring hemoglobin A 1C, fasting blood sugar, systolic blood pressure, and lipid profiles, in addition to the usual measurements of body weight and girth. Because obesity has now been declared a disease, this treatment may be covered by various insurance companies.

Because obesity, in and of itself, carries with it a known mortality and decrease in life span, decreasing excess body weight by any means is an important step forward in adding years to one’s life and life to one’s years.