Eleven studies were included in the systematic review, separated to three groups, and based on the length of the follow-up: short (3–4), medium (6–11), and long (≥12 months) (Table. 29.1). Abdominal liposuction, mostly large volume, was performed in nine studies, while abdominoplasty in three studies. The short follow-up group included three studies of 145 patients [29–31]. Significant BMI change was reported in each study, which corresponded to the lipectomy mass. Similar results were recorded in the medium follow-up group of 242 patients, in all but one study with normal-weight subjects, who underwent small-volume liposuction [32–36].

However, the results of the long-term follow-up group with three studies of a total of only 34 patients were inconclusive [37–39]. One study reported significant weight loss, one no change, and one significant weight gain (Table. 29.1). The 7 subjects in the study by Mohammed et al. [37] maintained the same improved body weight and composition 10 weeks and 21–48 months after liposuction. Conversely, 7 patients studied by Rinomohta et al. gained weight 18 months post-abdominoplasty, while in a similar study in 20 patients, who were followed up for nearly 2 years, the BMI did not change significantly [38, 39]. The authors concluded that the weight and BMI reduction, following abdominal lipectomy in overweight and obese female patients, corresponds to the lipectomy mass with no additional long-term benefit. This “lipectomy effect” seems to subside after 1 year.

These findings are supported by a recent randomized controlled trial conducted by Hernandez et al. [40]. Thirty-two healthy premenopausal women (18–50 years), weight stable for at least 3–6 months with a BMI of 22–27 kg/m², randomized either to liposuction or no treatment. Liposuction was performed in the thighs and hips in 14 cases and in lower abdomen in 11 of these patients, while 18 patients were controls. Baseline characteristics were similar among the groups apart from the body weight (62.6 kg liposuction group vs. 69.2 kg control group; p = 0.01), lower levels of adiponectin, and higher serum glucose concentrations in the control group. Although liposuction (2936 ± 272 mL) reduced body fat and total fat mass at 6 weeks, these differences were decreased gradually at 6 months and by 1 year were no longer significant. Measurements by dual-energy X-ray absorptiometry and magnetic resonance imaging (MRI) showed that the liposuctioned areas at the hip/thigh retained the fat loss at 1 year, while the abdominal region showed a preferential fat accumulation, which was accompanied by a similar trend in other upper-body areas. Interestingly, MRI of visceral depot revealed a similar to subcutaneous depots volumetric pattern, with a trend for the lipectomy group to gain more fat than the control group (13 % vs. 7.9 % gain, respectively; p = 0.62). Notably, abdominal visceral depot of liposuctioned patients was the only region to show more fat accumulation than baseline levels relative to controls.

A compensatory increase of visceral fat 6 months after abdominal liposuction was revealed by another clinical trial [35]. Thirty-six healthy normal-weight physically inactive women (20–35 years old; BMI = 23.1 ± 1.6 kg/m²) underwent a small-volume abdominal liposuction (1240.3 ± 363.6 mL). Two months after the surgery, the subjects were randomly allocated either to a training (TR) group or non-training (NT) group. Although a sustained subcutaneous abdominal fat reduction was reported 6 months after liposuction in both groups, the NT group showed a significant 10 % increase in visceral fat compared to baseline whereas the TR group values remained unchanged. In addition, NT group had decreased energy expenditure when compared with TR group. Consequently, the study did not reveal any evidence of fat regrowth at the aspirated depot but a compensatory growth of visceral fat, which could be counteracted by physical activity.

Montoya et al. [34] reported also on visceral fat depots in a cohort of 31 women who underwent liposuction and then were randomly assigned either to orlistat (n = 12) or balanced diet (n = 19) for 6 months. Although both groups had significantly reduced weight, BMI, and waist circumference at 6 months after surgery, analysis of visceral fat area by computed tomography showed no statistical differences from baseline levels.

Swanson examined, prospectively, the effects of lipectomy (liposuction and/or abdominoplasty) in a large group of predominantly nonobese patients [36]. Based on standardized photographs, he demonstrated a stable favorable outcome at least 3 months after surgery in the treated areas of the lower body in 178 women with lower-body lipectomy and in 67 women who had both lower- and upper-body surgery. However, he reported similar long-term results (at 1 year or more after surgery) from a small only subset of 46 patients. Although the study was not designed prospectively to address the question of possible fat redistribution, the author reported no significant differences, comparing a subgroup of 67 women who underwent liposuction and/or abdominoplasty and simultaneous cosmetic breast surgery with a retrospective group of 78 women who had breast surgery alone. Consequently, the validity and reliability of these findings were questioned [41].

Compensatory fat growth after liposuction of the abdomen and flanks or thighs/hips has been also reported in the upper body as breast enlargement in a significant number of patients (nearly 40 %) in a few retrospective studies [42–44]. This outcome was reported after both traditional and power-assisted liposuction and was attributed to an altered androgen to estrogen ratio after liposuction [42, 43]. The weight gain after liposuction and the body fat redistribution in areas of the body that were not aspirated seem to be another plausible explanation.

Overall, liposuction seems to achieve stable favorable long-term aesthetic outcomes of the aspirated areas but is also associated with a compensatory growth of other non-aspirated subcutaneous and visceral fat depots. Liposuction by no means can improve the body weight in the long term and should not be considered as an option to ameliorate the effects of obesity.