Fat redistribution following suction lipectomy: defense of body fat and patterns of restoration. Modification of subcutaneous adipose tissue by a methylxanthine formulation: a double-blind controlled study. Effect of Distinct Lifestyle Interventions on Mobilization of Fat Storage Pools: CENTRAL Magnetic Resonance Imaging Randomized Controlled Trial The effects of the surgical removal of subcutaneous adipose tissue on energy expenditure and adipocytokine concentrations in obese women. Long-term beneficial effect of a 16-week very low calorie diet on pericardial fat in obese type 2 diabetes mellitus patients. Effects of sex on the change in visceral, subcutaneous adipose tissue and skeletal muscle in response to weight loss Expression of tumor necrosis factor (TNF)-alpha protein in the subcutaneous and visceral adipose tissue in correlation with adipocyte cell volume, serum TNF-alpha, soluble serum TNF-receptor-2 concentrations and C-peptide level. Differential effects of rosiglitazone and metformin on adipose tissue distribution and glucose uptake in type 2 diabetic subjects. Effects of acupuncture therapy on abdominal fat and hepatic fat content in obese children: a magnetic resonance imaging and proton magnetic resonance spectroscopy study.
No r and omized studies in humans have examined whether fat returns after removal or where it returns . We undertook a prospect i ve , r and omized-controlled trial of  suction lipectomy in nonobese women to determine if adipose tissue ( AT ) is defended and if so , the anatomic pattern of redistribution . Healthy women with disproportionate AT depots ( lower abdomen , hips , or thighs ) were enrolled . Baseline body composition measurements included dual-energy X-ray absorptiometry ( DXA ) ( a priori primary outcome ) , abdominal/limb circumferences , subcutaneous skinfold thickness , and magnetic resonance imaging ( MRI ) ( torso/thighs ) . Participants ( n = 32 ; 36 ± 1 year ) were r and omized to small-volume liposuction ( n = 14 , mean BMI : 24 ± 2 kg/m(2 ) ) or control ( n=18 , mean BMI : 25 ± 2 ) following baseline . Surgery group participants underwent liposuction within 2 - 4 weeks . Identical measurements were repeated at 6 weeks , 6 months , and 1 year later . Participants agreed not to make lifestyle changes while enrolled . Between-group differences were adjusted for baseline level of the outcome variable . After 6 weeks , percent body fat ( % BF ) by DXA was decreased by 2.1 % in the lipectomy group and by 0.28 % in the control group ( adjusted difference ( AD ) : -1.82 % ; 95 % confidence interval ( CI ) : -2.79 % to -0.85 % ; P = 0.0002 ) . This difference was smaller at 6 months , and by 1 year was no longer significant ( 0.59 % ( control ) vs. -0.41 % ( lipectomy ) ; AD : -1.00 % ; CI : -2.65 to 0.64 ; P = 0.23 ) . AT reaccumulated differently across various sites . After 1 year the thigh region remained reduced ( 0.77 % ( control ) vs. -1.83 % ( lipectomy ) ; AD : -2.59 % ; CI : -3.91 to -1.28 ; P = 0.0001 ) , but AT reaccumulated in the abdominal region ( 0.64 % ( control ) vs. 0.42 % ( lipectomy ) ; AD : -0.22 ; CI : -2.35 to 1.91 ; P = 0.84 ) . Following suction lipectomy , BF was restored and redistributed from the thigh to the abdomen BACKGROUND Excessive subcutaneous adipose tissue is typically treated by physically removing the fat through liposuction , but cost and accessibility have popularized alternative treatments for reducing adipose tissue thickness . OBJECTIVE The purpose of this study was to test the absolute and relative effectiveness of a liposome-encapsulated caffeine-based cream in modifying subcutaneous adipose tissue . METHODS Forty-one patients consented and completed the double-blind , single-center , placebo-controlled study . Caliper measurements , tape measurements , and photographs were taken over a 2-month period . RESULTS Both concentrations of the cream were found to significantly reduce the thickness of the adipose tissue in all areas of the body . In addition , the more concentrated cream was significantly more effective than the less concentrated cream in the areas of the hips and the triceps . CONCLUSION The caffeine-based liposome-encapsulated cream significantly reduced the thickness of the subcutaneous fat over a 2-month period Background : We aim ed to assess whether distinct lifestyle strategies can differentially affect specific body adipose depots . Methods : We performed an 18-month r and omized controlled trial among 278 sedentary adults with abdominal obesity ( 75 % ) or dyslipidemia in an isolated workplace with a monitored provided lunch . Participants were r and omized  to isocaloric low-fat or Mediterranean/low-carbohydrate ( MED/LC ) diet+28 g walnuts/day with/without added moderate physical activity ( PA ; 80 % aerobic ; supervised/free gym membership ) . Overall primary outcome was body fat redistribution , and the main specific end point was visceral adipose tissue ( VAT ) . We further followed the dynamics of different fat depots ( deep and superficial subcutaneous , liver , pericardial , muscle , pancreas , and renal sinus ) by magnetic resonance imaging . Results : Of 278 participants ( age , 48 years , 89 % men , body mass index , 30.8 kg/m2 ) , 86 % completed the trial with good adherence . The low-fat group preferentially decreased reported fat intake ( −21.0 % versus −11.5 % for the MED/LC ; P<0.001 ) , and the MED/LC group decreased reported carbohydrates intake ( −39.5 % versus −21.3 % for the low-fat group ; P<0.001 ) . The PA+ groups significantly increased the metabolic equivalents per week versus the PA− groups ( 19.0 versus 2.1 ; P=0.009 ) . Whereas final moderate weight loss was indifferent , exercise attenuated the waist circumference rebound with the greatest effect in the MED/LCPA+ group ( P<0.05 ) . VAT ( −22 % ) , intrahepatic ( −29 % ) , and intrapericardial ( −11 % ) fats declines were higher than pancreatic and femur intermuscular fats ( 1 % to 2 % ) loss . Independent of weight loss , PA+ with either diet had a significantly greater effect on decreasing VAT ( mean of difference , −6.67cm2 ; 95 % confidence interval , −14.8 to −0.45 ) compared with PA−. The MED/LC diet was superior to the low-fat diet in decreasing intrahepatic , intrapericardial , and pancreatic fats ( P<0.05 for all ) . In contrast , renal sinus and femoral intermuscular fats were not differentially altered by lifestyle interventions but by weight loss per se . In multivariate models further adjusted for weight loss , losing VAT or intrahepatic fat was independently associated with improved lipid profile , losing deep subcutaneous adipose tissue with improved insulin sensitivity , and losing superficial subcutaneous adipose tissue remained neutral except for an association with decreased leptin . Conclusions : Moderate weight loss alone inadequately reflects the significant lifestyle effects on atherogenic and diabetogenic fat depots . The MED/LC diet mobilizes specific ectopic fat depots , and exercise has an independent contribution to VAT loss . Fat depots exhibit diverse responsiveness and are differentially related to cardiometabolic markers . Distinct lifestyle protocol s may uniquely induce fat mobilization from specific anatomic sites . Clinical Trial Registration : URL : https://www . clinical trials.gov . Unique identifier : NCT01530724 OBJECTIVE To analyze the effects of the surgical removal of subcutaneous adipose tissue by ultrasound-assisted megalipoplasty ( UAM ) on energy expenditure and adipocytokine concentrations in obese women . METHODS Fifteen premenopausal obese women with BMI 37.5+/-6.3 kg/m(2 ) ( range : 30.7 - 53.6 kg/m(2 ) ) underwent UAM .  Body composition ( by DEXA ) , resting metabolic rate ( REE ) by indirect calorimetry , insulin resistance ( by the HOMA method ) , leptin , C-reactive protein , interleukin-6 , resistin and adiponectin were measured before and 1 , 3 , 28 and 180 days after the procedure . RESULTS UAM significantly reduced fat mass at day 3 , without further changes in the following days . REE increased at day 3 after UAM , returned to baseline levels at day 28 and significantly declined at day 180 . Leptin levels transiently increased after UAM and then declined according to fat mass reduction . C-reactive protein , interleukin-6 and resistin levels acutely increased after UAM and then returned to the baseline levels . Adiponectin levels acutely declined after the procedure and then stabilized to a plasma level slightly lower than at baseline . Insulin resistance deteriorated in the acute post-operative phase and then improved . CONCLUSION The surgical removal of subcutaneous fat was associated to an acute inflammatory reaction with high REE and insulin-resistance . Later on , the metabolic effects of fat mass removal appeared , with a reduction of leptin levels and REE and an improvement of insulin resistance Pericardial fat accumulation has been associated with an increased cardiovascular risk . A very low calorie diet ( VLCD ) improves the cardiovascular risk profile in patients with type 2 diabetes mellitus ( T2DM ) , by improving the metabolic profile , heart function , and triglyceride ( TG ) stores in (non)adipose tissues . However , long-term effects of a VLCD on pericardial fat volume and tissue-specific TG accumulation have not been documented . The aim of this study was therefore to assess the effects of a 16-week VLCD and of subsequent 14 months follow-up on a regular diet on pericardial fat in relation to other TG stores in obese T2DM patients . We included 14 obese patients with insulin-treated T2DM ( mean ± s.e.m . : age 53 ± 2 years ; BMI 35 ± 1 kg/m(2 ) ) . Pericardial fat and other (non)adipose TG stores were measured using magnetic resonance ( MR ) imaging and proton spectroscopy before and after a 16-week VLCD and after a 14-month follow-up without dietary interventions . A 16-week VLCD  reduced body weight , pericardial fat , hepatic TG content , visceral and subcutaneous abdominal fat volumes to 78 , 83 , 16 , 40 , and 53 % of baseline values respectively , ( all P < 0.05 ) . After an additional 14 months of follow-up on a regular diet , the reduction in pericardial fat volume sustained , despite a substantial regain in body weight , visceral abdominal fat , and hepatic TG content ( respectively 90 , 83 and 73 % of baseline values ) . In conclusion , VLCD-induced  weight loss in obese T2DM patients is accompanied by a substantial decrease in pericardial fat volume , which is sustained even after subsequent weight regain OBJECTIVE : To examine the influence of sex on whole body and regional subcutaneous , visceral , total adipose tissue ( AT ) , skeletal muscle ( SM ) , and lean tissue in response to weight loss induced by diet alone ( DO ) or the combination of diet and aerobic ( DA ) or resistance exercise ( DR ) . DESIGN : Sixty upper‐body obese men and women were r and omly assigned to one of three treatments : DO , DA , or DR . All tissues were measured using a whole body , magnetic resonance imaging protocol . RESULTS : Within each group reductions were observed for body weight ( ~11 kg ) , subcutaneous and visceral AT ( P<0.01 ) . After controlling for pretreatment differences in tissue size , reductions in total adiposity , total and regional subcutaneous and visceral adipose tissue were not different between sexes ( P>0.1 ) . Independent of sex , the reduction in visceral AT was greater than subcutaneous AT ( P<0.05 ) in response to DO and DA . With the exception of DA women , the reduction in abdominal subcutaneous AT was greater ( P<0.05 ) than lower‐body subcutaneous AT in response to diet and exercise , but not diet alone , in both sexes ( P>0.05 ) . Independent of sex , skeletal muscle mass was preserved within the exercise groups ( P>0.05 ) but not diet alone ( P<0.05 ) . Peak VO2 ( l/min ) improved in the DA groups as did muscular strength in the DR groups ( P<0.01 ) . CONCLUSIONS : These findings indicate that in response to diet or diet and exercise‐induced weight loss , reductions in total adiposity , subcutaneous and visceral adipose tissue distribution are not different in obese men and women . Independent of sex , the combination of diet and exercise results in a preservation of skeletal muscle mass , a preferential reduction of abdominal subcutaneous AT , and improved functional capacity by comparison to diet alone OBJECTIVE The aim of the study was to evaluate the expression of tumor necrosis factor (TNF)-alpha protein in the subcutaneous and visceral adipose tIssue in correlation with adipocyte cell Volume , serum TNF-alpha , soluble TNF-receptor-2 ( sTNFR-2 ) and indirect parameters of insulin resistance in overweight/obese and lean healthy persons . DESIGN A cross-sectional case-control study was used . PATIENTS Twenty-eight overweight/obese prob and s with normal glucose tolerance ( BMI > 27 kg/m(2 ) ) and 15 lean people ( BMI < 25 kg/m(2 ) ) , all of them undergoing planned surgical operation , participated in the study . METHODS Two to four grams of subcutaneous and visceral adipose tIssue were removed and studied using semi-quantitative immunohistochemical staining of the TNF-alpha protein . Serum TNF-alpha , sTNFR-2 ( ELISA ) and fasting C-peptide ( RIA )  were measured . RESULTS TNF-alpha protein was expressed in adipocytes of both depots . The expression was evaluated visually and found to be greater in the obese patients . Significantly higher serum TNF-alpha ( 5.58+/-0.87 pg/ml vs 4.21+/-0.55 , mean+/-s.d . , P<0.01 , Mann-Whitney ) and sTNFR-2 levels ( 7.84+/-3.56 ng/ml vs 4.59+/-1.35 , P=0.005 ) were found in the obese subgroup in correlation with the fasting C-peptide level ( r=0.49 , P=0.003 ; and r=0.74 , P=0.001 ) and the C-peptide/ blood glucose ratio ( r=0.47 , Spearman , P=0.005 ; and r=0.70 , P=0.001 ) . The cell Volume of both adipocyte depots was found to have a significant positive correlation with serum TNF-alpha and sTNFR-2 levels in the total group of patients ( subcutaneous : r=0.52 , P=0.0003 ; r=0.69 , P<0.0001 ; visceral : r=0.65 , P<0.0001 ; r=0.63 , P<0.0001 ) and in both subgroups . CONCLUSIONS Adipocyte cell Volume of both the subcutaneous and visceral fat depots may be determinants of TNF-alpha , sTNFR-2 production and obesity-linked insulin resistance We evaluated the effects of rosiglitazone ( 4 mg b.i.d . ) and metformin ( 1 g b.i.d . ) monotherapy for 26 weeks on adipose tissue insulin-stimulated glucose uptake in patients ( n = 41 ) with type 2 diabetes . Before and after the treatment , glucose uptake was measured using 2-[(18)F]fluoro-2-deoxyglucose and positron emission tomography and adipose tissue masses were quantified using magnetic resonance imaging . Rosiglitazone improved insulin-stimulated whole-body glucose uptake by 44 % ( P < 0.01 vs. placebo ) . Mean body weight was unchanged in the rosiglitazone group , while it decreased by 2.0 kg in the metformin group ( P < 0.05 vs. placebo ) . In visceral adipose tissue , glucose uptake increased by 29 % ( from 17.8 + /- 2.0 to 23.0 + /- 2.6 micro mol x kg(-1 ) x min(-1 ) , P < 0.05 vs. placebo ) in the rosiglitazone group but to a lesser extent ( 17 % ) in the metformin group ( from 16.2 + /- 1.5 to 18.9 + /- 1.7 micro mol x kg(-1 ) x min(-1 ) , P < 0.05 vs. baseline ) . Because the visceral adipose tissue mass simultaneously decreased with both treatments ( P < 0.05 ) , no change was observed in total visceral glucose uptake per depot . Rosiglitazone significantly enhanced glucose uptake in the femoral subcutaneous area , either when expressed per tissue mass ( from 10.8 + /- 1.2 to 17.1 + /- 1.7 micro mol x kg(-1 ) x min(-1 ) , P < 0.01 vs. placebo ) or per whole-fat depot ( P < 0.05 vs. placebo ) . In conclusion , metformin treatment result ed in improvement of glycemic control without enhancement of peripheral insulin sensitivity . The improved insulin sensitivity of the nonabdominal subcutaneous adipose tissue during treatment with rosiglitazone partly explains the enhanced whole-body insulin sensitivity and underlies the central role of adipose tissue for action of peroxisome proliferator-activated receptor gamma agonist in vivo OBJECTIVES The aim of this study was to use magnetic resonance imaging ( MRI ) together with proton magnetic resonance spectroscopy ( (1)H-MRS ) to study the influence of acupuncture therapy on abdominal fat and hepatic fat content in obese children . DESIGN The design was a longitudinal , clinical intervention study of acupuncture therapy . SUBJECTS SUBJECTS were 10 healthy , obese children ( age : 11.4 ± 1.65 years , body-mass index [ BMI ] : 29.03 ± 4.81 kg/m(2 ) ) . MEASUREMENTS Measurements included various anthropometric parameters , abdominal fat ( assessed by MRI ) and hepatic fat content ( assessed by (1)H-MRS ) at baseline and after 1 month of acupuncture therapy . RESULTS One ( 1 ) month of acupuncture therapy significantly reduced the subjects ' BMI by 3.5 % ( p = 0.005 ) , abdominal visceral adipose tissue ( VAT ) volume by 16.04 % ( p < 0.0001 ) , abdominal total adipose tissue volume by 10.45 % ( p = 0.001 ) , and abdominal visceral to subcutaneous fat ratio by 10.59 % ( p = 0.007 ) . Decreases in body weight ( -2.13 % ) , waist circumference ( -1.44 % ) , hip circumference ( -0.33 % ) , waist-to-hip ratio ( WHR ) ( -0.99 % ) , abdominal subcutaneous adipose tissue ( SAT ) volume ( -5.63 % ) , and intrahepatic triglyceride ( IHTG ) content ( -9.03 % ) were also observed , although these were not significant ( p > 0.05 ) . There was a significant correlation between the level of abdominal fat ( SAT , VAT ) and anthropometric parameters ( weight , BMI , waist circumferences , hip circumferences ) . There was no statistically significant correlation between IHTG and anthropometric parameters or abdominal fat content . CONCLUSIONS The first direct experimental evidence is provided demonstrating that acupuncture therapy significantly reduces BMI and abdominal adipose tissue by reducing abdominal VAT content without significant changes in body weight , waist circumference , hip circumference , WHR , abdominal SAT , or IHTG content . Thus , the use of acupuncture therapy to selectively target a reduction in abdominal VAT content should become more important and more popular in the future
These results corroborate the evidence from experimental and clinical studies , which support fat redistribution and compensatory fat growth , as a result of feedback mechanisms , triggered by fat removal .
Adipose tissue is considered as an endocrine organ , which is developed in specific depots , distinguished either as subcutaneous or visceral .
Lipectomy , by means of liposuction or abdominoplasty , is a common plastic surgery procedure , which can remove substantial amounts of subcutaneous fat .
This systematic review aims to evaluate the impact of surgical removal of abdominal subcutaneous adipose tissue on  body weight and fat mass in females in the short- and long-term .