Chapter VIWhat We Know About Fat CellsIf you have ever looked at fat on an ordinary uncooked beef roast, you will have a realistic picture of what a fat deposit looks like. The layer of fatty tissue, whether inside another animal or a human body, is composed of millions of fat cells. Each fat cell has a cell wall, and inside is the fat. stored as tiny liquid droplets of lipid.
 
1. We see a view of the individual fat cell as shown through the electron microscope.
2. Below, a microscopic view of an aggregate of fat cells, showing their varied contours and size.
Researchers do not yet agree on how many fat cells the average person has at varying stages of life, although the latest findings seem to indicate that the number of fat cells quadruples between 20 weeks' gestation and two years of age. In other words, a child of two apparently has four times as many fat cells as it did when it was still in the womb, about halfway through pregnancy.
One school of thought believes that the total number of fat cells you will have is determined before you are born, and is largely based on the amount of nutrition the fetus gets from its mother. Thus, say these scientists, if the mother eats too much during pregnancy, the baby she is carrying is likely to develop a very large number of fat cells. The adult who once was that "overfed fetus", they say, will always have all those fat cells. And all the fat cells will be hungry for fat all the rest of the person's life. According to this theory, then, people who seem to put on fat easily probably have excess numbers of fat cells in their bodies which have always been there, and which will stay there, despite diet and exercise. A second theory contends that the fat cell population in your body is determined not before birth, but in the first two years of childhood. In other words, if you are fed too much as a youngster, you will develop a great many extra fat cells.
Both theories say you will likely get fat and will likely be fat the rest of your life because you have extra fat cells to feed.
In most people, the number of fat cells seems to stabilize from the age of 2 until about age 12, or just around the beginning of puberty. Then, fat cells seems to increase again in number, and remain constant in number all the way to adulthood.
Researchers believe, however, that in some overweight people, the number of fat cells increases between ages 2 and 12, the time period which is usually quiescent. In these cases, they say, persons probably become overweight as adults.
DOES THE NUMBER OF FAT CELLS MATTER?
Does it matter how many fat cells you actually have?
Not so much, I believe, as the total quantity of your excess fat, and where that fat is located. The percentage of body fat you have in any one body area, such as your buttocks or hips, in my opinion, is genetically predetermined. That is why body fat contours differ from person to person. It is your individual body fat distribution pattern that will determine the nature of your treatment with liposuction, as well as the number and extent of surgeries necessary to provide you with the body contours you desire.
 
1. We see the nature of a mass of fat cells before diet; and at right above following a diet. Individual cells show shrinkage but their number has not changed.
 
2. Bottom, left, a group of fat cells before liposuction; and at right, below, the diagram illustrates how this group is actually smaller-in number-the fat cells removed by liposuction are no longer there at all, and will not return.
Researchers also believe that certain body hormones, such as estrogen and estrogen-related hormones, help to regulate the size of individual fat cells in a particular area. For instance, the size of each fat cell in your chin or neck area may be a certain dimension; yet the size of each fat cell in your abdomen or hip area may be much larger. If this is so, it helps to explain the bulges you have in certain body parts.
THE STRUCTURE OF FAT CELLS
Fat cells live together in small groups, rather like members of a small family or community. Doctors call these groups "fat lobules." In each lobule, there are probably hundreds of thousands of fat cells present.
A small capillary, or branch of a blood vessel, supplies each lobule with nourishment and carries away waste products. Each individual fat cell has a cell wall and a nucleus. Unlike other kinds of cells, however, the nucleus of a fat cell is pushed over to the side of the cell. Almost all of the fat cell's interior space (about 90%) is taken up by a giant globule of liquid fat. Within the globule, tiny small molecules of triglycerides are suspended. As more fat is stored in the cell, the globule gets larger and larger, eventually growing to many times its original size.
Research at several universities, including the University of Massachusetts at Worcester, and the University of Illinois at Chicago, seems to show that eating a high-fat diet does, in fact, contribute to the growth of the fat globule inside the cells. In short, a calorie of carbohydrate or protein may not have the same effect on the body that a calorie of fat does. Much more needs to be learned about this subject.
DIFFERENCE BETWEEN DIETING AND LIPOSUCTION
Dieting is weight loss resulting from expending more calories than your body takes in, usually by cutting back on food. Research has found that dieting combined with regular moderate exercise is much more effective than diet alone.
1. A female patient shows the shape known as "violin deformity" in which fact cells accumulate in two distinct bulges above and below hips.
Liposuction is surgery that extracts certain fat cells permanently, banishing them from your body forever, along with the fat deposits they form.
If either dieting or liposuction can make you look better, why would a patient elect to have the surgery?
That's a realistic question. Here's my opinion.
Many people, especially women, find it extremely difficult to lose weight by dieting-and keep it off. In fact, researchers believe that too frequent or too extensive a weight loss and subsequent gain may make it more difficult to diet successfully each time you try.
We have all known persons who have dieted and have, in fact, lost pounds on the scale...yet have still, despite their most determined efforts, remained thick, bulging, lumpy, and unattractive in certain body parts. A woman's face and neck may be scrawny and pinched-looking, but she may still have the "thunder thighs" or riding-breeches look that makes her unhappy and unattractive.
It is in the removal of these refractory (meaning stubborn) fat deposits that liposuction can be such a blessing to so many men and women.
I believe there are several reasons why the operation works so well.
1. The patient's body shows contrast during surgery, between the right thigh which has been treated, and the left, which has yet to be done.
 
2-3. Diagram Indicates before- and after-dieting contours of a patient who suffered from violin deformity.
 
4-5. The same patient following liposuction surgery, which permanently removed fat cells that could not have been lost through dieting alone.
First, of course, is the actual removal of a sizable number of fat cells from the body. They are gone-cell wall, fat globule, and all. Those particular cells will not come back.
Second, I believe that during the tunneling process of liposuction, many tiny small blood vessels which supply blood to the fat cells are sucked out, along with the fat cells. Some of the tiny blood vessels that remain to supply the fat cells left behind are traumatized-damaged or shocked by the surgical process. These small blood vessels may die off, days and weeks after the surgery, and therefore are no longer supplying the remaining fat cells with nourishment. Consequently, those fat cells continue to shrink even after the surgery. That is one reason why the final results of liposuction will not be seen for considerable time after the surgery.
Another way in which liposuction helps get rid of the fat deposits is that when the fat cells themselves are injured or extracted during the surgery, they secrete an enzyme called intracellular lipase.This enzyme tends to break down fat cells.
These vascular and enzymatic changes continue in the weeks and months after the surgery. The experienced liposuction surgeon knows how to anticipate these changes and to use them for best effect in the final contouring of your body.
LIPOSUCTION TECHNIQUES
Different surgeons have different techniques for performing liposuction. Some choose the "dry" method, in which tunneling and fat removal are done without any help from chemicals. Some use the "wet" method, pioneered by Illouz, in which two special solutions are injected into the fatty tissue before the vacuum pump is used.
6. Patient, above, shows balanced contours and smoothed thighs, following liposuction of both legs. This is the same patient as in Photo 1, opposite page.
The other physicians and I who work at The Liposuction Institute in the Chicago area have seen the best results when a "double wet" method is used. This technique, which I invented, calls for injecting an ice-cold solution before suction is begun. The temperature of the solution helps to "harden" the fat, making it much easier to shape, much as a skilled sculptor can carve a design. The cold temperature of the solution also causes the capillaries supplying the fat lobules to constrict, thus cutting down on bleeding during the surgery. A surgeon using this technique has better control, I believe, over the volume of fat removed and the ultimate body contouring. Next, I vacuum out the unwanted fat deposits.
Finally, I inject the special solutions a second time, and suction again. The solutions, of course, help to break down the fatty tissue, making it more easy to liquify and remove. It has been my experience that this technique aids greatly in achieving the body contouring results patients desire.
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