Does Liposuction Improve Body Image and Symptoms of Eating Disorders?

Kai M. M. Saariniemi, PhD, MD; Asko M. Salmi, PhD, MD; Hilkka H. Peltoniemi, PhD, MD; Pia Charpentier, LP; Hannu O. M. Kuokkanen, MD


Plast Reconstr Surg Glob Open. 2015;3(7):E461 

In This Article


This study consists of 61 consecutive women who underwent aesthetic liposuction at the Plastic Surgery Hospital KL, Helsinki, Finland. The Surgical Ethics Research Committee of the Pirkanmaa Hospital District provided ethical approval (registration number R09166). All women who agreed to participate in the study were included. Participants signed an informed consent. Three outcome measures were applied at baseline and at follow-up: the eating disorder inventory, Raitasalo's modification of the Beck depression inventory (BDI), and the 15-dimensional (15D) general quality of life questionnaire. Questionnaires were given, filled, and collected independently from the actual clinical appointment to ensure privacy and confidence. Demographic data were obtained by an interview and a preliminary information form. Possible complications, such as hematoma, seroma, infection, or scar hypertrophy, were recorded at the follow-up.

Preoperative markings were made in the standing position. Patients were operated on by 2 plastic surgeons (H.H.P. and A.M.S). Patients underwent water jet–assisted liposuction with body jet (Human med AG, Schwerin, Germany). Liposuction was performed in the abdominal and/or the thigh area. Operations were done under epidural, spinal, or local anesthesia with sedation. A prophylactic antibiotic of 1.5 g of cefuroxime intravenously was administered preoperatively. Patients wore compression garments for 4 weeks. Discharge was planned on the day of surgery.

Outcome Measures

The eating disorder inventory is a diagnostic tool designed for use in a clinical setting to assess the presence of an eating disorder.[21] This self-report questionnaire comprises 64 questions divided into 8 subscales (drive for thinness, bulimia, body dissatisfaction, ineffectiveness, perfectionism, interpersonal distrust, interoceptive awareness, and maturity fears). An overall risk score for an eating disorder is also calculated. Threshold values are used when assessing clinical relevancy (Charpentier P, Finnish version of the Eating Disorder Inventory, unpublished data, 2001).

The Raitasalo's modification of the BDI mood questionnaire[22] is Raitasalo's modification of the short form of the BDI,[23,24] and it has been validated and used in Finland for nearly 30 years. It has 13 questions for depression and 1 question for anxiety. Evaluation of self-esteem is included in all 14 questions. Depression score ranges from 0 to 39 points. Five to seven points refer to mild depression, 8–15 points to moderate depression, and over 16 points to severe depression. Anxiety has 4 categories (0 = none, 1 = mild, 2 = moderate, and 3 = severe anxiety). Self-esteem score ranges from 0 to 14 points. Extremely high scores of self-esteem may refer to a manic condition.

General health-related quality of life was measured by the 15D. It is a generic, 15D, standardized, self-administered health-related quality of life instrument that can be used both as a profile and as a single index score measure.[25] It consists of 15 dimensions: breathing, mental function, speech ( communication), vision, mobility, usual activities, vitality, hearing, eating, elimination, sleeping, distress, discomfort and symptoms, sexual activity, and depression. The maximum single index score is 1 (no problems on any dimension) and minimum score 0 (equal to being dead). The minimal clinically important difference in the 15D score is considered 0.03.

Statistical Analysis

The data were analyzed with the aid of the PASW Statistics 18.0 for Macintosh (SPSS Inc., Chicago, Ill.). The algorithm for the basic scoring of 15D ran on PASW was obtained from the developer of the instrument. Data are expressed as mean (standard deviation, SD) or frequency (percentage). From baseline to follow-up, normally distributed data were compared with the paired t test, and the Wilcoxon signed rank test was applied for skewed or categorical data. The anxiety and depression categories were dichotomized into "symptomatic" and "nonsymptomatic," and changes from baseline to follow-up were tested with the McNemar test. Comparisons between follow-ups and dropouts were done with the Mann–Whitney test (continuous data) and χ2 test (categorical data). Probabilities of less than 0.05 were considered significant.