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


In our prospective study, we found that aesthetic liposuction significantly improves body satisfaction and reduces the overall risk for an eating disorder. Although similar effects regarding patient satisfaction, body satisfaction, self-esteem, and psychological problems have been noted in previous studies,[9,10,20] our study is the first to demonstrate this with validated questionnaires exclusively in a liposuction patient population. Nevertheless, as far as we know, our finding that fewer eating disorder symptoms are noted after aesthetic liposuction has not been presented before.

In their study, von Soest et al[9] found that cosmetic surgery had positive effects on body image, self-esteem, and psychological problems. This remained unchanged after 5 years.[10] However, most of the women who had liposuction had it in combination with abdominoplasty, and therefore, their results cannot be without doubt applied to liposuction patient populations. There were only 28 women in the combined liposuction-abdominoplasty group. In addition, main results were presented for the whole patient population. Their follow-up rate at 6 months was 79% and 65% at five years, reported for the whole patient population.

In a large prospective study of 219 liposuction patients (168 females and 51 males), high patient satisfaction and improved self-esteem were reported.[20] However, no validated measures were used. Only a semi-structured, independent interview was conducted in the physician's office by a nurse. Therefore, the results are prone to severe bias. The follow-up rate was 59% with a mean follow-up time of 4 months.

In our study, a significant proportion of all patients had preoperatively abnormal drive for thinness (48%) and dissatisfaction with their bodies (72%). Also cases for perfectionism (31%), bulimia (5%), and patients with an increased overall risk for an eating disorder (23%) were noted. However, questionnaire-derived information alone cannot be used to arrive at a diagnosis of psychopathology. Therefore, no final conclusions can be drawn from this study regarding the prevalence of eating disorders among aesthetic liposuction patient populations. However, our findings reflect the core issues why patients request for liposuction and the eventual impact of surgery. Nevertheless, our results are in concordance with previous findings that up to half of the women interested in liposuction report abnormal levels of eating disorder symptoms.[3,4]

Preoperatively, only 2 women self-reported a depressive disorder. However, according to the mood questionnaire, 7 women were found to be depressive and/or anxious. Excess psychological distress may affect outcome negatively.[10,26] Therefore, our findings support routine, validated assessment of preoperative psychological distress, as self-reporting may not be sufficient.

Many patients who did not fill in the follow-up measures reported feeling offended by the questions regarding eating disorder symptoms. Self-reported questionnaires may be less intruding, but they require more efforts from the research staff to ensure engagement. Especially with the high prevalence of eating problems among liposuction patients, an independent data collector with psychological educational background is preferable.

The methodological strengths of our study are validated measures with an exclusive female liposuction patient population. However, our study has some limitations as well. First, the mean follow-up time was 7 months, but 5 (8%) women had a follow-up time of less than 3 months. However, previous studies have had even shorter follow-up times.[20] Nevertheless, the findings in our study may change over time. Therefore, a study with a longer follow-up is warranted, and this is our plan in the near future. Second, our follow-up rate (59%) was rather low. However, it is comparable to previous prospective studies,[9,10,20] ranging from 57% to 79%, with the lowest rates noted in particular in liposuction patient populations. Finally, a larger patient population would have ensured and improved statistical power.