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Cosmetic
CASE REPORT
Summary: Obesity is a widespread health concern worldwide, necessitating
diverse interventions for effective weight management. Despite prior unsuccessful
attempts at weight loss through conventional methods, including dietary restric-
tions and physical exercises, this case underscores the challenges faced by indi-
viduals with morbid obesity. This case report presents the successful outcome of
VASER liposuction followed by a 6-month postoperative ketogenic diet regimen in
a 35-year-old man with a body mass index (BMI) of 40. The patient, initially weigh-
ing 127 kg with a BMI of 40.9 kg/m² and signicant fatty deposition primarily on
the chest, abdomen, and anks, underwent tumescent VASER liposuction, remov-
ing 5 L of fat. Subsequently, adhering to a modied ketogenic diet plan led to a
notable reduction in weight (from 127 kg to 97 kg) and BMI (from 40 to 31.5) over
the 6-month follow-up period. Effective pain management postoperatively and
improvements in skin retraction and energy levels were observed. The combined
approach of VASER liposuction and a ketogenic diet yielded favorable outcomes,
including signicant weight loss, improved BMI, and enhanced body contouring.
Importantly, minimal loose skin was observed despite substantial weight reduction,
highlighting the synergistic effects of the intervention. This case highlights the
potential synergistic effects of VASER liposuction and a ketogenic diet in address-
ing obesity, offering a promising approach for weight management in morbid
obese individuals. The synergistic effects included enhanced skin tightening,
safety, faster recovery, minimal pain, and substantial weight loss. (Plast Reconstr Surg
Glob Open 2024; 12:e6098; doi: 10.1097/GOX.0000000000006098; Published online 23
August 2024.)
Hasan Ali, MRCS, MSc (UK),
EBOPRAS (FRANCE)
Obesity, categorized into different classes based on
body mass index (BMI), presents signicant health
risks, including cardiovascular diseases, diabetes,
and reduced quality of life. Class III obesity, also known as
severe obesity, is diagnosed when an individual has a BMI
of 40 or higher. This class of obesity is associated with par-
ticularly elevated health risks and often necessitates vari-
ous interventions for weight management. Liposuction,
particularly VASER liposuction, offers a surgical solution
for localized fat reduction.1 Dietary modications such
as the ketogenic diet have gained popularity for weight
management.2 Here, I present a case demonstrating the
efcacy of VASER liposuction followed by a ketogenic diet
in achieving signicant weight loss and improved BMI in
a 35-year-old man with class III obesity. This approach was
chosen after extensive discussion with the patient regarding
various weight loss options, including bariatric surgery and
preoperative ketogenic diet, highlighting a well-informed
divergence from standard weight reduction guidelines.3
CASE REPORT
The patient, a 35-year-old man, presented with obe-
sity (127 kg, 1.76 m, BMI 40.9 kg/m²) and signicant fatty
deposition primarily on the chest, abdomen, and ank
areas.1 Notably, the upper and lower limbs were of normal
size and less affected compared with the main fatty depos-
its on the trunk area, which is unusual in morbidly obese
patients.4 Despite previous attempts at weight loss through
From the Hasan Surgery FZ LLC, Dubai, UAE.
Received for publication April 25, 2024; accepted July 2, 2024.
Copyright © 2024 The Author. Published by Wolters Kluwer Health,
Inc. on behalf of The American Society of Plastic Surgeons. This
is an open-access article distributed under the terms of the Creative
Commons Attribution-Non Commercial-No Derivatives License 4.0
(CCBY-NC-ND), where it is permissible to download and share the
work provided it is properly cited. The work cannot be changed in
any way or used commercially without permission from the journal.
DOI: 10.1097/GOX.0000000000006098
Successful Outcome of VASER Liposuction
Followed by Keto Diet in a 35-year-old Man with
Class III Obesity
Disclosure statements are at the end of this article,
following the correspondence information.
Related Digital Media are available in the full-text
version of the article on www.PRSGlobalOpen.com.
8
12
23August2024
23
August
2024
PRS Global Open • 2024
2
dietary restrictions, regular physical exercises, and weight
loss attempts with mild improvement, the patient con-
tinued to struggle with obesity-related concerns. His pri-
mary aim for liposuction was to address these stubborn fat
deposits and improve body contour, with the added ben-
et of potential skin tightening due to VASER liposuction.5
After thorough preoperative evaluation, the procedure
was safely performed under intravenous sedation in an
internationally accredited day surgery setup. Liposuction
of the chest, abdomen, and anks was carried out, with the
patient fully mobilized within 3 hours postsurgery and dis-
charged home comfortably within four hours post surgery.
Specic aspirate volumes from each area were as follows:
chest, 1600 mL; abdomen, 2400 mL; and anks, 1000 mL.
Intraoperative assessment, depicted in Supplemental
Digital Content 1, revealed improvement in the liposuction
areas shown on operating table. (See gure, Supplemental
Digital Content 1, which displays an intraoperative image
displaying the improvement in liposuction areas on the
surgical table, conrming the efcacy of VASER liposuc-
tion. http://links.lww.com/PRSGO/D447.) The liposuc-
tion was performed at the deep subcutaneous layer with
minimal supercial layers to avoid supercial irregulari-
ties. A total of 5 L of liposuction aspirate, comprising 90%
fat, was extracted, as depicted in Supplemental Digital
Content 2, (See gure, Supplemental Digital Content 2,
which displays cannisters with 5 liters of liposuction aspi-
rate, demonstrating the extent of fat removal during the
VASER liposuction procedure. http://links.lww.com/
PRSGO/D448.) Signicant improvement was evident
at the 6-month follow-up, depicted in Figure 1A (preop-
erative frontal view) and Figure 1B (postoperative frontal
view), as well as in Figure 2A and Figure 2B (side views).
I adhered to local authorities’ guidelines limiting the
aspirate volume to 5000 mL to ensure patient safety.6
Postoperatively, the patient reported a pain level of 3
on a 1–10 scale, managed with appropriate analgesia. He
wore postoperative compression garments for 6 weeks and
received lymphatic drainage massage for 1 month, com-
mencing 1 week after surgery. A modied ketogenic diet
plan was implemented in consultation with a dietitian,
emphasizing high protein, low carbohydrates, and healthy
fats such as avocado, nuts, olive oil, or full-fat Greek yogurt.
This was initiated 5 days postsurgery and continued for 6
months.7
Outcome
At the 6-month follow-up, the patient demonstrated
remarkable progress. His weight reduced to 97 kg, rep-
resenting a loss of 30 kg postliposuction and dietary
Fig. 1. Pre- and postoperative frontal views of the patient. A, Preoperative frontal view of the patient
before liposuction. B, Six-month postoperative results; frontal view, highlighting the improvement in
body contour and reduction of adiposity following VASER liposuction and adherence to a ketogenic
diet regimen.
Fig. 2. Pre- and postoperative side views of the patient. A, Preoperative right-hand side view of the patient
before liposuction. B, Six-month postoperative results, side view, showcasing the improvement in body con-
tour and reduction of adipose tissue after VASER liposuction and implementation of a ketogenic diet plan.
Ali • VASER Liposuction and Keto Diet in Morbid Obesity
3
intervention. The BMI decreased to 31.5, signifying a signif-
icant improvement from the obese to overweight category.1
Pre- and postoperative comparison images at 6 months
illustrated the patient’s physical transformation, including
improved body contour and reduced adiposity. Importantly,
the liposuction procedure resulted in satisfactory skin tight-
ening without the development of excessive loose skin. The
combination of liposuction followed by a ketogenic diet
has shown promising results in our practice, with similar
success observed in other patients, both men and women.
Postoperative complete blood count did not show signi-
cant changes in hemoglobin levels or other blood param-
eters. However, similar patients exhibited lower triglyceride
levels postoperatively, indicating metabolic improvements.
DISCUSSION
The decision to proceed with VASER liposuction fol-
lowed by a ketogenic diet was made after extensive dis-
cussion with the patient regarding various weight loss
options, including bariatric surgery and preoperative
ketogenic diet. Despite attempting a supervised ketogenic
diet and low-calorie diet with limited success, the patient
opted for liposuction due to concerns about loose skin
following massive weight loss.2 I understand that liposuc-
tion is primarily for body contouring rather than weight
loss. However, in this case, initiating weight loss with lipo-
suction helped in skin tightening, as VASER liposuction
aids in skin tightening in target areas.1 I believe that this
approach resulted in signicant weight loss and improved
body contour without excessive loose skin.
This case highlights the potential synergistic effects
of combining VASER liposuction with a ketogenic diet in
addressing obesity.7 VASER liposuction effectively targeted
localized fat deposits, facilitating substantial weight loss
and BMI reduction.1 Compared with traditional liposuc-
tion techniques, the minimally invasive nature of VASER
liposuction offers several advantages, including reduced
trauma to surrounding tissues, decreased postoperative
pain, and faster recovery times.8 Moreover, studies have
demonstrated that the ketogenic diet promotes weight
loss by inducing ketosis, where the body uses stored fat for
energy production.9
Although male and female fat deposition patterns
differ, we have successfully implemented this strategy in
both genders, particularly in younger populations where
weight loss can be challenging. The ketogenic diet speci-
cally targets visceral fat, whereas liposuction addresses sub-
cutaneous fat and aids in skin tightening in both genders.
CONCLUSIONS
Combined VASER liposuction and adherence to a keto-
genic diet can yield favorable outcomes in morbidly obese
individuals seeking weight loss and body contouring.1 This
case exemplies the importance of personalized treat-
ment approaches and comprehensive postoperative care in
achieving successful results in the management of morbid
obesity. Although liposuction is not typically targeted for
weight loss, it played a signicant role in skin tightening
and aided in weight loss in this case, thus avoiding more
aggressive surgical interventions. The main advantage
observed in this case was skin tightening and minimal loose
skin despite signicant weight loss, which is a notable out-
come of combining VASER liposuction with a ketogenic
diet.10 Compared with traditional liposuction techniques,
the minimally invasive nature of VASER liposuction offers
several advantages, including reduced trauma to surround-
ing tissues, decreased postoperative pain, and faster recov-
ery times. Further studies and clinical trials are warranted to
explore the broader applicability and long-term outcomes
of this combined approach in diverse patient populations.
Hasan Ali, MRCS, MSc (UK), EBOPRAS (FRANCE)
Hasan Surgery FZ LLC
Plastic and Reconstructive Surgery Center
Dubai Healthcare City
Dubai, UAE
E-mail: hasan@hasansurgery.com
Twitter: www.twitter.com/hasansurgery
Instagram: www.instagram.com/doctorhasanali
DISCLOSURES
The author has no nancial interest to declare in relation to
the content of this article.
ACKNOWLEDGMENT
The author would like to acknowledge the patient for his coop-
eration and consent for the publication of this case report.
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