Plastic Surgery

Too Young for Lipo?

UPDATED 11/13/2006 at 01:00 AM EST Originally published 11/13/2006 at 01:00 AM EST

As an adorably chubby toddler, Brooke Bates earned the family nickname Big Brooke. And her chipmunk cheeks were cute—until, of course, they weren't: When Brooke turned 11, she weighed 180 lbs., suffered from high blood pressure and was diagnosed as prediabetic. A year later the 5'5" sixth-grader was up to 220 lbs. and a size 22, limiting her back-to-school shopping trips to women's stores like Lane Bryant and prompting a doctor to classify her as morbidly obese. "I used to think of myself as a giant balloon," Brooke, now 13, says. "Always expanding."

She tried to lose the weight; in fact she had dieted most of her childhood. There was the $1,400 low-carb plan her parents enrolled her in during third grade. Then Richard Simmons's Deal-a-Meal in fourth grade and Weight Watchers in the fifth. Her parents tried to help at home by "getting rid of all the chips, crackers and cookies," her father, Joey, says. But regardless of any success she had, the pounds always came back. "Brooke seemed to be the kind of kid who gained weight from just looking at food," says her mother, Cindy.

Then one day in September 2005, as Brooke was curled up on the sofa in the family room of the Bates's ranch house outside Austin, Texas, she watched a documentary on a subject that seemed to offer an answer: liposuction. An elective procedure that uses a metal tube and suction pump to remove fat through the skin, liposuction, Brooke thought, would solve her weight woes. But when she brought the idea to her parents, they were less enthusiastic. "I thought, 'Do we really want to put our child through this? There's going to be considerable pain.' But Brooke was determined," says Joey.

Cindy and Joey had already ruled out gastric bypass surgery because a family friend had died from it. "Our friend had a childhood like Brooke's, and by the time she was 30 she weighed well over 400 lbs.," says Cindy. "Her theory was that her weight was past the point of no return. I didn't want Brooke to get to that psychological place, that point of no return." So when Brooke continued to badger her parents, Joey, 53, who owns a backhoe business, told his daughter he would "look into it." Still Cindy, 40, a stay-at-home mom, cautioned Brooke, "You're awfully young. I don't think we'd find a doctor willing to do liposuction on you."

It wasn't easy. Even Dr. Robert Ersek, a local plastic surgeon and the self-proclaimed "biggest fat-sucker in Texas," initially said no. But because Joey had that winter been diagnosed with bladder cancer (thought by the Bateses to be terminal), Ersek agreed to take Brooke as his patient. The girl had told him, "I want my dad to see me looking slim and pretty in a dress before he dies."

So on March 14, Ersek, who had worked on Joey after a 1985 car accident, vacuumed 35 lbs. of fat and fluid from Brooke's body. As a result she is now believed to be the country's youngest liposuction patient—a distinction that has raised eyebrows in the medical community. "We don't have any experience with people who are 12, with that kind of surgery," says Dr. Peter Fodor, a past president of the American Society for Aesthetic Plastic Surgery. "Metabolically, her whole system is still growing."

At issue was more than Brooke's age. Liposuction is used almost exclusively on adults to sculpt small, troublesome spots that resist sit-ups, lunges or triceps curls. Rarely is more than 10 lbs. removed, because the surgery is not intended "to make fat people skinny," says Dr. Rod J. Rohrich, chairman of the department of plastic surgery at the University of Texas Southwestern Medical Center in Dallas. Adds Dr. Roxanne Guy, president of the American Society of Plastic Surgeons: "To say to teens or preteens that this is an okay thing to do, I think is a bad message."

Teens do get liposuction. According to the American Society of Plastic Surgeons, last year over 3,000 people under age 18 did. (Of these, most are 16 to 18, and some needed corrective surgery, such as boys with overdeveloped breasts.) With the country's adolescent obesity rate near 16 percent, could liposuction, in some circumstances, be the lesser of two evils? "If the potential harmful effects of surgery don't outweigh the harm of being overweight, it is probably better to have it," says Dr. Doug Cluff, who runs a kids' weight-loss program in Dallas. "But you don't need it."

Certainly, Brooke—whose blood pressure is down to normal levels—is much healthier now than she was at 220 lbs. As she bounces on the trampoline in the backyard of her home, it is hard to imagine that, only a year ago, if she overexerted herself her heart rate would get so fast that "one doctor told me she was like a walking time bomb," Cindy says.

But Brooke says her physical pain was nothing compared with the psychological anguish she endured. One day in junior high, boys harassed her until she fled in tears. "I wanted to die," she says. In class no one wanted to sit next to her. "Kids would say, 'You stink,' because people tend to think fat people smell bad, even though I didn't."

All the while the family tried to monitor Brooke's eating habits: Joey and Cindy, as well as Brooke's half siblings Adam and Bailey Goodale from Cindy's prior marriage. "My mom has always tried to cook healthy meals," says Adam, 17. (He and Bailey, 15, don't have the same weight issues Brooke did.) "Things like grilled chicken or steak, and we'd always have a vegetable. And I hardly ever remember eating fried stuff."

In hindsight, the Bateses think they could have been more vigilant. "Brooke would help with the cooking," says Joey, "and do lots of tasting, which canceled out the small portions when we sat down to eat." One year Cindy brought her daughter salad for lunch every day at school. (Before then, Brooke admits to at times going through the lunch line twice.)

By the time Brooke and her parents contacted Ersek, "I just felt that liposuction was the right thing to do," Cindy says. Brooke's family physician, Dr. Sandra Esparza, didn't agree. "I thought Brooke was too young and still developing," she says.

So did Ersek, at first (see sidebar, page 134). It was only after he saw the severity of Joey's illness that Ersek changed his mind, offering to do several small liposuction sessions over a year or two. But when Brooke shared her hope that her father would see her thin and in a dress, Ersek agreed to do it all at once. (Says Joey of Brooke's plea: "I was touched, but I was also a little sad. I've always loved her unconditionally.")

The recovery period from the surgery—in which fat was sucked out from from Brooke's arms, back, midsection and chin—proved brutal. "The first week was pretty rough," says Joey, who slept on his daughter's floor for several nights. "Brooke was in a lot of pain; she was so sore she couldn't get off the bed by herself. It was hard on all of us. But each day she felt better. It helped that she was getting smaller and smaller."

Two months later Brooke returned to Ersek for a tummy tuck to take off the loose skin that remained around her middle and hung like an apron. The operation removed 10 lbs. from her body, and since then Brooke has dropped another 20 lbs. by committing to healthy eating habits. "The mirror used to be my worst enemy," says Brooke, who is down to 155 lbs. "But now it's my best friend."

Joey and Cindy are also happy with the results, despite the $25,000 cost for the two surgeries, which weren't covered by health insurance. (Ersek has placed them on an installment payment plan.) "For a kid who has basically been on a diet from the age of 3, this is just wonderful," says Cindy. "There is no way something like that would have happened for her with just dieting." Adds Joey: "Her self-esteem and improved health make it worth every penny."

To maintain her new figure, Brooke typically sticks to Special K cereal, fruit or poached eggs for breakfast, salad with chicken for lunch, grilled meat or fish and vegetables at dinner. She runs, takes self-defense class and jumps rope, "because I love that." She has also cut out middle-of-the-night snacks: "Now I just suck it up and go back to bed. Dinner is the last thing I eat before I wake up the next morning."

And the dress that she wanted to wear for her father? In August Brooke bought a brown, polka-dot number in a size 10. As soon as she came home she modeled it for Joey, whose cancer is now in remission. "My dad, when he saw me in it, said, 'Oh baby, you look so pretty,'" recalls Brooke with pride. "That's just what I wanted to hear."

And yet she has since passed on the dress to a cousin. "The dress," Brooke says with a smile, "is too big."

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