To determine the effects of suction lipectomy on regional adipose tissue metabolism, nine women had repetitive circumferential measurements and biopsies of subcutaneous adipose tissue from a lipectomy site (site A) and a nonlipectomy site (site B) up to 12 months following lipectomy. Maximum reductions from preoperative baseline in weight, body mass index, and circumferences of sites A and B occurred at 3 months. Because of variable long-term compliance (6 to 12 months), we created a “last visit” timepoint to assess adequately the effects of lipectomy for each individual. Not all subjects maintained reduction in site circumferences from 3 months to the last visit. The change in circumference of site A for that period was highly correlated with the change in circumference of site B (r = 0.828, p = 0.005). The change in circumference of site B, but not site A, at 3 months was related to the weight change above the weight of adipose tissue removed at suction lipectomy. Five subjects who were “sustained responders” to the lipectomy procedure were able to maintain or decrease circumferences of sites A and B from 3 months to the last visit. In contrast, four “limited responders” actually increased circumference of site A and had either no change or increased circumference of site B from 3 months to the last visit. The changes in circumference in both sites between 3 months and the last visit related to changes in body weight over the same interval. Ultimately, the decrement in circumference of site A was 3.4 percent (-2.4 cm) greater than that of site B (p = 0.0001). The response to lipectomy in site B, but not site A, between 3 months and the last visit was related to the change in fasting adipose tissue lipoprotein lipase from baseline to 3 months (r = 0.728, p = 0.026). This change in lipase activity in the control region may represent a metabolic defense of body weight in response to adipose tissue removal in the lipectomy site.