"Liposuction is not an accepted treatment for obesity," said plastic surgeon Zachary Gerut, a member of the American Society for Aesthetic Plastic Surgery’s body contouring committee and assistant clinical professor of plastic surgery at Albert Einstein Medical Center in New York. "It’s like cutting out a piece of skin for psoriasis. The problem is still there. The person is going to get psoriasis everywhere else."

Gerut referred to liposuction performed by Austin plastic surgeon Robert Ersek on Brooke Bates of Pflugerville in March, during which he removed 35 pounds of fat from the girl’s midsection, back and arms. Surgeons typically take out about 5 to 10 pounds during the fat-removal procedure. Now 13, the sixth-grader’s story has been featured in People magazine and on ABC’s "Good Morning America."

According to the U.S. Food and Drug Administration, liposuction is a procedure for body shaping, not weight loss. It is enormously popular, and the American Society of Plastic Surgeons reports liposuction was the top cosmetic surgery procedure in 2005 with 324,000 performed. Of the total, 3,084 procedures were performed on patients 18 or younger, a 22 percent increase since 2000. As with any major surgery, liposuction carries some serious risks. The amount suctioned out is carefully monitored and, usually, patients get intravenous fluids during these operations to avoid excessive fluid loss that could lead to shock.

While he’s aware of the controversy, the girl’s father, Joey Bates, said he and Brooke’s mother, Cindy, are convinced liposuction was the correct decision. "We’ve been astounded at the dramatic change in her appearance, and Brooke is so happy with the new her. She went from being last year the girl that everybody teased with fat jokes to this year where her self-esteem has gone through the roof. She feels so good about going out with her girlfriends and being able to buy the same clothes they do. Before she was a size 20 or 22. She went from 220 pounds to 155. And she’s watching her diet because she doesn’t want to go back to being a teased little girl."

The girl at the center of all the attention was overweight from early childhood, and Bates said she tried repeatedly to lose weight with only minor success. Depressed and hurt by cruel remarks at school, she got the idea for having liposuction from cosmetic surgery makeover shows on television.

In a recent interview from his ranch, Ersek, the plastic surgeon, insisted liposuction can be used for weight loss, as well as body contouring, and defended his decision to operate on the girl. He explained he was moved to perform surgery because the girl was desperate and because she told him she wanted her father, who was diagnosed with bladder cancer, to see her in a dress before he died. Bates said the cancer is now in remission.

The 35 pounds were removed during a two-hour, outpatient operation under local anesthesia. Ersek said he followed safe procedures with the girl receiving about 8 liters of fluid intravenously. She banked two units of her own blood beforehand. A tummy tuck was performed several months after the liposuction to remove an apron of hanging abdominal fat. The fee for the surgeries was $25,000, and the family is on a payment plan.

"In terms of age, what is the right age?" asked Ersek. "She is now down to 155 pounds. Did we do her any good? Wow. Did we treat obesity? Wow. We did the best thing for this little girl. Now, we’re not suggesting that every 12 year old get sucked down to a size 2 so she can make the cheerleading squad. This was a special case, and if her dad wasn’t sick I might have put it off longer."

Ersek, who has been in practice for about 30 years and jokes about being "the biggest fat sucker in Texas," has appeared on television and a few years ago generated media stories when he performed liposuction on himself to demonstrate that fat contains stem cells. Recalling that surgery he said, "I think of myself as a scientist."

Bates had known Ersek for years and said he felt comfortable having him operate. "If my little girl had been born with a cleft palate or some other deformity, we would have looked for the services of a plastic surgeon right off the get-go. I realize this is a weight thing, but we tried dieting for years and years, and it would all come back."

Still, some plastic surgeons raise concerns. Speaking generally, Rod Rohrich, chairman of the department of plastic surgery at the University of Texas Southwestern Medical School in Dallas and past-president of the American Society of Plastic Surgeons, observed, "Teenage cosmetic surgery is very limited in this country — especially liposuction — to unusual circumstances, and this certainly is an unusual circumstance. But body contouring and liposuction for teenagers is not the norm. Liposuction is not a treatment for obesity. I need to run and eat less to lose weight. Why would it be different for a kid?"

Childhood obesity is a growing health problem, but from his office on Long Island, Gerut pointed out studies that show liposuction doesn’t bestow the health benefits of diet and exercise. He said that after liposuction, the girl actually might be less healthy than before. That’s because liposuction removes only fat immediately beneath the skin. The most dangerous fat in the body lies around major organs, so in an obese patient, a large proportion of potentially harmful body fat would remain after liposuction.

"Lipo is for proportional changes, not weight changes — for a person who has two or three areas that are out of proportion," he concluded. "If lipo was as good as diet and exercise, I’d be thinner because I would have done it myself instead of struggling for the past 20 years with my 25 pounds."

Asked what parents of obese youngsters who try, unsuccessfully, to lose weight could do, Gerut suggested lap-band bariatric surgery. Unlike gastric bypass surgery, the lap-band procedure is reversible and does not carry the nutritional concerns of a bypass. He noted there are trials under way studying the procedure in children.

Bates mentioned that the family rejected the idea of gastric bypass surgery for the girl because a family friend had died of complications after the weight-loss operation. "We think Brooke was headed in the same direction. I realize people are very critical and ridicule us about what we did, but if I had a choice, I would liked to have done it at a younger age so that through the third, fourth and fifth grade she wouldn’t have been picked on the way she was. We hope that we’ve changed her life. Our society looks down on heavyset people. Now, so many things could open up for her."

For his part, Gerut worries others will pursue this kind of quick fix. "This sends the message to all young people that: ‘Don’t worry. If you’re fat, you can have lipo, and you’re cured.’ That is totally wrong."