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Can liposuction make you healthier?

Liposuction, a surgical procedure for removing unwanted body fat, is one of the most popular items in cosmetic surgery. It also has a growing number of variants and cousins, such as ultrasound body contouring, CoolSculpting®, laser liposuction and others. In fact, the desire to get rid of unwanted fat is the number one reason why people see cosmetic surgeons, at least in the US.

While people resort to liposuction and its variants in ever greater numbers, many feel guilty about doing so. They feel that by choosing liposuction over healthy lifestyle as a means of body-shaping, they prioritize vanity over health, appearance over substance.

Getting rid of excess fat through some combination of healthy eating, exercise and willpower is indeed commendable and preferable when possible. However, due to variations of individual physiology, age-related metabolic changes as well as constraints of modern life, getting rid of excess fat without help, especially in certain areas of the body, may sometimes be an almost unachievable feat. Critics would say that even then liposuction would just be an unnecessary and potentially risky cosmetic procedure without any value beyond image improvement. Why not just learn to accept the natural look and be happier for it?

This type of debate about liposution has been going on for quite a while. Yet until recently the opposing positions have been rather clearcut. However, a recent study has made things more complicatied. It turns out that liposuction may have an interesting side effect: it might make you healthier.

In a 2011 study published in the Plastic & Reconstructive Surgery journal, Dr. Eric Swanson investigated the effects of liposuction on blood chemistry and blood cell count. Essentially, Dr Swanson treated 322 consecutive patients (270 women and 52 men) with ultrasonic liposuction and compared their blood test results before and 3 month after the treatment. He found that after liposuction the patients' blood triglyceride level were on average 25% lower, with even greater reduction seen in people with abnormally elevated triglycerides before the procedure. Other important metabolic parameters, such as cholesterol and blood glucose were unchanged.

Triglycerides are a type of fat (lipid) found in your the bloodstream. It is also the type of fat stored in fat cells. When people consume more calories then they burn, those extra calories end up converted to triglycerides and then stored in fatty tissue. Conversely, when there is a lack of food energy, triglycerides are released from fat cells into the bloodstream and then burned to produce energy throughout the body. Abnormally high level of triglycerides in the bloodstream (when fasting) is a known risk factor for heart disease and possibly other conditions. Therefore, the reported triglyceride lowering effect of liposuction should at a minimum be taken seriously.

Another potentially beneficial effect of liposuction reported by Dr Swanson was a decrease in white cell count. White blood cells (primarily leukocytes) are a part of the immune system and their number in the bloodstream indicates the level of the immune system activity -- and inflammation in particular. Inflammation is known to be a risk factor in heart disease and many other conditions. The reported inflammation-reducing effect of liposuction is consistent with an established idea that excess fatty tissue increases the level of inflammation in the body. In any case, any treatment promising to lower inflammation should be taken seriously.

So, should everyone who can afford it make a guilt-free dash to a surgeons office to discuss liposuction as a means for better health – with a side benefit of image improvement? Not just yet, unfortunately. As is often the case in medical science, there are caveats requiring a lot more comprehensive research that has been done so far.

Let me explain. First, this was just one study with design limitations. Considering the great complexity of the human body, a single study - even a large, well-designed one – is generally insufficient to prove something as a medical fact. Dr. Swanson's study was a so-called uncontrolled prospective study, i. e. a study where you essentially test patients before and after a treatment and compare the results. The study did not have a meaningful control group, which makes the results less reliable. While Dr. Swanson's study is valuable as a starting point for further research, additional studies with more comprehensive design (so-called randomized controlled studies) are needed to confirm these effects of liposuction.

Second, Dr. Swanson only looked at relatively short-term effects of liposuction. The patients were tested post-treatment only once, three month after the procedure. It is unclear whether the observed positive effects would persist longer term. In fact, there is a reason to suspect than they might not. A 2011 University of Colorado study found that liposuction subjects regain lost fat after about a year (albeit it gets distributed differently – see my article about that study for more details). This makes me wonder if the reported positive “health effects" of liposuction may disappear after a year. To answer this question, studies with longer followup are needed.

Finally, the use of metabolic parameters instead of actual health outcomes to determine health benefits of a treatment is often a slippery road. For example, diabetes drug rosiglitazone, while effective in improving blood sugar levels and possibly other metabolic parameters, was found to increase all-cause mortality in patients aged 65 or older. Understandably, it is far more difficult, time-consuming and expensive to conduct studies based on long-term health outcomes. Many researchers with best intentions are not in the position to do so. But we should at least be aware that observing an improvement in one or more metabolic parameters (however indicative they may be) is not the same as demonstrating a net improvement in health and longevity.

In the light of the above, it is premature to view liposuction as a treatment proven to improve health. However, the results reported by Dr. Swanson and certainly interesting and potentially promising. Further research into the possible health effect of liposuction is clearly warranted. Who knows, one day liposuction may become as guilt-free as a cosmetic procedure can get.


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