Is fat removal more than simply cosmetic?

Liposuction is meant to get rid of stubborn bulges, but now a study suggests that patients may also gain health benefits.

The study shows for the first time that patients with high levels of triglyceride — a type of fat in the blood — saw a significant reduction in those levels after their fat was sucked out in a liposuction procedure. White blood cell counts dropped, as well.

High triglyceride levels and elevated white blood cell counts are associated with a higher risk for cardiovascular disease, stroke and diabetes.

"These findings suggest that patients who are considering liposuction who have at-risk triglyceride levels may reduce their risk of developing these serious health problems, while correcting body disproportions," said Dr. Eric Swanson, a plastic surgeon in Leawood, Kan., who conducted the study. He added, however, that further research is needed.

Some doctors are skeptical that liposuction can carry a health bonus. And physicians stress that the procedure remains a cosmetic one.

"This liposuction study doesn't carry much weight — no pun intended — for me," said Dr. Terry Dubrow, a board-certified plastic surgeon in Newport Beach. "The effects of liposuction on obese individuals has long been studied and it seems clear that it offers little to no benefit unless accompanied by changes in diet and exercise."

The new study was published in Plastic & Reconstructive Surgery: The Journal of the American Society of Plastic Surgeons and was presented at the American Society of Plastic Surgeons annual conference in Denver.

Swanson called the decrease in triglyceride levels "surprisingly dramatic," saying it revealed that "the permanent removal of excess fat cells by liposuction has a major impact on circulating levels of triglycerides."

The study measured triglyceride and cholesterol levels in more than 300 patients undergoing liposuction and/or a tummy tuck. Most patients — 71 percent — had liposuction only.

Triglyceride levels in patients with normal levels before liposuction were not affected. But patients with elevated, at-risk levels had an average 43 percent reduction in triglyceride levels after surgery — about twice what is achieved with a drug often prescribed to reduce levels. The effect was similar in men and women. (The author said this does not mean that liposuction can replace medications in patients with very high triglyceride levels.)

The study also found that white blood cell counts were, on average, 11 percent lower after liposuction. High white blood cell counts are associated with a raised level of inflammation within the body and have been linked to obesity, coronary heart disease, hypertension and diabetes.

No significant changes in total cholesterol, LDL cholesterol or HDL cholesterol were detected after the liposuction, according to the study.

What part did diet or exercise play in the results?

"The patients were not instructed to change their diets or activity levels, apart from not exercising for a period of up to a month after surgery," Swanson said in an interview.

"The cholesterol levels remained very consistent after surgery. Cholesterol levels, as we all know, are affected by diet, so this finding suggests that diets did stay constant during the study period. Also, weight fluctuations, on average, were minimal, also suggesting that the study's findings are caused by fat removal and not a drop in weight or change in diet."

The study had no control group for comparison purposes, Swanson said.

"Ideally, there would be another group of patients of a similar number, male/ female ratio and weights, who would not have surgery, but have their blood drawn at the same intervals," he said.

"However, it is difficult to conceive of any significant differences in blood tests in such a group, but from a pure science standpoint, this is the ideal.

"In practice, this doesn't always happen because of impracticality of finding such patients (who may or may not match the study group well) or financial considerations."

Liposuction is among the most popular types of cosmetic plastic surgery. The American Society for Aesthetic Plastic Surgery, based in Garden Grove, estimates that 289,000 liposuction procedures were performed last year in the United States.

In the past, research into liposuction demonstrated no health improvements, according to a 2006 Johns Hopkins medical health alert.

Dubrow, the Newport Beach plastic surgeon, remains doubtful.

"Triglycerides alone, without an associated change in lipid profiles (the 'good' HDL and 'bad' LDL), offer no health benefits regarding insulin resistance, metabolic syndromes and cardiovascular risk factors," he said. "The fact this study found a reduction in triglycerides is at best interesting and at least irrelevant."

He added, "In this economy it's nice for plastic surgeons to suggest that liposuction may be a healthy idea, but in my opinion only the plastic surgeon's wallet receives any 'health' benefits."

Have patients who've seen news reports about the study been asking about it?

"Yes, the wives are hoping I will tell them it's true so they can convince their husbands it's a good idea health-wise," Dubrow said, "but sadly, no."

A professor at the University of California, Irvine, School of Medicine said Swanson's results appear promising but more study is needed, both long term and also to look for differences in results between men and women.

"To really see if there are decreases in heart attacks or strokes, you would have to follow the patients for several years," said Dr. Shaista Malik, medical director of the Preventive Cardiology Program. "This is just a small signal and we don't know what it really means years down the road. The findings are still interesting and relevant. They did show a pretty big change in triglyceride levels and white blood cell counts."

Noting that cholesterol levels stayed the same, she added, "In terms of heart disease, you usually have to change the bad cholesterol, LDL, or the good cholesterol, HDL, to see a reduction in heart attacks."

While liposuction patients shouldn't yet assume they can stave off certain diseases, Malik added, "At least you're not doing harm when it comes to these risk factors.

"However, I wouldn't sign up for liposuction for health benefits," she said. "It's still a cosmetic procedure."