Recently, the LA Times published an article about the possible health benefits of liposuction. Specifically, a California Plastic surgeon, Eric Swanson, presented his study at the annual Society of Plastic Surgeons meeting this year. He reports that after liposuction, his patients experienced a significant improvement in their blood lipid profile–specifically in regards to triglycerides. It will be interested in finding out more about how the study was performed, if other elements of the lipid panel improved, and if it lasts. I am looking for the paper in our journal, and I hope to go over and share the results with you as soon as they are available.
But Dr. Swanson’s findings bring up a very interesting aspect about adipose tissue which I have certainly reiterated over and over again. Specifically: (a) not all fat tissue is the same and (b) adipose tissue is both a very metabolic sensitive and active organ. And ultimately, it seems to me that adipose tissue should be thought of not only as an organ or but more specifically a set of organs because fat around the body, as I’ve said, is just not the same from place to place.
To illustrate this point, I’ve already mentioned the radial forearm free flap, and how it is used for reconstruction of the mouth because forearm simply never gets “fat” in any conventional sense of the word, while other flaps do. If you transplant skin and fat from a persons stomach/tummy to their mouth and the patient gets fat, that flap in their mouth will also get fat. And I’ve also mentioned, as have other doctors, the extreme metabolic sensitivity and immunological reactivity of omental and visceral fat, and how important it is to try and minimize this fat.
It would be wonderful, in my view, if liposuction could become a valuable adjunct to weight loss, especially in patients who have things like metabolic syndrome and diabetes who are trying to lose weight. Although I don’t suggest surgery as a first solution to a chronic illness like obesity and diabetes, and I don’t think liposuction will ever become a first line of treatment for chronic illness, it may one day serve as a useful additional procedure for those who can not lose weight. And at the very least, it may shed some light on the metabolism of fat and what it’s role is in regulating our metabolism and health in general.*
As a procedure, liposuction is conceptually simple. A cannula is used which actually sucks fat out of the body using negative pressure suction. But in spite of its ease and simplicity, there is nuance to it–and that’s important to note. You can kill someone with liposuction if you don’t know what you are doing, and sadly, this has happened in the hands of inexperienced practitioners who put profit over patient safety and don’t understand what liposuction does or even is. **
Also, liposuction, and I will say this over and over again, is not a tool to lose weight. It is used to contour the body, especially the areas where weight is hard/contour is hard to achieve to lose through proper dieting and excerise. Those places are the tummy, the thighs, and the gluteal regions, generally speaking, and sometimes underneath the arms, or what is known as the brachial area.
We know several things about this type of fat, which is called a gynoid fat, or a pear shaped distribution of fat. First of all, when compared to visceral fat, gynoid fat is not as toxic–that is, it does not predict things like heart disease and diabetes as well as the so called beer belly/android fat. And secondly, it is awfully hard to lose. Why? Well if you have read Gary Taubes book: Good Calories, Bad Calories, he discusses this in terms of the fat having different receptors to hormones like insulin and epinephrine.
In GC, BC, Taubes talks about this fat being specifically very sensitive to epinephrine and he also mentions how nicotine can help get rid of his fat, which leads to one of Taubes’ more striking claims that smoking does actually help you lose weight. He doesn’t condone it or say its healthy, but physiologically that is what happens. But that being said, it still doesn’t explain totally why triglycerides go down after liposuction in this area.
And it is important to stress that gynoid fat is not completely metabolically inert, even though it is considered to be “safer.”*** I have performed many panniculectomies in my practice who are morbidly obese, who literally have an overhanging apron of fat, and need to me to remove this skin for hygiene purposes.
I have had patients where I have removed 20-30 lbs. of skin and fat, and have seen their insulin requirements go down to 1/2 the usual amount after surgery. The point is, gynoid fat is not necessarily benign, but generally a lesser evil. But of course, it is never that simple… In general, I agree with Dr. William Davis’ concept in Wheat Belly, that we must strive to get our abdominal girth down, as it is a good predictor of future illness. I don’t think he is the only one who has advocated for this nor is it a unique sentiment, but his book is totally amazing and important. If you do not subscribe to his blog, you really should….But that is a sidenote.
Ultimately, I am hoping Dr. Swanson’s study will provide further research and insight into the nature of fat metabolism in our bodies.
* Surgery is only a adjunct to weight loss, at best. 99.9% of the time, if you can avoid surgery, and lose weight with diet and lifestyle (which you can if you know how), then do that.
** I will make it very clear that the people who do liposuction the best are board certified plastic surgeons, which I am. Biased? You say? You bet. But I am the kind of person who doesn’t want necessarily want to hire a plumber who does electrical work on the side to do a complex wiring job in my house, either. But to be fair, the story is a bit more complex than that.
Currently our country is simply wild about cosmetic surgery (which is not totally a good thing in my view, but that’s another story). Unfortunately, most doctors, who are not plastic surgeons, are completely frustrated with the current health care system as it is (once again another story, but if you have been a patient you probably know). As a result, the reimbursement for general medical care is generally poor, and commercial insurance companies constantly play games with doctors to withhold payments, or pay them less than what they’ve promised. It’s a totally frustrating system. Ask your primary doctor if you don’t believe me.
Is it any wonder, then, that more and more non-plastic surgeons are getting into the field of cosmetic surgery where you can get paid a fair and even very handsome price for your service the same day of that you perform it? However this comes at a cost, as many of these procedures are not carefully regulated so basically any doctor can take a weekend course in liposuction, and start performing it in his office. This is unsafe as I see it and antithetical to the oath that a doctor takes to first do no harm. So it is important to be educated carefully about your options.
***Gynoid fat is considered safer fat when compared to omental, visceral, or android fat because people who only have a gynoid distribution of fat generally do not have a high risk of developing diabetes and heart attacks, but that doesn’t mean that gynoid fat is (a) not important (b) you can just keep gaining this type of fat and it will be okay. As in all things, it is more complex than that. My point is simply that gynoid fat is very metabolically important because your body will give up its own muscle and organ tissue before it gives up this fat for energy.