Metabolic Effects of Liposuction

  • Eric Swanson


The metabolic effect of liposuction has been poorly understood. In the absence of reliable data, some investigators speculate that liposuction may cause a metabolic imbalance, causing the body to gain weight to compensate for lost fat cells. The possibility that removing subcutaneous fat may cause a deleterious increase in the relative proportion of the “bad” visceral fat volume has been considered.

In order to investigate the metabolic effect of liposuction and liposuction combined with abdominoplasty, the author undertook a laboratory study of 322 predominantly nonobese patients, with sequential measurements of lipid levels, fasting blood glucose, and leukocyte counts. Patient weights were also recorded to ensure caloric neutrality during the study.

There were no significant differences in cholesterol levels after surgery. Fasting blood sugars were unchanged. However, there was a highly significant mean 43% reduction in triglyceride levels 3 months after liposuction in patients with elevated preoperative triglyceride levels (p < 0.001). Surprisingly, mean white blood cell counts decreased 11% after liposuction, also a highly significant change (p < 0.001).

Adipocytes do not manufacture cholesterol but do synthesize triglycerides. The reduction in triglycerides in patients with elevated preoperative levels (≥150 mg/dL) is likely caused a postsurgical reduction in subcutaneous fat cell volume. Subcutaneous fat may be no less metabolically relevant than visceral fat, challenging the concept of a metabolic syndrome.

Excessive triglyceride levels are associated with serious health problems such as diabetes, coronary artery disease, and stroke. Elevated white blood cell counts have also been linked to health problems. Adipocytes induce production of inflammatory cytokines, which may contribute to coronary artery disease and type II diabetes. Although the long-term health benefits of these changes, if any, are unknown, patients may be reassured that any metabolic effect of removing extra subcutaneous fat seems to be favorable.


Metabolic Liposuction Triglyceride Leukocyte Count Cholesterol Adipocytes Levels Reduction 


  1. 1.
    Yost TJ, Rodgers CM, Eckel RH. Suction lipectomy: outcome relates to region-specific lipoprotein lipase activity and interval weight change. Plast Reconstr Surg. 1993;92:1101–8. discussion 1109–1111CrossRefPubMedGoogle Scholar
  2. 2.
    Hernandez TL, Kittelson JM, Law CK, et al. Fat redistribution following suction lipectomy: defense of body fat and patterns of restoration. Obesity. 2011;19:1388–95.CrossRefPubMedGoogle Scholar
  3. 3.
    Swanson E. Prospective clinical study reveals significant reduction in triglyceride level and white blood cell count after liposuction and abdominoplasty and no change in cholesterol levels. Plast Reconstr Surg. 2011;128:182e–97e.CrossRefPubMedGoogle Scholar
  4. 4.
    Swanson E. Photographic measurements in 301 cases of liposuction and abdominoplasty reveal fat reduction without redistribution. Plast Reconstr Surg. 2012;130:311e–22e. discussion 323e–324eCrossRefPubMedGoogle Scholar
  5. 5.
    Giese SY, Bulan EJ, Commons GW, Spear SL, Yanovski JA. Improvements in cardiovascular risk profile with large-volume liposuction: a pilot study. Plast Reconstr Surg. 2001;108:510–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Giese SY, Neborsky R, Bulan EJ, Spear SL, Yanovski JA. Improvements in cardiovascular risk profile after large-volume lipoplasty: a 1-year follow-up study. Aesthet Surg J. 2001;21:527–31.CrossRefPubMedGoogle Scholar
  7. 7.
    Spalding KL, Arner K, Westermark PO, et al. Dynamics of fat cell turnover in humans. Nature. 2008;453:783–7.CrossRefPubMedGoogle Scholar
  8. 8.
    Mayer J. Regulation of energy intake and the body weight: the glucostatic theory and the lipostatic hypothesis. Ann N Y Acad Sci. 1955;63:15–43.CrossRefPubMedGoogle Scholar
  9. 9.
    Matarasso A, Kim RW, Kral JG. The impact of liposuction on body fat. Plast Reconstr Surg. 1998;102:1686–9.CrossRefPubMedGoogle Scholar
  10. 10.
    Reaven GM. Role of insulin resistance in human disease. Diabetes. 1988;37:1595–607.CrossRefPubMedGoogle Scholar
  11. 11.
    Liese AD, Mayer-Davis EJ, Haffner S. Development of the multiple metabolic syndrome: an epidemiologic perspective. Epidemiol Rev. 1998;20:157–72.CrossRefPubMedGoogle Scholar
  12. 12.
    Miller M, Stone NJ, Ballantyne C, et al. Triglycerides and cardiovascular disease. A scientific statement from the American Heart Association. Circulation. 2011;123:2292–333.CrossRefPubMedGoogle Scholar
  13. 13.
    National Cholesterol Education Program (NCEP). Expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III). National Institutes of Health Publication No 02-5215. Sept 2002.Google Scholar
  14. 14.
    Swanson E. Assessment of reduction in subcutaneous fat thickness after liposuction using magnetic resonance imaging. J Plast Reconstr Aesthet Surg. 2012;65:128–30.CrossRefPubMedGoogle Scholar
  15. 15.
    Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity among US adults, 1999-2008. JAMA. 2010;303(3):235–41.CrossRefPubMedGoogle Scholar
  16. 16.
    Sackett DL, Straus SE, Richardson WS, Rosenberg W, Haynes RB. Evidence-based medicine. 2nd ed. Toronto: Churchill Livingstone; 2000. p. 109.Google Scholar
  17. 17.
    Samdal F, Birkeland KI, Ose L, Amland PF. Effect of large-volume liposuction on sex hormones and glucose- and lipid metabolism in females. Aesthet Plast Surg. 1995;19:131–5.CrossRefGoogle Scholar
  18. 18.
    Baxter RA. Serum lipid changes following large-volume suction lipectomy. Aesthet Surg J. 1997;17:213–5.CrossRefPubMedGoogle Scholar
  19. 19.
    González-Ortiz M, Robles-Cervantes JA, Cárdenas-Camarena L, Bustos-Saldaña R, Martínez-Abundis E. The effects of surgically removing subcutaneous fat on the metabolic profile and insulin sensitivity in obese women after large-volume liposuction treatment. Horm Metab Res. 2002;34:446–9.CrossRefPubMedGoogle Scholar
  20. 20.
    Klein S, Fontana L, Young VL, et al. Absence of an effect of liposuction on insulin action and risk factors for coronary heart disease. N Engl J Med. 2004;350:2549–57.CrossRefPubMedGoogle Scholar
  21. 21.
    Liszka TG, Dellon AL, Im M, Angel MF, Plotnick L. Effect of lipectomy on growth and development of hyperinsulinemia and hyperlipidemia in the Zucker rat. Plast Reconstr Surg. 1998;102:1122–7.CrossRefPubMedGoogle Scholar
  22. 22.
    Robles-Cervantes JA, Yanez-Diaz S, Cardenas-Camarena L. Modification of insulin, glucose and cholesterol levels in nonobese women undergoing liposuction: is liposuction metabolically safe? Ann Plast Surg. 2004;52:64–7.CrossRefPubMedGoogle Scholar
  23. 23.
    Vandeweyer E. Does liposuction influence lipidogram in females: in vivo study. Aesthet Plast Surg. 2002;26(1):17–9.CrossRefGoogle Scholar
  24. 24.
    Ybarra J, Blanco-Vaca F, Fernández S, et al. The effects of liposuction removal of subcutaneous abdominal fat on lipid metabolism are independent of insulin sensitivity in normal-overweight individuals. Obes Surg. 2008;18(4):408–14.CrossRefPubMedGoogle Scholar
  25. 25.
    Robles-Cervantes JA, Castillo-Salcedo T, González-Ortiz M, et al. Behavior of visfatin in nonobese women undergoing liposuction: a pilot study. Aesthet Surg J. 2010;30:730–2.CrossRefPubMedGoogle Scholar
  26. 26.
    Ross R, Léger L, Morris D, de Guise J, Guardo R. Quantification of adipose tissue by MRI: relationship with anthropometric variables. J Appl Physiol. 1992;72:787–95.CrossRefPubMedGoogle Scholar
  27. 27.
    Ross R, Shaw KD, Martel Y, de Guise J, Avruch L. Adipose tissue distribution measured by magnetic resonance imaging in obese women. Am J Clin Nutr. 1993;57:470–5.CrossRefPubMedGoogle Scholar
  28. 28.
    Kvist H, Chowdhury B, Grangård U, Tylén U, Sjöström L. Total and visceral adipose-tissue volumes derived from measurements with computed tomography in adult men and women: predictive equations. Am J Clin Nutr. 1988;48:1351–61.CrossRefPubMedGoogle Scholar
  29. 29.
    Schreiber JE, Singh NK, Shermak MA. The effect of liposuction and diet on ghrelin, adiponectin, and leptin levels in obese Zucker rats. Plast Reconstr Surg. 2006;117:1829–35.CrossRefPubMedGoogle Scholar
  30. 30.
    Tiikkainen M, Berghom R, Vehkavaara S, et al. Effects of identical weight loss on body composition and features of insulin resistance in obese women with high and low liver fat content. Diabetes. 2003;52:701–7.CrossRefPubMedGoogle Scholar
  31. 31.
    Goodpaster BH, Kelley DE, Wing RR, Meier A, Thaete FL. Effects of weight loss on regional fat distribution and insulin sensitivity in obesity. Diabetes. 1999;48:839–47.CrossRefPubMedGoogle Scholar
  32. 32.
    Purnell JQ, Kahn SE, Albers JJ, Nevin DN, Brunzell JD, Schwartz RS. Effect of weight loss with reduction of intra-abdominal fat on lipid metabolism in older men. J Clin Endocrinol Metab. 2000;85:977–82.PubMedGoogle Scholar
  33. 33.
    Dattilo AM, Kris-Etherton PM. Effects of weight reduction on blood lipids and lipoproteins: a meta-analysis. Am J Clin Nutr. 1992;56:320–8.CrossRefPubMedGoogle Scholar
  34. 34.
    Lemieux S, Prud’homme D, Bouchard C, Tremblay A, Després J-P. Sex differences in the relation of visceral adipose tissue accumulation to total body fatness. Am J Clin Nutr. 1993;58:463–7.CrossRefPubMedGoogle Scholar
  35. 35.
    Camhi SM, Bray GA, Bouchard C, et al. The relationship of waist circumference and BMI to visceral, subcutaneous, and total body fat: sex and race. Obesity (Silver Spring). 2011;19:402–8.CrossRefGoogle Scholar
  36. 36.
    Terry RB, Stefanick ML, Haskell WL, Wood PD. Contributions of regional adipose tissue depots to plasma lipoprotein concentrations in overweight men and women: possible protective effects of thigh fat. Metabolism. 1991;40:733–40.CrossRefPubMedGoogle Scholar
  37. 37.
    Bjorntorp P. “Portal” adipose tissue as a generator of risk factors for cardiovascular disease and diabetes. Arteriosclerosis. 1990;10:493–6.CrossRefPubMedGoogle Scholar
  38. 38.
    Abate N, Garg A, Peshock RM, Stray-Gunderson J, Grundy SM. Relationships of generalized and regional adiposity to insulin sensitivity in men. J Clin Invest. 1995;96:88–98.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Havel RJ, Kane JP, Balasse EO, Segel N, Basso LV. Splanchnic metabolism of free fatty acids and production of triglycerides of very low density lipoproteins in normotriglyceridemic and hypertriglyceridemic humans. J Clin Invest. 1970;49:2017–36.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Jensen MD. Is visceral fat involved in the pathogenesis of the metabolic syndrome? Human model. Obesity. 2006;14:20S–4S.CrossRefPubMedGoogle Scholar
  41. 41.
    Martin ML, Jensen MD. Effects of body fat distribution on regional lipolysis in obesity. J Clin Invest. 1991;88:609–13.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Guo Z, Hensrud DD, Johnson CM, Jensen MD. Regional postprandial fatty acid metabolism in different obesity phenotypes. Diabetes. 1999;48:1586–92.CrossRefPubMedGoogle Scholar
  43. 43.
    Goodpaster BH, Thaete FL, Simoneau JA, Kelley DE. Subcutaneous abdominal fat and thigh muscle composition predict insulin sensitivity independently of visceral fat. Diabetes. 1997;46:1579–85.CrossRefPubMedGoogle Scholar
  44. 44.
    Kahn R, Buse J, Ferrannini E, Stern M. The metabolic syndrome: time for a critical appraisal. Joint statement from the American Diabetes Association and the European Association for the Study of diabetes. Diabetes Care. 2005;28:2289–304.CrossRefPubMedGoogle Scholar
  45. 45.
    Kahn R. Metabolic syndrome – what is the clinical usefulness? Lancet. 2008;371:1892–3.CrossRefPubMedGoogle Scholar
  46. 46.
    Austin MA, Hokanson JE, Edwards KL. Hypertriglyceridemia as a cardiovascular risk factor. Am J Cardiol. 1998;81:7B–12B.CrossRefPubMedGoogle Scholar
  47. 47.
    Assmann G, Schulte H, Funke H, von Eckardstein A. The emergence of triglycerides as a significant independent risk factor in coronary artery disease. Eur Heart J. 1998;19(Suppl M):M8–M14.PubMedGoogle Scholar
  48. 48.
    Sattar N, McConnachie A, Shaper G, et al. Can metabolic syndromes usefully predict cardiovascular disease and diabetes? Outcome data from two prospective studies. Lancet. 2008;371:1927–35.CrossRefPubMedGoogle Scholar
  49. 49.
    Kershaw EE, Flier JS. Adipose tissue as an endocrine organ. J Clin Endocrinol Metab. 2004;89:2548–56.CrossRefPubMedGoogle Scholar
  50. 50.
    Esposito K, Giugliano G, Scuderi N, Giugliano D. Role of adipokines in the obesity-inflammation relationship: the effect of fat removal. Plast Reconstr Surg. 2006;118:1048–57.CrossRefPubMedGoogle Scholar
  51. 51.
    Ahima RS, Flier JS. Adipose tissue as an endocrine organ. Trends Endocrinol Metab. 2000;11:327–32.CrossRefPubMedGoogle Scholar
  52. 52.
    Kern PA, Ranganathan S, Li C, Wood L, Ranganathan G. Adipose tissue tumor necrosis factor and interleukin-6 expression in human obesity and insulin resistance. Am J Physiol Endocrinol Metab. 2001;280:E745–51.CrossRefPubMedGoogle Scholar
  53. 53.
    Yudkin JS, Kumari M, Humphries SE, Mohamed-Ali V. Inflammation, obesity, stress and coronary heart disease: is interleukin-6 the link? Atherosclerosis. 2000;148:209–14.CrossRefPubMedGoogle Scholar
  54. 54.
    Ziccardi P, Nappo F, Giugliano G, et al. Reduction of inflammatory cytokine concentrations and improvement of endothelial functions in obese women after weight loss over one year. Circulation. 2002;105:804–9.CrossRefPubMedGoogle Scholar
  55. 55.
    Rizzo MR, Paolisso G, Grella R, et al. Is dermolipectomy effective in improving insulin action and lowering inflammatory markers in obese women? Clin Endocrinol. 2005;63:252–8.CrossRefGoogle Scholar
  56. 56.
    Giugliano G, Nicoletti G, Grella E, et al. Effect of liposuction on insulin resistance and vascular inflammatory markers in obese women. Br J Plast Surg. 2004;57:190–4.CrossRefPubMedGoogle Scholar
  57. 57.
    Bulló M, García-Lorda P, Megias I, Salas-Salvadó J. Systemic inflammation, adipose tissue tumor necrosis factor, and leptin expression. Obes Res. 2003;11:525–31.CrossRefPubMedGoogle Scholar
  58. 58.
    Danesh J, Collins R, Appleby P, Peto R. Association of fibrinogen, C-reactive protein, albumin, or leukocyte count with coronary heart disease. Meta-analyses of prospective studies. JAMA. 1998;279:1477–82.CrossRefPubMedGoogle Scholar
  59. 59.
    Coller BS. Leukocytosis and ischemic vascular disease morbidity and mortality. Is it time to intervene? Arterioscler Thromb Vasc Biol. 2005;25:658–70.CrossRefPubMedGoogle Scholar
  60. 60.
    Madjid M, Awan I, Willerson JT, Casscells SW. Leukocyte count and coronary heart disease. J Am Coll Cardiol. 2004;44:1945–56.CrossRefPubMedGoogle Scholar
  61. 61.
    Stevens VJ, Obarzanek E, Cook NR, et al. Long-term weight loss and changes in blood pressure: results of the trials of hypertension prevention, phase II. Ann Intern Med. 2001;134(1):11.CrossRefGoogle Scholar
  62. 62.
    Swaminathan R, Major P, Snieder H, Spector T. Serum creatinine and fat-free mass (lean body mass). Clin Chem. 2000;46:1695–6.PubMedGoogle Scholar
  63. 63.
    Baxmann AC, Ahmed MS, Marques NC, et al. Influence of muscle mass and physical activity on serum and urinary creatinine and serum cystatin C. Clin J Am Soc Nephrol. 2008;3:348–54.CrossRefPubMedPubMedCentralGoogle Scholar
  64. 64.
    Haeck P, Swanson J, Gutowski KA, et al. Evidence-based patient safety advisory: liposuction. Plast Reconstr Surg. 2009;124(4S):28S–44S.CrossRefPubMedGoogle Scholar
  65. 65.
    Israeli Society for Prevention of Heart Attacks. Secondary prevention by raising HDL cholesterol and reducing triglycerides in patients with coronary artery disease: the Bezafibrate infarction prevention (BIP) study. Circulation. 2000;102:21–7.CrossRefGoogle Scholar
  66. 66.
    Ross R. Atherosclerosis – an inflammatory disease. N Engl J Med. 1999;340:115–26.CrossRefPubMedGoogle Scholar
  67. 67.
    Brown DW, Giles WH, Croft JB. White blood cell count: an independent predictor of coronary heart disease mortality among a national cohort. J Clin Epidemiol. 2001;54:316–22.CrossRefPubMedGoogle Scholar
  68. 68.
    Loimaala A, Rontu R, Vuori I, et al. Blood leukocyte count is a risk factor for intima-media thickening and subclinical carotid atherosclerosis in middle-aged men. Atherosclerosis. 2006;188:363–9.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Eric Swanson
    • 1
  1. 1.Swanson CenterLeawoodUSA

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