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I am trying to decide between traditional liposuction and laser liposuction (Smart...

Q:

I am trying to decide between traditional liposuction and laser liposuction (Smart Lipo, specifically). The areas I am most interested in are my stomach, inner thighs, and posterior flanks.  However, I am having a hard time finding objective discussions of the effectiveness and risks of using Smart Lipo vs. traditional liposuction.  I would love some honest feedback about whether I should have any concerns about using Smart Lipo over traditional liposuction.

A:

Liposuction was popularized in the United States in 1981.  Since then there has been several milestone improvements in technique and outcome.

The first was the introduction of TUMESCENT technique, which allowed us to do large volume liposuction with minimal blood loss.

Second was the introduction of smaller cannulas, which has less cannula  marks, dents, etc.  Then ULTRASOUND liposuction was introduced and thoroughly studied.  It works by AVITATION, to dissolve fat which is then suctioned.

Recently laser and hydro (water) power has been introduced as a source of energy to dissolve the fat and then suction it.  All ultrasound, laser, Hydro, or traditional suction with the power of the surgeon's arm work well.

Laser and Hydro has very little peer reviewed scientific studies; they rely on individual surgeon experience.

Traditional  liposuction and ultrasound liposuction are well studied with significant peer reviewed studies.

The experience of the surgeon is the most important aspect of your surgery, any surgery. The instrument used is nothing but an extension of the surgeon.  All can be effective; all can be dangerous and have risks and complications.

For the time being, and after 33 years in practice doing liposuction since 1981, I use traditional and ultrasound liposuction.  I am waiting for the science to support the laser and hydro before I incorporate them into my practice.

 

A:

Your dilemma is a common one and all the more difficult because of marketing hype. Proponents of laser lipo, of which "smart lipo" is one, have made claims about it being less invasive, safer, and tightening skin so that it could even be an alternative to a tummy tuck.  However, because it is still liposuction, by definition the addition of the laser makes it more invasive, and the laser carries its own risks in addition to lipo alone.  Skin tightening requires that the laser be applied superficially, which is riskier, and the most that has been measured is around 15-20% more than with lipo alone, which is very subtle.  Informal surveys of plastic surgeons at meetings I have been to in recent years show that very few believe there is enough benefit to using the laser to justify the additional costs and risks.  The most important variable in your outcome will be the skills of the surgeon, not the technology.

Richard A. Baxter, M.D. - View Other Answers by this Doctor
Mountlake Terrace, WA

A:

I can appreciate your dilemma in this situation.  The marketing that is "pushing" these so-called technologies as being "better" is very prominent and can sway patients into choosing some of the newer techniques which may or may not deliver results.  In general, an even more important factor in obtaining the results is the experience of the surgeon performing your operation.  In other words, choosing a more experienced surgeon, who focuses on liposuction in particular, is more likely to lead to better results and less complications no matter what technique is used, whether it it laser, ultrasound, water-jet, or tumescent.

Scottsdale, AZ

A:

You are right to be seeking information before having surgery, however the most important choice you will make is the plastic surgeon you choose, not the tool she or he uses to achieve your results.  I agree with the other surgeon's opinions on this blog.  I like to use the analogy "its not the magic wand that matters but the witch or warlock performing the spell."

I do not believe there is clear data supporting any one type of tool or device over the others.

In many communities, so-called Smart lipo is marketed heavily by non-surgeons who wish to attract patients for liposuction surgery procedures.  Check the credentials of the individuals you consider.  Membership in ASAPS implies that the surgeon is certified by the American Board of Plastic Surgery.

A:

It's not the tool - it's who is using it!  Though some legitimate Board Certified Plastic Surgeons do use smart-lipo,  many purveyors of this technology are not even surgeons - so beware.

ASAPS membership is even better evidence of competence in cosmetic procedures such as liposuction.  The majority of plastic surgeons still use straightforward suction lipectomy and/or ultrasonic assisted liposuction.

Bruce K. Barach, M.D. - View Other Answers by this Doctor
Schenectady, NY

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