"The nice thing about Smartlipo is what we'd call immediate gratification. Patients see results" — including flatter abdomens and bulge-free thighs — within a few weeks to approximately a month, says Bruce E. Katz, M.D., director of Juva Skin & Laser Center in New York and clinical professor of dermatology at Mount Sinai School of Medicine.
Laser lipolysis uses a one-millimeter cannula through which a 1,064-nm Nd:YAG laser fiber is introduced to deliver energy directly to subcutaneous fat cells, he says. The laser energy also coagulates tissue, thereby reducing bleeding and inducing collagen retraction, according to Cynosure.
STITCH-FREE TIGHTENING Compared to conventional liposuction, Dr. Katz says, "The major benefit is that not only does laser liposuction remove fat, but it also tightens skin at the same time." Conventional liposuction can worsen skin that's already loose or bulgy — "the deflated balloon effect," as Dr. Katz calls it. Conversely, he states, "Laser lipolysis represents a significant advance because we can do with lasers what we could not do with liposuction alone — tighten the skin."
Additional advantages of laser liposuction include the fact that "The incisions are so small we don't even have to use sutures," and they produce almost imperceptible scarring, Dr. Katz says.
After surgery, Dr. Katz adds, "We see a lot less bruising and swelling compared to traditional liposuction. Laser liposuction is much less painful for the patient" and requires no general anesthesia, only local tumescent anesthesia, he says. For such reasons, he says most of his patients are able to return to work two days after the procedure.
"With traditional liposuction," Dr. Katz notes, "recovery can take a week or two."
DOCTOR AS PATIENT "As a patient, I can affirm that the recovery is really comfortable. I underwent the procedure twice," says Alberto Goldman, M.D. "To our patients, this new medical option represents a kind of miracle which enables the reduction of trauma, risks and pain," adds Dr. Goldman, who estimates he's treated thousands of patients with the technology over six to seven years. He is director of the Goldman Clinic of Plastic Surgery in Porto Alegre, Brazil, and president of the Brazilian Society for Lasers in Medicine and Surgery, South Region.
With laser lipolysis, treating a single body area such as the abdomen takes about an hour, Dr. Katz says. However, he notes, most patients choose to treat two or three areas. "If one is treating the abdomen, hips, thighs and flanks," he says, "it can take three hours."
Postsurgically, Dr. Katz tells patients to wear a surgical garment over the treated area and not to exercise for two weeks. "If they're having it done on the neck area," he adds, "they must wear a band that goes under the chin and over their head for about three days."
LIPO LIMITS As with traditional liposuction, one shouldn't use laser lipolysis to remove more than five liters of fat, advises Dr. Katz. Additionally, he says laser liposuction's results are permanent, like those of traditional liposuction.
As for drawbacks, Dr. Katz claims that laser liposuction has none. "If one is going to do liposuction," he states, "this is the safest way to do it, with the fewest side effects and the least downtime."
TRAUMA EXCHANGE Laser lipolysis merely "substitutes thermal trauma for mechanical trauma," says Michael Kane, M.D., a plastic surgeon in private practice in New York. "The body does not care whether the fat is liquid or solid when it leaves." The skin contraction that Smartlipo's manufacturer says heating produces "might be advantageous in small areas. But overall, I don't see a big advantage" over traditional liposuction, he says.
Laser lipolysis can be "a great tool for focal areas of fat deposition in the right candidate," says Ranella J. Hirsch, M.D., a Boston-based dermatologist in private practice and president-elect of the American Society for Cosmetic Dermatology and Aesthetic Surgery. However, she cautions, "It's not a solution for everyone. Patient selection is paramount, and that's where the claims can fall short." Laser-assisted liposuction represents "a useful and important advance. But it's not a miracle. Patient selection and good sense are the keys to obtaining a safe and satisfactory result," adds Dr. Goldman. Other disadvantages of the technology include its learning curve and equipment cost, he adds.
Ultimately, many physicians will continue performing traditional liposuction, particularly those unfamiliar with lasers, Dr. Katz adds. However, he says of laser lipolysis, "Once they try it, they may change their minds."