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  • Although Smartlipo provides results within a few weeks, some experts have their doubts as to whether it will supplant the traditional liposuction technique

Dr. Katz
NATIONAL REPORT — For some cosmetic surgeons and their patients, Smartlipo (Deka/Cynosure) represents aesthetic surgery's holy grail: a tool that melts fat, producing results more quickly and comfortably than traditional liposuction while tightening skin to boot. However, some experts tell Cosmetic Surgery Times that this technology simply replaces one type of trauma with another and doubt that it will supplant conventional liposuction.

"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.

Dr. Goldman
HIGH DRAMA "It's not like laser studies where one might have some improvement of wrinkles, but one really can't tell" because results are so subtle, Dr. Katz adds. "With liposuction, particularly with the laser, it's pretty dramatic." In fact, in a 60-patient study the results of which Dr. Katz was collating at press time, he says, "About 80 percent of our patients were very happy with the results." That's because 80 percent of study patients achieved at least 50-percent to 75-percent (characterized by investigators as marked to dramatic) improvement in treated areas, he says. The above figures coincide with what he's observed in his practice, adds Dr. Katz, who has treated about 400 patients — and has led pioneering Institutional Review Board studies of the technology.

Patients shown before (top row) and following (bottom row) SmartLipo laser lipolysis treatment. Photo credit: Bruce E. Katz, M.D.
Moreover, he says that to date, "Blood tests have not shown any problems with increased triglyceride levels or cholesterol" in treated patients. "And we've seen no serious side effects," in either the study or his practice — just one minor skin infection that responded to antibiotics, says Dr. Katz.

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."

Dr. Katz serves as a consultant to Deka Laser Technologies.
Dr. Hirsch is an investigator for Candela, Cynosure, Palomar and HOYA ConBio.
Dr. Kane reports no relevant financial interests.
Dr. Goldman is a consultant and researcher for Deka.

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