All About SmartLipo

Smartlipo, is a minimally invasive surgical technique, which utilizes a fiber optic laser fiber to melt the fat and tighten the skin, after which this melted fat is removed by liposuction. It has been available in the USA since 2007, so there is a significant amount of experience with Smartlipo. It is not one of those fly-by-night fads that is talked about one year and then is unheard of a few years later. Looking at reviews on RealSelf of Smartlipo, there is a very high satisfaction rate by patients who have undergone Smartlipo.

HOW DOES SMARTLIPO DIFFER FROM TRADITIONAL LIPOSUCTION.

1. Smartlipo is almost always done in a surgeon’s office with local anesthetic. Dr. David Berman, a board certified plastic surgeon in northern Virginia, also utilizes oral sedation (which requires someone to drive the patient) which he feels makes the entire procedure even easier and more pleasant.

Traditional liposuction is usually done under general anesthesia, in the operating room, with an anesthesiologist (or nurse anesthesiologist).. This requires the additional expense of an anesthesiologist and a formal operating room.

1. Both require infiltration of numbing medicine. However, with Smartlipo, a higher concentration of local anesthetic will be used in the infiltrate since the patient is awake. According to Dr Berman, this will require that patients wanting to do more than 3 areas at one time, may have their procedure split between 2 different operating days, in order to keep the lidocaine blood levels in a safe range.
2. Traditional liposuction does not utilize a laser. Fluid is infiltrated into the area and then it is liposuction out with accompanying fat.

With Smartlipo, before the fat is removed by liposuction, it is first melted by a small fiber optic laser fiber which is inserted into the subcutaneous fat and moved back and forth while firing the laser. This should allow a smoother result and some skin tightening due to the laser (this skin tightening does not replace the need for skin excision if there is a lot of loose skin). Also due to the small size of the laser, Dr. Berman feels there is less chance of unevenness post operatively, though this depends on the skill of the plastic surgeon and the skin tone of the area being treated. 

1. Return to work

Most patients after traditional liposuction will require 4-5 days before returning to work. According to Dr. Berman, 90% of his patients return to work the day after the procedure. This is because the laser causes decreased sensation in the areas treated, leading to less discomfort. 

2. Return to exercise

After Smartlipo, Dr. Berman allows his patients to return to full exercising after only 5 days. With traditional liposuction this time frame is closer to a week. 

3. Bruising

  There is generally less bruising after Smartlipo because one of the wavelengths emitted from the laser coagulates small blood vessels. Usually, there is minimal bruising after Smartlipo, but occasionally a patient may bruise a lot after Smartlipo. It will take about 2-3 weeks for the bruising to resolve and there are no long term complications from bruising.

4. Time to do the procedure

Smartlipo definitely takes more time to do properly. Because the patient is awake, it is necessary to slowly numb each area being treated. Also, the extra step of using a laser (which is not used in traditional liposuction) takes time. The good news is that, there is no increased risk since the patient is awake and moving their legs during the procedure. The time to do the Smartlipo varies with how large the area is and the number of areas. A small area, such as the chin area may be 30-45 minutes but to do the abdomen and flanks, may take over 2 hours. 

5. Risk of blood clots and DVT

Since the patient is not under general anesthesia with Smartlipo, there should be no increased risk of blood clots. Traditional liposuction, since it is done under general anesthesia, does have an increased risk of blood clots and DVT and complications arising from blood clots such as a pulmonary embolus. 

WHICH AREAS CAN BE TREATED BY SMARTLIPO?

With the exception of the eyelids, if there is fat present, it will generally can be treated by Smartlipo. 

The most popular areas to treat with Smartlipo (as well as all other types of liposuction are):

Upper and lower abdomen

Pubic area

flanks/love handles

Bra fat/lateral back

Thighs – both medially and laterally

Banana roll (which is the roll of fat, just below the buttocks posteriorly, on the upper thigh posteriorly)

Submental (double chin)

Fat pad lateral to the breast – anterior and medial to the axilla

Upper arms

Knee area

Less commonly the calves – often this is due to muscles and not fat.

WHAT OTHER FACTORS DETERMINE A GOOD RESULT?

As mentioned previously this is not a weight loss technique. You can still get some better shaping if you are moderately overweight, but if you are significantly overweight, then you should lose weight first.

To get a good result from any type of liposuction, your skin has to have the ability to tighten. Generally, as we age we lose skin tone. However, that varies a great deal from person to person. Some areas are almost always good at tightening up such as the flanks. However, it is not uncommon for the medial thighs and upper arms to lack the ability to tighten after the procedure. An experienced plastic surgeon should be able to give you some idea of your skin elasticity, after your consultation. An honest plastic surgeon will tell you if your skin tone is not sufficient to give a good result. Another advantage is seeing a plastic surgeon, is that he/she has other options such as a tummy tuck or arm lift or thigh lift and is not dependent on Smartlipo alone. 

As always, aim for improvement and not perfection. Sadly today, many people “tweak” their online photos and that can lead to unrealistic expectations by others viewing these photos. 

HOW LONG ARE POST OPERATIVE GARMENTS NEEDED?

Dr. Berman feels that this should vary from patient to patient and there should not be one rule that fits everyone. Often if the skin tone is good, Dr. Berman feels that wearing a garment (no need for an expensive fancy garment, Spanx or Spandex if fine) for 5 days is all that is necessary. If the skin tone is poor, Dr. Berman will recommend a longer use. However, he feels that sometimes doctors over-emphasize the need and benefit of a post op garment, after Smartlipo. 

WHAT IS THE ROLE OF POST-OPERATIVE MASSAGE?

Although some doctors recommended lymphatic massage, this adds a considerable amount of expense and time commitment for the patient. Dr. Berman does not feel that this is necessary. It is not uncommon to feel some firm areas beneath the skin after Smartlipo, especially in those areas with more fat. Dr. Berman recommends self massaging these areas for 2-3 minutes, 2-3 times per day and they will gradually go away over weeks to months. They are not visible but can be felt. Of course, if a patient wants to do lymphatic massage or any other type of massage, this is perfectly fine. 

COMPLICATIONS FROM SMARTLIPO

Every procedure has risks and this is no exception. If you go to a board certified plastic surgeon who has experience with Smartlipo, there should be few complications and they should be minor. If you elect to use someone who is not a board certified plastic surgeon, then you are at greater risk of burns from the laser, unevenness and in rare case, bowel perforation (the 2 cases that Dr. Berman is aware of where this happened, were performed by a family doctor in one case and a gynecologist in the other) 

IS SMARTLIPO A WEIGHT LOSS TECHNIQUE?

No type of liposuction is a weight loss technique and it should never be marketed as one! It is a great tool to help give a better body contour. It is not a magic wand. Reputable plastic surgeons will tell the patient that this procedure is a partnership. If the patient wants to maximize their post op appearance, they can improve their final result by better eating habits and exercise, if they are overweight. 

HOW MUCH DOES SMARTLIPO COST?

As you might expect, the cost will vary primarily on how many areas are being treated. You should expect to pay more if you are treating 5 different areas on your body, than if you are treating one area. 

There are geographic price differences for all procedures. You will generally pay more in a major center with high rents such as New York or Los Angeles, than you would in a rural community in the South or Midwest. You should expect to pay more if you use a board certified plastic surgeon, than if you select  another specialist or just a family doctor, who has perhaps spent a few hours watching a specialist do the procedure, before they bought the equipment. Just remember this is still surgery and this is NOT the place to shop for the lowest prices. 

HOW LONG DOES IT TAKE TO SEE THE FINAL RESULT?

Although you usually see a difference by 2 weeks (but not always), you will continue to see improvement for a full 6 months so you need patience. As stated earlier, you can influence the final result, by decreasing your total body fat and increasing your muscle tone (first by better eating habits or dieting and secondly, by exercising). 

HOW LONG WILL RESULTS LAST?

The results will last forever (obviously we all age with time and our skin tone decreases as we age) provided you do not gain weight. Dr. Berman has been told by patients that they read, “you can never get fat in those areas again.” This is not true because fat cells are left behind and though it is true, there will be less fat cells in the areas which are treated, if you put on weight (fat not muscle) then those remaining fat cells will hypertrophy (get larger) and this will make you look fat. 

OTHER MINIMALLY INVASIVE TECHNIQUES FOR FAT REDUCTION BESIDES SMARTLIPO.

There are a number of different techniques from Vaser to Bodytite etc. they use different technologies from ultrasound to radiofrequency etc. There are no head to head comparison studies. I strongly suspect what is most important is the skill of the operator and proper patient selection. Each surgeon will have a natural bias towards equipment that they have purchased. 

NON SURGICAL ALTERNATIVES TO SMARTLIPO

There are a number of non-invasive techniques but they will always produce much more subtle changes than Smartlipo or any invasive liposuction technique. They often require more than one session. However, there are no incisions and they usually cost less money, so they are another option.  

Some of the better known examples are: 

Coolsculpting – very well known due to an extraordinary amount of marketing. It has poor ratings on RealSelf and is presently the subject of a multi-million dollar lawsuit due to Paradoxical Adipose Hyperplasia, a complication unique to Coolsculpting due to the freezing process. 

Warm Sculpting – made by Cynosure which is the same company that makes Smartlipo. Uses heat to melt the fat via lasers that can safely pass through the skin. Requires at least 2 sessions.

Ultrashape – uses ultrasound therapy to rupture fat cells.

Vanquish – uses radiofrequency to heat and destroy fat cells.