Smart Liposuction

Read what Dr. Voss has to say about "Smart Lipo" or "Smartlipo":

Laser Lipolysis (aka Smartlipo or cool lipo) is a new and heavily marketed technique. I would buy the equipment to perform laser lipolysis in a heartbeat if I thought that the claims of better fat removal, lifting and tightening of the skin were true.
The process of laser lipolysis is done in two parts. The first part is putting a Nd:Yag laser filament through a liposuction cannula, where it causes heat and "melting" of the fat as the cannula is threaded through the fat (which has a low melting point so the laser does not have to be very hot). The second part of the procedure is where the patient undergoes liposuction to suck out all the "melted" fat.

To actually shrink collagen in the dermis of the skin you need to make it pretty hot (about 50C). The only way you can tighten or lift skin with lasers is to heat the dermis sufficiently. If the Nd:Yag laser is hot enough to shrink dermis then it is also hot enough to burn skin. In my opinion there is no scientific proof that laser lipolysis gets hot enough to shrink dermis unless you held the cannula in the same place for a prolonged period (and risk burning the skin, and causing ulceration and necrosis). To generate the heat needed the cannula would also have to be positioned directly against the dermis as well. Having a cannula that superficial would cause ridging. In liposuction we take out the fat closest to the muscle first and work our way more superficially, but never come close to the dermis to avoid complications.

I have also looked at all available before and after pictures and have never seen any kind of skin shrinkage that was better than what we get with tumescent liposuction alone.

Here is the letter that Dr. Voss wrote to her patients back in 2007:

Smartlipo™, also marketed as Coolipo™, is the newest twist on Liposuction. This is a two step procedure, touted as first “melting fat” and then removing it. Smartlipo™ thus needs a modified cannula to “melt” the fat prior to the liposuction procedure of the melted fat.

The technique is similar to “Ultrasonic™” liposuction that also “melted” the fat – in that case with agitation. Ultrasonic™ liposuction was a fad several years ago, but has now been dropped due to problems with burns. Smartlipo™ is very new and trendy (and very heavily marketed and trademarked), but at this point in time seems to only have disadvantages over the True Tumescent Liposuction technique.

I am worried about burns, but also about unevenness, about nerve damage from heat and fat emboli from melted fat getting into essels. Additionally, in order to achieve the marketed skin tightening, the probe would have to be both substantially hot and right against the superficial dermis -- and that would make burns of the skin a very real risk.

Even though skeptical, I have asked the SmartLipo™ company to let me test their equipment, but they declined to let me “try it before you buy it.” To me this policy translates into a lack of confidence in their own product. (Plus my before and after pictures already show better results than those marketed with SmartLipo™!)

The beauty of Tumescent Liposuction is that it is a delicate procedure, where I use tiny cannula (straws) so that the fat cells come out intact with little trauma. This minimal trauma allows the healing to occur quickly and the discomfort from the procedure to remain very low. First melting the fat into oil makes the procedure needlessly more aggressive and also turns an incredibly safe procedure into one that is much more risky. Finally, I like the fact that in Tumescent Liposuction any fat-dissolved toxins are removed inside the intact fat cells – why split those cells up? It is far more reassuring to know that a fat cell is permanently gone than to hope it injured by heat to later be salvaged.

As always, I strive to offer my patients real results the safest way possible. Without bamboozling them.

Julie E. Voss, M.D.