Smart, smarter, smartest lipo: Update on liposuction and body contouring

What is the smartest approach to liposuction and body contouring? The answer is it depends on who you ask and what your specific situation is. There is a multitude of options to choose from now, including noninvasive fat freezing (Coolsculpting®), laser-assisted liposuction (e.g., Smart Lipo®), noninvasive laser (e.g., SculpSure®), liposuction with ultrasound (VASER®), noninvasive ultrasound (e.g., UltraShape®), injectables (Kybella®) and many others. All of these work best for localized areas of fat that are resistant to change with diet and exercise, and none of them will tighten loose skin very much or dramatically smooth out cellulite. I’ve tried many of these technologies over the years (I was the first to perform ultrasonic liposuction in the Northwest, and helped develop the first noninvasive focused ultrasound device for body contouring), and here’s what I have concluded: the smartest liposuction still depends more on skill and the surgeon’s judgment than technology.


Take for example laser-assisted liposuction. There are several brands, but probably the most recognized is “Smart Lipo.” When this was first

introduced, many plastic surgeons expected it to be a flash in the pan. The laser caused burns and scarring, and although it was purported to tighten skin, it didn’t do that well enough to be noticeable in most cases. Why add the considerable expense of a laser to liposuction, with increased risk and questionable benefit? I think what happened had more to do with marketing than technology. Rather than discussing the pros and cons of the laser, the brand became identified with the use of local anesthesia. No dangerous general anesthesia required! There is nothing about the laser, however, that changes the options for anesthesia. Local anesthesia, known as tumescent technique, works equally well with any type of liposuction. If you are not a good candidate for tumescent technique as the only anesthesia, using the laser won’t make a difference.

before and after female patient body contouring angle view

Plastic surgeons have a saying about devices like this: When you have a golden hammer, everything looks like a nail. If your practice has invested in an expensive body contouring device, suddenly everyone looks like a candidate for it. Those of us with years of experience have seen dozens of patients who had been signed up somewhere for a treatment that wasn’t right for them, often resulting in scarring or dissatisfaction. Corrective surgery can be very challenging in these situations.


So what is the smart liposuction patient to do? First, don’t be swayed by online marketing alone. If you see something that sounds like a good option, consult a plastic surgeon who offers it as well as traditional liposuction and body contouring such as tummy tucks. As a board-certified plastic surgeon, my interest is in steering the patient to the best option for their specific goals and circumstances, whether it be noninvasive, surgical, or neither.  I am not going to recommend a tummy tuck unless that is truly the best option, or a noninvasive treatment if it isn’t going to work well.

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