Background:  The heavy or fat neck is a common problem in younger patients who often have a concomitant body fat issue. The neck is often a symptom of the patient’s overall weight and its size may yo-yo very much like their body does with cyclical weight changes. But for many of these patients, weight loss is not the total solution for their heavy neck and rarely results in a conpletely satisfying neck change.

Unlike the older patient, patients under 45 or 50 years of age rarely have signficant skin excess with their full necks. While there is some skin excess to be sure, it is not a large amount and only appears that way with a sagging convex neck profile due to the amount of fat. Their skin is almost always thick with reaonable elasticity.

Liposuction of the neck is a very common procedure and is done in conjunction with other procedures (e.g., facelift) as much as it is done by itself. It is an above the platysma muscle cannula technique for subcutaneous fat removal. There are other fat compartments, which can be significant, that are below the platysma muscle and are not accessible by cannula extraction. If present, these need to be removed as part of a more advanced neck contouring procedure known as a submentoplasty.

Liposuction technology has advanced over the past fifteen years, primarily in how the fat is mobilized prior to suction evacuation. One of these technologic advancements has been the use of fiberoptic cables to deliver energy (heat) directly to the fat layer. This has become widely know as laser liposuction, with the brand name Smartlipo as the most recognizeable market name. While often percieved as ‘zapping’ fat, this is not how it really works. It is more about raising the internal temperature to a level that is considered damaging to fat cells. This is generally in the range up to 45 or 46 degrees C. At this temperature level, the collagen in the skin is also induced to shrink and contract, theoretically aiding the necessary skin contraction needed for a good contour result. 

Case Study: This 40 year-old female wanted to get rid of her fat neck. It had always been there as she struggled with her weight over the years. She had recently lost 30 lbs but her neck did not change significantly. It had gotten a little smaller but not nearly enough for her satisfaction. She stated people would look at her neck and tell her she needed to lose weight.

Under general anesthesia, she underwent other body contouring procedures but her neck was treated by Smartlipo liposuction. After tumescent neck infiltration, the submental and lateral neck areas were treated by initial fiberoptic probe tunneling raising the temperature to 47 degrees as determined by internal measurements. Cannula extraction was then done, removing 55cc of aspirate.

Her postoperative course was typical for any form of neck liposuction. While there were visible improvements in the size of her neck initially, considerable swelling and firmness existed for three weeks after surgery until it began to soften. By six weeks after surgery, the neck was much softer but with a few areas of firmness and was still tender to squeezing and massage. By three months after surgery, the neck was completely soft and the skin had resolved all of its numbness. The final shape of the neck could be appreciated.

Case Highlights:

•         Liposuction of the full or fat neck can effectively reduce the fat content above the plastysma muscle but the quality of the result will ultimately be determined by the degree of skin contraction.

•         The type of neck liposuction performed may offer improved results if it aids in helping the skin to contract. Smartlipo provides a dermal heating effect that adds a theoretical effect on skin shrinking.

•         Recovery after neck liposuction is a process that, while some immediate effect is evident, takes several months to see the final result.

Dr. Barry Eppley

Indianapolis, Indiana

Background:  Enlargement of the breast tissue in a teenage or adult male, well known as gynecomastia, is a challenging aesthetic chest problem. It is comprised of several components including the amount of breast tissue, the size of the areola, and the position of the nipple-areolar complex on the anterior chest wall. Much of the focus of gynecomastia surgery, understandably, is on the reduction of the size of the breast mound whether it is throughout the whole chest or just limited to around the nipple-areolar complex.

Reduction of the breast tissue in gynecomastia can be done by either liposuction, direct excision through a lower areolar incision or both. Which of these approaches is best is determined by the size and quality of the breast tissue. Male breast tissue can be simplistically divided into ‘soft’ and ‘hard’ types. Hard breast tissue is known as glandular tissue and is very firm, lump-like and largely relegated to underneath and around the nipple-areolar complex. Soft breast tissue is largely comprised of fat with some fibrous tissue, known as fibrofatty tissue. It can occupy the entire chest or be an extension beyond the zone of glandular tissue underneath the nipple.

As a general rule, hard gynecomastia responds best to direct excision as it needs to be cut out. Soft gynecomastia can be extracted without excision by liposuction. Many gynecomastia conditions require both methods given the mixed hard and soft tissue make-up. If glandular tissue is not recognized before surgery, residual lumps or areolar fullness may be left behind by liposuction.

Case Study: This 35 year-old male from Indianapolis had developed increasing chest fullness which started when he was a teenager. It continued to grow as he got older and gained some weight. Exercise did not make it get smaller. He finally resolved to himself that he had to get rid of his ‘man boobs’ by surgery. Examination showed that he had generalized breast mound fullness of which all of the tissue was soft and non-glandular. Even under the nipple-areolar complexes no lumps or firm tissue could be felt.

Under general anesthesia, the chest was first infiltrated with a Hunstad solution. Then through small stab incisions at the side of the chest wall, each breast mound was first treated by a Smartlipo probe to heat all of the fatty tissues. Suction aspiration then removed a total of 1300cc of aspirate from both sides of the chest, a large amount by gynecomastia standards. The chest areas became flat and well contoured on both sides without any residual lumps of breast tissue under the nipples.

He wore a chest compression wrap for two weeks after surgery. By three weeks after surgery, all bruising and most of the swelling had resolved. By six weeks after surgery, the chest had a completely flat appearance and the chest skin and underlying tissues felt soft again.

Most cases of gynecomastia surgery require excision if small and a combined excision and liposuction approach when larger. It is not common to find a gynecomastia patient in which a completely flat chest can be obtained in one surgery by liposuction alone. In either case, Smartlipo provides a good method of liquefying the fatty breast tissue in gynecomastia.

Case Highlights:

1)      Male gynecomastia responds to different treatment approaches based on the type of breast tissue and the size and position of the nipple-areolar complex.

2)      In ‘soft’ forms of gynecomastia without significant glandular tissue, liposuction can be very effective at chest contouring/reduction.

3)      Liposuction of gynecomastia, specifically using Smartlipo, can be done with very small incisions and without the need for drains.

Dr. Barry Eppley

Indianapolis, Indiana

While the neck is technically not part of the face, it makes a very important contribution to one’s appearance. The concept of the ideal neck shape is one that has a near 110 degree cervicomental angle. This helps highlight the jawline and makes a clear transition between the two.When the neck is more obtuse it may be the result of too much fat, loose or saggy skin or a combination of both.

How to reshape the full or obtuse neck requires an understanding of why it looks the way it does. As a general rule, younger patients have a greater contribution of too much fat with skin that still has good elasticity. Older patients (depending upon how you want to define older) may also have significant fat but the diminishing quality of the skin’s elasticity and how much it sags become contributing factors as well.

Many neck contouring treatments are available that range from non-surgical (light, infrared or ultrasound), minimally invasive (threadlifts) or actual surgical procedures such as liposuction and different forms of necklifts. The degree of effectiveness of any of these neck procedures depends on how well the treatment changes the amount of fat in the neck, tightens the skin or preferably does some of both. When the patient’s problem matches what the treatment does best, an improved neck shape will occur. If not, results will be poor.

One potential neck contouring treatment is liposuction. As the only known treatment method that can remove fat, it is no surprise that it is a part of almost any surgical neck procedure. A basic principle of liposuction, anywhere on the body, is that the skin must retract afterwards. Part of its reshaping effects relies on the skin shrinking down to the reduced understructure. What is unique in neck liposuction is that the skin must actually shrink upward which is a bit more of a skin redraping challenge.

While traditional liposuction does not have any direct effects on creating skin tightening, that has changed with the use of Smartlipo or laser liposuction. The heat created by the melting of fat and the ability to run the fiberoptic probe along the underside of the skin can create a effect on his collagenous structure. This creates the potential for better skin retraction and some degree of actual tightening.

Smartlipo has been and remains my preferred technique when liposuction of the neck is done as a stand alone procedure. When used in younger patients with fuller fatty necks, good skin retraction and reshaping can be seen. It is very common for the neck to feel very firm for weeks afterwards and minor cords or banding can occasionally be seen. These are temporary skin effects that take a one or two month to soften and go away.

In older patients with significant skin sagging, the tightening effects of Smartlipo can be expected to be ineffective in skin with decreased elasticity and greater volume. When forced to do it in a few patients who refused any other form of surgery, I have seen a few impressive neck reshaping results. But I do not consider it the treatment of choice in the older neck and patients should temper their expectations accordingly. Its benefits are also obviated when liposuction is done as part of a face or necklift where skin undermining and flap repositioning are far more effective methods for neck reshaping.

Dr. Barry Eppley

www.eppleyplasticsurgery.com

Indianapolis, Indiana

Background: Liposuction is a well established method of surgical fat removal. While it may seem crude in the manner in which it is performed, its effectiveness is undeniable in extracting large volumes of fat. The extraction method is primarily based on pulling fat through a tube (cannula) based on a negative pressure of about one atmosphere. The size of this cannula determines how fast the fat is removed. As the size of the cannula increases so does the risk of visible skin irregularities afterwards as it ‘punches’ bigger holes in the fat tissue.

When most people think of liposuction, they envision people who are grossly overweight or just plain fat. The reality is that most liposuction patients, while not thin, are far from being obese. Most are likely in the 15 to 30lb above their ideal body weight category and just can’t lose the stomach or skin rolls that they have. Others have an inherited or congenital fullness of the thighs, knees and arms that is not exercise and diet-responsive. Liposuction is also used as a complement to other body contouring procedures such as tummy tucks, armlifts and breast reshaping.

But there is a distinct subset of liposuction patients who actually are reasonably lean and do not have fat rolls in the classic sense. They may have always been very thin and now have some unacceptable thickening of some body areas as they have aged. Or they may be very athletic and want further body refinements that they just can not achieve with rigorous diet and exercise. These represent a more finesse form of liposuction that is much lower in the volume of fat that needs to be removed. This is best known as liposculpture since the objective is shaping more than it is about high volumes of fat removed. To avoid irregularities in these small volume extractions, it is necessary to use small cannulas.

Case Study: This 42 year-old female was unhappy with her lower stomach and waistline areas. Despite being a good weight, she could not lose the small amount of accumulated fat and a little loose skin that had developed as she had aged and after having children. Her fat problem was around the waistline and into the back or flank areas.

Under anesthesia, she was treated with Smartlipo. Through small stab incisions inside the belly button and at the lateral waistline and flanks, she was initially infiltrated with a Hunstad solution. Approximately 10,000 joules of laser energy was delivered by a fiberoptic probe to the problem areas. Then a 3mm cannula was used to extract 575cc of aspirate in a cross-tunnel fashion from the lower abdomen and 175cc of aspirate from the flank areas in a radiating linear fashion. The entrance incisions were not closed to allow for drainage afterwards. She was placed in a circumferential binder with absorbant pads underneath.

She unwrapped her binder the next day, removed the pads, and showered. She wore her abdominal binder for the next week. While she saw improvement in her waistline from the very first day, it took a full 6 weeks until all the swelling had resolved and the final shape appreciated.

Critical analysis was done at three months after surgery. She was pleased and a visible reduction with some skin tightening achieved. There were a few areas of irregularities across the lower abdomen but these were not of a concern to her.

Case Highlights:

1) Small volume or discrete areas of liposuction can be described as liposculpture or finesse body contouring.

2) Liposculpture is used for average weight to thinner patients who need discrete areas of contouring, usually of the stomach, waistline and into the back. Smartlipo can help not only in the removal but can produce some slight skin retightening as well.

3) In small areas of fat removal and body contouring the biggest risk is that of skin irregularities and asymmetry after surgery.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

Indianapolis, Indiana

Background: Gynecomastia is a well known condition that largely affects the teenage and younger male. Male breast enlargement is most likely to be affected during the hormonal changes that occur during and after puberty. On the opposite side of puberty, the andropause era of men may cause gynecomastia as testosterone levels drop and numerous drugs for medical conditions may cause it. This is sometimes unflatteringly referred to as ‘senile gynecomastia’. But this is an inaccurate term and is better referred to as older gynecomastia to differentiate it from juvenile gynecomastia.

Older gynecomastia is different than that which appears in younger men in numerous ways. The amount of breast enlargement is often less and more diffuse in consistency. But the biggest difference is in the shape and amount of chest skin. The chest skin is more loose and sags and the nipple position is much lower than normal. Often the nipple may be close to or at the level of the inframammary fold. The skin also has lost much of its native elasticity. The lax skin and the droopy shape of the chest is often far more significant than the volume of breast tissue.

Because of differing tissue characteristics, the older gynecomastia male patient requires greater consideration of the extra skin problem and the position of the nipple. Ideally procedures such as horizontal excision of overhanging skin and free nipple grafting or liposuction with periareolar nipple lifts may be needed. But many men do not want the scars that result from these procedures and prefer liposuction alone to avoid this concern.

Case Study: This 68 year-old male wanted chest reshaping as his favorite activity in the summer was to be out on the beach at his lake. He was embarrassed because of the way his chest looked, particularly when contrasted to the chest of many younger men. In revewing his options, I initially recommended a periareolar mastopexy with liposuction. But he did not want the risk of any visible scar around his nipples and opted for liposuction alone.

Under general anesthesia, he underwent liposuction of both sides of his chest. A Smartlipo (laser liposuction) technique was done for optimal skin retraction. A fiberoptic laser probe was initially inserted and 20,000 joules of energy was delivered, raising the internal subcutaneous tissue temperature to 48 degrees C. Then 600cc of tissue was aspirated from each side of his chest up into the armpit area. He wore a chest compression garment for one week after surgery. It took another six weeks until all swelling and bruising subsided to appreciate the final result.

His final result showed significant chest contour improvement. But the outcome was not ideal due to only a limited amount of skin retraction. He desired no further efforts as he still did not want any chest scars.

Smartlipo offers an effective treatment for gynecomastias in older men but the amount of skin retraction is limited. It does not always result in an ideal chest result from a skin redraping standpoint but that is the trade-off for avoiding visible scars.

Case Highlights:

1) Gynecomastia in older men is different than in younger men and teenagers. The primary problem is soft tissue sagging that has lost much of its elasticity. The amount of breast enlargement is usually less significant than the size of the overlying skin problem.

2) Ideal older male chest contouring addresses the sagging skin through nipple repositioning and skin tightening/lifts. The scars that result from these procedures, however, may be unappealing to some men.

3) Liposuction of older gynecomastia provides improvement but not an ideal result as there is too much skin. Smartlipo aids the skin retraction process and is helpful in this form of gynecomastia treatment.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

Indianapolis, Indiana

Background:  One of the most bothersome facial features in late middle-aged and older men is the droopy neck or neck wattle. The skin of the jowls and neck eventually develops some sag due to its weight and loss of underlying attachments. This will be magnified in those men who have fat collections that have developed in the neck and often have a bit of a body weight issue.

The sagging neck in older men always has a significant component  of extra skin that has lost some amount of its original elasticity. This means that the best treatment is a procedure that addresses both loose skin and too much fat. The well known name for that procedure is a lower facelift or necklift. It is tremendously effective because it both removes the extra neck skin and lifts it as well. However, many men would prefer to avoid a facelift for a variety of understandable reasons including cost and recovery issues.

Short of a facelift, the only other neck treatment option is liposuction. If significant neck fat is present, liposuction will offer some improvement. The key question is how much? And does the result justify the effort? While no result can be predicted with absolute certainty, one predictor is the quality of the neck skin. Is it thick or thin? Does the neck feel tight or does it feel loose? Does it feel like there is a significant fat layer between the skin and the muscle. These are all signs that liposuction may offer a promising improvement in the profile of one’s neck.

Case Study:  A 68 year-old male wanted improvement in his hanging neck wattle. On eyeing his neck in a conversation from across the room, I initially thought that only a necklift could offer any improvement. But on examination, his neck felt very firm and the skin was taut. This indicated that there  was a fair amount of fat in the neck. This was consistent with the rest of his body being clearly overweight. Liposuction was also a good option because he was not about to undergo any form of a necklift procedure.

Under IV sedation, the neck was initially infused with a lidocaine and epinephrine solution using a small stab incision under the chin. Then a Smartlipo probe was used to treat the neck just anterior to the sternocleidomastoid muscles and down to the prominence of the thyroid cartilage with 7,500 joules of laser energy. Using a small cannula, 25cc of fat aspirate was removed by liposuction with minimal blood seen. He was dressed with a snug chin strap after the procedure.

He wore the chin strap for five days and showered daily. Even at two weeks after surgery, he had a significant improvement despite some light swelling and bruising. By six weeks after the procedure, he had his final result as the neck felt surprisingly soft although a tad tender on squeezing the skin. This tenderness went completely away by 8 weeks after surgery.

It is hard to know precisely what role laser liposuction had in getting such a good result. In my opinion, it clearly provides some benefit just hard to know whether it is significant compared to traditional liposuction alone. Heating the subcutaneous tissues of the neck prior to fat extraction seems like a beneficial step to do and may help in decreasing bruising and improving the quality of the skin retraction. While this result should not be confused with what a necklift can do, it was more than satisfactory for his expectations.

Case Highlights:

1)      The traditional approach for fixing a neck wattle in an older male is a necklift. (facelift) In some cases, liposuction may make enough of an improvement to avoid any type of skin removal or lifting.

2)      The success of liposuction in improving the sagging neck in an older male depends on the elastic quality of the neck skin and the expectations of the patient.

3)      Smartlipo (laser liposuction) offers an edge in neck liposuction by potentially improving the retraction of the overlying neck skin, which is essential to avoid skin that is loose and rippled.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

Indianapolis, Indiana

Smartlipo has become a very popular body contouring procedure that attracts the interest of many people with fat deposits that have proven refractory to their best efforts. As a technologic advance and with a very trendy name, Smartlipo does offer certain advantages in the reduction/removal of stubborn and unsightly fat. The internet is full of much information about Smartlipo, much of which is highly promotional. Having used this device for the past two years, I have consulted with many body contouring patients. From these discussions, it has become very clear that there are many myths and misconceptions about Smartlipo that merit a detailed discussion. They can be summarized into the following:

SmartLipo is not surgery. While it is a laser device, it must be inserted into the body to be effective. It is not an external treatment. It should not be confused with non-surgical fat treatments such as Zerona, Zeltiq or even Lipodissolve. It is a liposuction procedure that is associated with all of its potential risks and complications.

It is less invasive than traditional liposuction. Smartlipo is liposuction and is just as invasive as this traditional method of surgical fat removal. Whether it is a metal cannula that is being thrust back and forth through a small incision or it is a laser fiberoptic cable that is run back and forth with less obvious elbow grease, it is equally invasive and traumatic to the tissues.

Smartlipo does not use suction. While Smartlipo uses a laser to help loosen the fat tissue, it shares the need with all forms of liposuction for actual vacuuming or suctioning to remove the mobilized fat. There are some practitioners that do not suction out the fat after laser treating fatty areas, relying on the body to absorb any liquefied fat. This is not what should be done. I have seen many patients who have had such an approach and they wonder why they don’t look any different weeks to months later…or have noticed very little improvement. Smartlipo requires suctioning to be effective.

Smartlipo zaps fat cells to eliminate them. While lasers are focused light, it is not like a video game. The real objective with the laser is to heat up the treated area to a temperature that causes fat cells to break down, roughly 46 to 48 degrees C. Some fat cells do get ‘killed’ by direct contact with the laser probe but the real objective is to heat up the room, so to speak, to a temperature that the sensitive fat cells do not like.

Smartlipo effectively treats cellulite and stretch marks. It does not. There is no evidence that the heat generated from a laser improves skin irregularities or imperfections. It is a good theory and it seems like it should, but it is not a reliable outcome. I have certainly seen some patients who do have sustained improvement in the appearance of their cellulite but this should be viewed as an unexpected bonus not an assured result.

Smartlipo does not require general anesthesia. This is by far the biggest misconception and that is because it is a half-truth. It can be done under local anesthesia, and can get comparable results to liposuction performed under general anesthesia, if the area is small enough. The key is the size of the area to be treated. When multiple areas are involved, local anesthesia alone may not make it a comfortable enough experience to do a thorough fat reduction effort. It is important for patients to understand that the type of anesthesia used can affect the final result.

Smartlipo tightens loose skin. This is a true statement but it is a matter of perspective. From a scientific standpoint and based on my clinical experience, skin tightening can be achieved as measured in millimeters. (mms) A patient’s expectation, however, is viewed as in centimeters (cms) or inches. Many patients come in thinking that the inches of skin hanging over their waistline will be tightened by the laser. The hope of substantial skin tightening has many patients thinking that liposuction is the answer when some form of excisional surgery is needed as well.

Smartlipo has numerous benefits over traditional liposuction in my experience including better long-term results, less bruising, less discomfort and some small degree of skin tightening. But it is not magic and it is real surgery. It is not a lunchtime procedure and it is associated with real recovery and risks.

Dr. Barry Eppley

www.eppleyplasticsurgery.com

Indianapolis, Indiana

The technique of laser lipolysis has been one of the more well known and popular advancements in liposuction surgery in the past decade. Branded now as Smartlipo (although this is just one manufacturer), it is the addition of laser wavelengths to the liposuction process. Anytime the technology of laser is applied to any surgical procedure, many misconceptions arise from the perception of laser beams shooting and melting all in its path. This is not exactly how laser lipolysis works.

But what is it exactly and how does it really work? To understand it, one has to go back and look at how the most ancient of liposuction methods, tumescent infiltration, works and why it is still the backbone of successful results from liposuction today. By introducing fluid into a fatty tissue space, the fat cells expand due to imbibition and the surrounding fluid pressure. Once suction is introduced into this infiltrated space, fat cells actually break down (a process known as lipolysis) and whole cells, part of cells, and their free fatty acid contents can be extracted.

When laser energy is introduced into this fluid-filled fat pocket, two effects happen. First, there is the elevation of heat into the space, raising the temperature well above body temperature of 98.6 degrees F. This raised heat will cause some fat cells to open up and release their contents, not to mention those fat cells that got penetrated and exploded when the laser probe actually touched them. Second, there is the photo-acoustic effect (sound waves) from the pulsing laser energy that can also cause some fat cell breakdown. The combination does cause some overall lipolytic effects but it is not the primary mechanism of fat cell breakdown. Suctioning of the treated fat area is the main reason fat is removed, the laser lipolysis just makes the extraction process easier and more complete.

While laser lipolysis is the destructive side of the process, the effects of the laser can also be beneficial in building new tissue in the treated site. This is the result of better or accelerated collagen deposition in the healing process. Many have touted this as creating a skin tightening effect and making for faster healing. The accelerated healing part I am not so sure about, but there is something to the collagen and skin tightening effects as I have repeatedly seen it. But it will take months to see this delayed effect from healing after liposuction.

While the technology and devices that employ laser lipolysis are great, they are no better than the hands and experience of the surgeon using them. You have to have a lot of liposuction experience before you can use Smartlipo to take advantages of its benefits. Therein lies the greatest problem with laser lipolysis today. Because the devices are freely available with nothing more than a credit card and a medical license, many inexperienced practitioners are using them with little to no prior liposuction experience. This lack of training and understanding of basic liposuction effects is a major contribution to the bad results and injuries that are being seen. The allure of the technology makes it seem like it is magical and easy to do. The reality of any high-energy based device is that is actually takes more experience, not less, to reap the benefits and avoid permanent soft tissue damage.

Dr. Barry Eppley

www.eppleyplasticsurgery.com

Indianapolis, Indiana

Liposuction continues to be one of the most popular plastic surgery procedures. Due to the abundance of numerous fat sites for treatment, its widespread use shows no sign of slowing down. With this popularity has come numerous methods to improve this body reshaping process. Technologies have largely focused on more efficient methods of fat extraction by which the fat can more easily be suctioned out.

One of these new innovations has been Smartlipo or laser liposuction. Using a small probe, laser energy is delivered to the fat areas which results in its partial emulsification. Many benefits are espoused  to this approach including improved fat removal, less bruising, decreased pain, and some degree of skin tightening.

One of the benefits of Smartlipo highly touted and marketed is the ability to do the procedure under local anesthesia. The allure of having fat removed without needing to be put to sleep is understandably of great interest to potential patients…probably more to some than even whether the method is more efficient at ultimate fat removal or results in a quicker recovery.

The association of Smartlipo and local anesthesia has lead in my experience to several misconceptions about this liposuction procedure. One of the biggest perceptions that many patients have about Smartlipo is that it is a less invasive procedure than ‘regular’ liposuction. Some even believe that it is a non-invasive procedure. In reality, Smartlipo is every bit as invasive as regular liposuction. The amount of trauma that occurs under the skin is the same no matter what form of liposuction is done.

A second common misconception is that it requires less recovery than other forms of liposuction. The use of local anesthesia conveys that it is less of an operation and that there is less pain and a quicker return to activities. Some patients believe that they will be returning to their job or working out in just a day or two. This is an obvious fallacy as the degree of invasiveness with Smartlipo is no different.

Because of the promotion of local anesthesia with Smartlipo, many patients believe that they can walk in, have it done, and drive home on their own. This perception is not dissuaded by many touting it as a ‘lunchtime’ procedure or a weekend body shaping experience.

While Smartlipo can be done under local anesthesia, it is not in my opinion often the best way to do the procedure and get the best result. Local anesthesia does not allow one to be as aggressive or as thorough with the fat removal as the patient’s comfort is the limiting factor. Some practitioners will certainly say that they can do the same quality work whether the patient is awake or not. For other than small areas, this is simply not true in my experience.

Given the limitations of what can be done under local anesthesia, what is the origin and prevalence of this association with Smartlipo? While I don’t know the exact percentage, it is my perception that many laser liposuction machines in this country are not owned by plastic surgeons. A significant number are owned and operated by other medical specialities. Many do not have hospital or operating room privileges and, as a result, work within their own office. In this setting, any form of IV sedation or general anesthesia is not available. This makes the use of local anesthesia and oral sedation as the only available option. This leads to a lot of marketing and advertising, both locally and across the internet, as promoting Smartlipo under local anesthesia…and suggesting that it is both better and less invasive as a result.

What I caution patients about when considering local vs general anesthesia for Smartlipo is to remember…the operation is about fat removal and not about the anesthetic.

Dr. Barry Eppley

www.eppleyplasticsurgery.com

Indianapolis Indiana

There has been an influx of patients who have presented for treatment of secondary problems after undergoing laser liposuction. While liposuction has been around for almost 30 years, its traditional method of the manual loosening of fat has seen some recent technologic advances. One of these is the heating or melting of the fat by a laser probe prior to its vacuum extraction.

Advertised under brand names like Smartlipo™, SlimLipo™, and CoolLipo™, laser liposuction devices use a low-energy laser to melt targeted fat cells. Its touted benefits include skin tightening, reduced bruising, and quicker recovery over conventional liposuction methods. Having done a lot of Smartlipo liposuction, its benefits in my experience do include more effective fat removal and less bruising and pain afterwards. Its skin tightening effects, however, remain moderate at best. (and overstated from a patient expectation perspective)

With the emergence of laser liposuction technology has come a lot of promotional hoopla. A quick trip to the internet and with minimal searching, one can find a lot of marketing claims. The most prominent are those that revolve around how quick and easy the procedure is and, quite frankly, how much better it is than traditional liposuction. Many of these claims imply that it is better because it is less surgery. The reality is that laser liposuction is just as invasive as traditional liposuction and has all of associated risks and complications as well.

While liposuction, like any plastic surgery procedure, does not provide guaranteed results and is not free of potential complications (like unevenness or waviness) there are numerous laser liposuction patients I have seen for postoperative problems. These postoperative problems fall into two categories; lack of a significant result or change in contour and irregularities and wavy skin problems.

While plastic surgeons are certainly not immune from postoperative problems and complications, the vast majority of laser liposuction problems that I have seen have come from non-plastic surgery providers. With variable medical backgrounds and limited liposuction training and experience, it is no surprise that the potential exists for a higher rate of complications. With many doctors expanding into services they were never fully trained to perform, disappointing results are inevitable. Many people are surprised to learn that their liposuction surgeon was trained as a family doctor or internist, and simply took a weekend course to learn how to use a surgical laser to perform liposuction and body contours. While using lasers to perform liposuction may sound like a simple ‘Star Wars’ approach, the energy from these devices can drastically increase the risk of a negative result from liposuction.

Contributing to this training issue is the intentional indiscriminate sales policies of the laser liposuction manufacturers. As long as you are a licensed physician, they do not appear to care about your educational and training background. All that you need is a medical license and a valid credit card or check. This makes it possible for any physician to buy a laser liposuction machine regardless of whether they are really qualified and experienced (from a patient’s perspective) to be doing body liposuction surgery.

Without a broad scope of training and experience in body contouring, such providers are not able to perform liposuction in an accredited surgery center or hospital. This leads to laser liposuction procedures being done in office facilities under local anesthesia, which may sound appealing to patients, but may lead to suboptimal results and difficult patient experiences. Local anesthesia for liposuction is not for everyone or everyone’s fat problems.

What patients need to remember is that a device is never solely responsible for making a surgical result. The one holding and using a device is what is most important. Liposuction results are most directly tied to the surgeon’s ability and not the technology.  Above all, it’s important to choose your liposuction surgeon carefully. Don’t be swayed by special offers and discounts. All laser liposuction surgeons are not the same – even if the machines they are using may be.

Dr. Barry Eppley

www.eppleyplasticsurgery.com

Indianapolis, Indiana