Explore Plastic Surgery

Even though we are in the middle of the summer (or maybe because we are), you may have decided to get serious about getting rid of those unsightly fat areas that diet and exercise just won’t. But with different methods of fat removal available, which one is right for you? It may be tempting to think that a non-surgical method such as LipoDissolve which offers low cost and no recovery time is best, but let’s examine the facts first.
Traditional liposuction is still the gold standard to which all other methods of fat removal must be compared. Done through small incisions near where the fat is to be removed, a small thin hollow tube (cannula, about the width of a pencil or less)) is placed underand the dislodg the skin. By moving the cannula back and forth, fat is dislodged and the vacuum to which the cannula is attached removes the loose fat. This is the preferred method among board certified plastic surgeons for removing larger amounts of fat tissue and has been used in the United States for almost thirty years.All liposuction today is done with the tumescent or wet technique which keeps blood loss to only about 1% of the total fat removed. Liposuctioned fat volumes removed today are kept around five or six liters in a single operation to keep the risk of complications low. Serious side effects with liposuction are very rare. The most common problem with liposuction is skin irregularities but this problem is kept limited when done by skilled and experienced hands. Very good results can be obtained in the neck, stomach, waistline, outer thighs, and knees. More modest results are seen in the arms, back, inner thighs, and buttocks.
Liposuction done with the aid of a laser, also known as Smart Lipo, is one of the newer FDA-approved types of liposuction. A laser is inserted through tiny incisions in the skin. When the laser is fired, it melts the fat purportably tightening the skin at the same time. Smart Lipo has not been proven to produce better results than traditional liposuction but may be an alternative for removing smaller fat areas. This is certainly the way it is currently being sold, particularly to non-plastic surgeons which make up a significant percent of the targeted market. Because the removed fat volume is more limited, serious side effects are unlikely. The real question in my mind is whether Smart Lipo can help perform smaller liposuction procedures under local anesthesia in the office setting. This is where it would offer an advantage over traditional liposuction.
Lipodissolve, also known as injection lipolysis, uses a mixture of emulsifying chemicals (lecithin and cholic acid) which are injected under the skin to the targeted fat areas. This is a non-FDA approved treatment method although in my experience has proven to be safe. I have not seen any of the complications that are widely reported. Lipodissolve is certainly not a replacement or alternative to liposuction. It is best viewed as a fat removal technique when any form of liposuction is a bigger solution than the problem justifies. It is done as a series of injection done in the office over three or four months.I have found that it works well for small fat areas in the neck, jowls, bra rolls, stomach, flanks, thighs, and knees. The emphasis here is on the concept of small fat area, geernally no bigger than the size of my hand. The biggest issue with liposuction is whether the results, and time to get them, justify the cost. It is also a great method to touch-up any excess areas of fat after a liposuction procedure.
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

Advancements in methods of fat removal by liposuction continue to change and be ‘improved’. One of the most noteworthy methods that is currently marketed and touted is laser liposuction, or more accurately, laser-assisted liposuction. As opposed to the traditional technique of cannula insertion, eating up the fat tissue, and then sucking it out, the mechanical beat-up is replaced by laser energy. A laser fiber is inside the liposuction cannula which delivers heat to the fat cells, thus breaking them down inito a more liquid state making it easier to be sucked up the cannula. In theory, the heat from the laser also causes the overlying skin to tighten.

As of this date, there are three such laser-assisted liposuction systems available in the U.S. They are under the marketed tradenames of SMARTLIPO (Cynosure), COOLLIPO (CoolTouch), and PROLIPO (Sctiton). All of them tout more effective fat removal, less bruising and swelling, a faster recovery, and skin tightening.

The real question is….are they really better than traditional liposuction…and are there increased costs over traditional liposuction worth it? (someone has to pay for the equipment purchase…and that is you the patient!) To date, they remain tremendously appealing, particularly to the general public. Historically, any treatment associated with the word, laser, always causes mass patient allure. No clinical trials have yet been reported, that I have seen, that have ever directly compared any laser-assisted vs traditional liposuction procedure. Nor has any large clinical trial been done that even compares two differently-treated patient groups, no matter how impossible it really is to ‘match’ patients from different groups.

Much like ultrasonic-assisted liposuction when it was introduced 10 years ago, laser-assisted liposuction may be a popular trend that, in the end, will fare no better. It will undoubtably have its place in liposuction options and armamentarium but I doubt if it is magic and offers a quantum leap in patient outcomes and recovery times. It may offer some improvement in fat removal efficiency, but I am truly dubious of overall better outcomes, a much better and faster recovery, and skin tightening (of which I remain the most skeptical)

I am all for any form of advancement in liposuction, which is a fairly traumatic procedure on the tissues. While effective, liposuction is still one of the most ‘brutal’ procedures that we as plastic surgeons do. Is laser-assted liposuction a real improvement…ask me again in 5 years!

Dr Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.eppleyliposuction.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis