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The most simplistic understanding of Smartlipo (laser liposuction) is that it induces thermal lipolysis. This accomplished by the direct destruction of fat cells through heat energy delivered by a fine laser probe. A secondary effect of the use of laser energy is that there is a build-up of heat throughout the treatment zone which also disrupts the walls of fat cells. (that are not directly contacted by the laser probe) This results in liquid fat being released from the broken down fat cells which can then be removed by intraoperative suction or can be absorbed and eliminated by the body days to weeks after surgery.

In reality, fewer fat cells are destroyed by the laser probe (mechanical destruction) than by the general heating process. (thermal cell destruction) The laser probe, being only 1mm in size, cannot directly contact every fat cell in the treatment area. Rather the internal tissue temperature is driven to a level that the fat cells can no longer stay intact. While normal tissue temperatures in which fat resides is around 37 degrees C, the goal in Smartlipo is to drive up the temperatures to 50 degrees C or greater. Running the laser probe around enough times in a given area will achieve high internal tissue temperatures. This is the real goal of any form of laser liposuction, collateral fat cell damage.

By bulk heating the treatment area, not only will fat cells be destroyed at the time of surgery, but the thermal damage affects cells after surgery as well. Some fat cell walls remain intact but the internal damage induces deterioration and cell death afterwards. Therefore, those fat cells will release their contents days or weeks later. This translates to the clinical effect that the final result (amount of fat loss and shaping) will take months to completely see. During the early postoperative period, the released fat (triglycerides) is taken up and removed by the body’s natural processes. This removal process is not fast and can only handle so much at a time which is why it takes such a long time to get to the final result.

A side benefit to this internal heating process is the potential for postoperative skin retraction. Much has been made of this benefit and it is real. But a patient’s perception of skin shrinkage and that of a plastic surgeon is usually quite different. To put it in a patient’s viewpoint, I would say that the amount of skin shrinkage is mild and sometimes moderate but never dramatic. In short, it will not avoid the need for a tummy tuck, for example, if a lot of loose skin exists in the stomach area.

Dr. Barry Eppley
Indianapolis, Indiana

 

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