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Dr. Barry Eppley

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Double Board-Certified Plastic
Surgeon Dr. Barry Eppley

Posts Tagged ‘smartlipo’

The Importance of Skin Elasticity in Liposuction

Saturday, January 3rd, 2015


Liposuction is the ‘largest’ cosmetic procedure performed around the world if it is rated based on surface area alone. It is certainly by sheer numbers one of the top five aesthetic body procedures performed every year as shown by annual statistics. But the extent of the surface area it treats is what really distinguishes liposuction from any other plastic surgery where tissues are excised (e.g., tummy tuck)

But because it does not remove loose skin, the body contouring effects of liposuction rely upon a phenomenon created by the often large underlying surface area that it treats…skin retraction. Once some of the underlying fat is removed, there is actual skin excess. It is important that this skin shrink down to create an optimal contour reduction result. The shrinkage of the skin is primarily important to reflect the volume of tissue that has been removed. But it is secondarily important to help make the skin surface smooth.

Smartlipo Abdominal Liposuction result front view Dr Barry Eppley IndianapolisIt is the skin’s retractive ability that is important to a satisfying liposuction result. And this is often a physical characteristic patients overlook or hope that it won’t have a big impact on their result. Many times patients, understandably, want to avoid an excisional procedure like a tummy tuck or an arm lift to achieve a contour change. But a smaller contour that has a lot of skin irregularities and unevenness may be less appealing that a fuller contour that has a very smooth skin surface.

Smartlpo Abdominal Liposuction result side view Dr Barry Eppley IndianapolisSkin that does not respond well to the effects of liposuction is either damaged or aged. Women that have a lot of stretch marks around the belly button and lower abdomen is the classic example of lost skin elasticity. Older women, usually around age 60 and older, have skin that is thinner with almost equally poor retractive capability even if no stretch marks are present. Conversely men usually not have the same skin retraction problems, not because they do not get pregnant which helps, but because their skin is thicker and often has hair. (which ensures a greater number of elastic fibers)

When liposuction is done on skin of poor retraction potential, it is important that patients understand the trade-offs. Deflated looking skin is often the result. And while many new energy-based liposuction technologies exist, none of them have a magical ability to create a substantially improved retraction of the skin…despite how they marketed and promoted.

Dr. Barry Eppley

Indianapolis, Indiana

Understanding The Array of Liposuction Technologies

Monday, February 11th, 2013


Liposuction is one of the most commonly performed body contouring procedures done around the world. It is unique from all other plastic surgery procedures in that there are no significant incisions and putting tissues back together by suturing is a trivial part of the operation and has no impact on the final result. It is a blind procedure whose results are determined by the use of combined tactile and visual feedback as the fat is removed. Yet patients understandably desire and expect a precise sculpting outcome.

One of the main driving issues to raising patient expectations from generalized liposuction to a liposculpting standard has been the plethora of technologies now available to do it. Whatever the benefits of these liposuction technologies may be, their cost and generalized practice competition has led to considerable marketing efforts to promote them. This has led to patients wondering which one is better for their particular contour concerns.

One of the first laser technologies to emerge was the application of ultrasonic energy. Originally called Liposonix and now Vaser, the ultrasound produces both heat and cavitation that breaks up fat. This allows it to be removed easier. The heat that is generated has collagen stimulation and skin tightening effects. This development was followed by the application of laser energy through fiberoptic cables to create laser-assisted liposuction, most popularly known as Smartlipo. The laser energy creates a zone of heat which raises the temperature of the treated area above 45 degrees C, a temperature that breaks down fat cells. The generated heat also has some skin tightening effects. Power-assisted liposuction, known as PAL, works by reciprocating the cannula back and forth hundreds of times a minute. This reduces the workload for the surgeon and less traumatic for the patient. More recently Hydrasolve lipoplasty speeds fat extraction through the use of a pressurized stream of heated saline inside the liposuction cannula which generates enough heat to liquefy fat as it enters into it.

When a prospective patient reads articles or see advertisements for all of these various liposuction technologies, it is understandable why they would be confused. Each has similar claims/benefits that revolve around easier and more efficient fat removal, faster recovery and the ability to create some degree of skin tightening. As is human nature, the latest technology always seems or promises to be better than whatever came before.

Since there are no prospective comparative studies between any of these liposuction technologies that exist, or will likely ever be done, there is no scientific evidence that one is better than the other. Plastic surgeons may prefer or feel more comfortable with one particular technology, and that is extremely important, but that is not an endorsement of its potential superiority. The most important criteria in any liposuction procedure is the skill and experience of the surgeon in whose hands might be a certain liposuction instrument or machine. Technology will not make up for poor judgment or skill but does have the potential to make good results even better.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Smartlipo of the Waistline

Thursday, August 25th, 2011

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

Indianapolis, Indiana

Case Study: Secondary Liposuction After Tummy Tuck Surgery

Sunday, April 24th, 2011

Background:  Tummy tucks, or an abdominoplasty, is one of the successfully proven methods of abdominal and waistline contouring. The foundation of a tummy tuck is the removal of a segment of loose skin and fat, a horizontal ellipse that is taken out below (mini-tummy tuck) or above the umbilicus. (full tummy tuck) Other adjunctive techniques that contribute to the final result of a tummy tuck include rectus muscle plication and liposuction.

Liposuction is an important part of a tummy tuck and is used in almost all cases. Liposuction can reach fat areas that lie beyond the excision and pull of the abdominal tissue that is removed. Few patients that need an abdominoplasty don’t have fat bulges in adjoining areas. One very common area of fat excess is in the upper abdominal area between the belly button and the bottom of the rib cage. This is outside of the area of the skin and fat that is cut out and can have quite a thick fat layer. Some of this thickness is thinned out as the skin is pulled down from below. But this initial fat thickness is the reason some tummy tuck patients have a residual upper abdominal bulge that is not as flat as the lower abdomen after surgery.

Some plastic surgeons will liposuction the upper abdomen during a tummy tuck to thin it out while others will not for fear of impairing the blood supply to the healing skin and incision below. My preferred approach is the latter as necrosis of the lower skin flap, while uncommon, is a nightmare for all involved should it occur.

The long-term results of most tummy tucks are based on how successful one is at keeping fat from re-accumulating and thickening the skin flaps and the contour of the waistline. Unless a woman gets pregnant after a tummy tuck, skin excess will not be recreated.   

Case Study: This is a 48 year-old female who had a full tummy tuck over 6 years ago. As she has gotten older and gone through menopause, she felt she had gotten ‘thicker’ though the waistline and abdominal area. She wanted to redefine her waistline again through liposuction and become overall more sculpted again.

Smartlipo was used to perform her liposuction due to the anticipation that she would have some scar from her prior surgery. Her entire upper and lower abdomen and her flanks into her back were initially treated with 30,000 joules of energy prior to suctioning. A total of 2,200cc of aspirate was obtained which was more than I would have thought going into the procedure.

After three weeks most of her swelling and the little bit of bruising which had occurred was largely gone. Her recovery from her secondary liposuction compared to her original tummy tuck was in her estimation a ‘1’ compared to the first ‘10’.

Every patient who undergoes a tummy tuck should be aware that secondary liposuction may be desired. Whether it is to thin out a still full upper abdominal area or to take down fat reaccumulations years later, touchups or revisions using liposuction can be beneficial I preoperatively advise all of my patients of this potential reality. While a tummy tuck is a great procedure, it is not always perfect nor is it always completely permanent.

Case Highlights:

1)      Tummy tucks produce significant changes in the contour of the abdomen and around the waistline. Having a completely flat abdomen, particularly the upper part, may not always be possible given the thickness of fat tissue in this part of the abdominal skin flap.


2)      The residual thickness of fat in the upper abdomen or the accumulation of fat with weight gain after a tummy tuck, even years later, can mar a well-defined waistline and abdominal shape.


3)      Liposuction may be needed after a tummy tuck as a secondary procedure to thin out the abdominal skin flap to obtain optimal contouring or may need to be much later to restore the previous shape of a tummy tuck from fat re-accumulation.

Dr. Barry Eppley

Indianapolis, Indiana

Smartlipo, Laser Lipolysis and Why It Can Produce Better Liposuction Results

Wednesday, March 23rd, 2011

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

Indianapolis, Indiana

Complications from Laser Liposuction (Smartlipo)

Wednesday, January 5th, 2011

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

Indianapolis, Indiana

Smartlipo Treatment of Axillary Hyperhidrosis

Monday, April 26th, 2010

While many people regularly sweat during exercise and exposure to high heat conditions, there are some people that do so under completely normal conditions. It is estimated that about 1% of the American population suffers from such excessive sweating known as axillary hyperhidrosis. It is both a source of embarrassment and clothing inconvenience.

While mild cases of axillary hyperhidrosis responds to strong antiperspirants, more significant and persistent conditions require other forms of treatment. The well known neurologic injections of Botox and Dysport  provide profound and sustained reduction in axillary sweating. The injection treatments are quick to do but not inexpensive, often ranging in cost of between $750 to $1,000 for treatment of both armpits. While the results are temporary and must be repeated to be sustained, they will often last for up to one year.

Numerous surgical approaches have been advocated over the years, all of which try to destroy the offending sweat glands which are largely situated underneath and around the axillary hair follicles. No single technique has been shown to be consistently effective. But the use of  heat (thermal destruction) is a logical method to permanently damage the sweat glands and hair follicles. The issue has always been how to deliver the heat to the underside of the skin without creating a full-thickness burn to the skin.

The use of laser liposuction (Smartlipo) is now a well accepted and effective method of liposuction. By introducing a small 1mm fiberoptic probe under the skin, heat energy is delivered to the fatty target tissues. When the laser probe is under the skin, it may not look like it is doing much but feeling the outer skin will soon dispel that perception. The tip of the laser probe can deliver a very significant amount of heat. While the tip energy is not as much as an electrocautery, it is still significant enough to thermally damage whatever it contacts.

The use of Smartlipo can be used in the treatment of axillary hyperhidrosis through the introduction of the laser probe. Running the probe underneath the axillary skin delivers heat exactly where the glands lie, causing either their vaporization and disruption of the ducts up into the skin.While complete elimination of sweating may not occur, reduction is significant and is reportedly maintained for up to several years after a single treatment. Using power settings of 30 watts with wavelengths blends of 1064nm and 1360nm, a high amount of heat can be selectively delivered.

This treatment can be done under local anesthesia or IV sedation, whichever the patient prefers. There are no dressings and any special care needed afterwards. The armpits will be a little sore and tender for a few days but there are no physical restrictions. One can return to work the following day in most cases. Very physical jobs may require a few days until the axillary soreness improves. I have seen a few partial skin burns which appear as blisters the following day. These will go on and heal on their own uneventfully. While on the one hand I don’t like to see blistering, those healed blistered areas will likely never sweat again.

The use of the Smartlipo laser probe  is a more contemporary approach to the concept of subdermal shaving in the treatment of axillary hyperhidrosis.

Dr. Barry Eppley

Indianapolis, Indiana

Common Questions about Liposuction Surgery

Friday, January 22nd, 2010

1.      How much weight should I lose before having liposuction?


Ideally, liposuction is best used as a ‘spot’ treatment for resistant areas of fat. This would imply that one should be near to what they consider to be their ideal body weight. On a more practical basis, one’s weight should be down to what can be achieved with a reasonable effort.


The ‘weight loss before liposuction’ approach is best for two reasons. First, the amount of liposuction needed will be less…and less surgery of any kind is always better than more. Secondly and most importantly, the losing weight process allows one to have made lifestyle changes before surgery. The effort to do so and the induced lifestyle changes provide for a better chance that the liposuction results will be longer lasting.


Conversely, I have seen a few patients who have taken the opposite approach. They were interested in having liposuction as a starter method to their weight loss program. While the immediate results seen after liposuction can be initially stimulating, long-term diet and exercise changes may or may not follow. This is a more risky and less certain approach to good long-term results. Plus, more liposuction surgery is needed in a patient who is not in as good as shape as someone who has better prepared their body for recovery and healing.


2.      What Alternatives Are There to Liposuction?


Localized or spot fat reduction has been touted with a variety of non-surgical methods. Dissolving fat with injections, often called Lipodissolve, has been widely marketed over the past few years but has lose much of its appeal recently. Besides being a non-FDA approved injection method, it produces only very mild fat reduction and does so very inefficiently…requiring months of injection sessions resulting in a week of swelling afterwards each time.


The more recent non-surgical method is Zerona. Using low energy external laser sessions, combined with daily water intake and oral niacin supplements, inches are promised to be lost around one’s mid-section. This is relatively new and widespread clinical use is just beginning. W e will know in a few years if this will go the way of other hyped non-surgical weight loss devices and techniques or will find a long-term niche as a viable method of localized fat reduction.


3.      What type of liposuction is the best?


There are numerous liposuction devices currently available such as ultrasonic, laser (hot), and water jet (cool)devices. With these methods comes the associated marketing and hype that is associated with the manufacturers as well as endorsements by surgeons. In addition, because some of these devices are new, they are promoted as the latest and the greatest.


What all these liposuction technologies share is that they are used for the first phase of the surgical process…loosening up the fat…which is then suctioned out as the second phase. Whether anyone of these methods is better than another can be debated but no one can conclusively prove that one is better than another. The reason is that the technology is only as effective as the surgeon who is using it.


The role of the surgeon in performing liposuction is so important that any technology can produce great or poor results based on how well and carefully it is used. The most important element in liposuction, therefore, is the surgeon’s experience and familiarity with whatever approach they use.


The current use of Snartlipo (laser-assisted liposuction) has a three or four year history of widespread clinical use. While just a promising tool a few years ago, today’s units have higher powers, temperature monitoring, and multiple wavelengths. The very sensitive nature of fat cells to heat makes this technology the most theoretically appealing.


4.      How type of anesthesia is used for liposuction?


Liposuction can be done under every conceivable method of anesthesia, from local, sedation, or general anesthesia. But what can be done with each type of anesthedia is different. And the time and costs to do it are also affected.


Local anesthesia, using tumescent or Hunstad infiltration, works well for smaller areas of fat removal. It is not an effective method for larger areas of fat reduction on multiple body areas. For this reason, some perform liposuction in stages for larger areas while others do all areas at once under a general anesthetic.


Sedation is used as a supplement to local anesthesia and helps reduce anxiety that comes from the longer times that the use of local anesthesia requires. It is given by pills an hour or so prior to the procedure or through an IV at the time of surgery.


Which type of anesthesia is best for your liposuction procedure depends on a lot factors including extent of the procedure, your level of anxiety about surgery and anesthesia, the time you have to recover, and the surgeon’s background and experience.


5.      How much pain is there after liposuction?


The trauma induced to the tissues from liposuction is not pain-free. While how much liposuction you are having and your own pain tolerance influences the level of discomfort, you should prepare yourself for more recovery time than you think. Patients are naturally very optimistic as to how well they will do after any surgery and how quickly they will return to normal. I would not anticipate that it will take twice as long as you think to feel close to normal. This does not mean that you will be incapacitated or bed-ridden, just that you will feel more sore and be slowed down more significantly than you think.


6.      Are liposuction results permanent?


One of the common myths is that once fat is removed, it can not come back. As patients often say, ‘I have heard that once fat cells are removed, they can not return.’


This perception is false for two reasons. First, not all fat cells are removed from any area that is suctioned. That is not only impossible but unaesthetically undesireable. There needs to be a certain layer of fat between the skin and the muscles so the skin is not stuck down and tethered. Secondly, stem cells exist in fat which always have the potential to turn into fat cells if properly stimulated. Excess food intake and the need for fat storage is just the stimulus for fat re-accumulation.


The best answer is that the long-term results from liposuction are stable if your weight remains fairly stable. If you gain weight of any significance (greater than five pounds), it has to go somewhere and that will likely be from whence it was originally removed.


7.      How much time should I allow for recovery before going on vacation or a trip?


It is quite common that I see patients who have a trip or vacation planned and want to do some body shaping before they go. The biggest mistake is to not give enough time for a ‘full recovery’. You don’t want to go on a well planned and long thought out trip only to still be sore or limited in what you can do and enjoy. Depending on the number of body areas and amount of liposuction, I would allow for at least six to eight weeks (as a minimum) before leaving. Three months is most ideal.


There are also some patients who want to use a trip to recover and their intent is to go and lay around somewhere. In this case, I would recommend one week before you leave.

Dr. Barry Eppley

Indianapolis, Indiana

Smartlipo and Liposuction on Indianapolis Doc Chat Radio Show

Sunday, November 29th, 2009

SmartLipo is the newest innovation in liposuction surgery. It is a method that offers the best results with less trauma and less downtime. It has a fast recovery time and the cost is competitive to other liposuction methods. SmartLipo uses laser technology to melt and liquefy fat. Because of the heat from the laser, it can also smooth and tighten skin which other methods of liposuction can not do. It can be used to treat smaller areas of fat, such as below the chin, or for larger areas of fat such as in the abdomen, flanks and thighs.

Smartlipo still requires the use of the tumescent technique. Tumescence is performed by instilling dilute solutions of lidocaine and epinephrine into the fatty areas to be treated. This fluid not only numbs the areas to be treated but also decreases any bleeding which can occur. With the use of tumescence and Smartlipo, some smaller fat removal procedures can be performed without a general anesthetic.

SmartLipo was the first laser to be approved by the FDA to be used for fat dissolution and removal with tumescent liposuction. Introduced in 2007, this laser technology utilizes a combination of 1064 and 1319 wave lengths to burst fat cells and coagulate blood vessels. The energy created by the laser increases internal tissue temperatures significantly which are monitored by a probe so that they do not get too high and burn tissues. It is this heat which is created that helps tighten skin from the underside during the procedure.

 Free liposuction  and Smartlipo consultations can be arranged by calling Dr. Eppley at IU Health North or IU Health West Hospitals at 317-706-4444 or sending an email inquiry to: info@eppleyplasticsurgery.com.

Smartlipo and Local Anesthesia

Sunday, November 29th, 2009

Smartlipo, or laser-assisted liposuction, is a significant advance in fat removal technology. Using heat to liquefy fatty deposits provides a more effective means of mobilizing and evacuating unwanted body contours. Based on advertisements and promotions which is widespread across the internet and in local markets, Smartlipo is almost synonymous with the use of local anesthesia. Patients frequently come in with the expectation that whatever fat they want removed can be done without the use of any form of anesthesia.

First and foremost, why is Smartlipo so highly associated with being done under local anesthesia? Does the laser make it less painful to do? The answer is no. There is nothing magical about the use of a laser for reducing pain. It is not a surgical light wand that melts fat while making the tissues numb along the way. The heat from the laser is quite painful as you might expect from something that is hot. It does require some form of anesthesia to use just like any surgical procedure.

The association of Smartlipo and local anesthesia, in my opinion, is largely because of the makeup of the providers. While I have no idea as to exact numbers, I would predict that the majority of Smartlipo providers are non-plastic surgeons. That is not a knock on any physician who provides liposuction services as, quite frankly, that issue is immaterial to me. Nor is that a negative on the manufacturer, they are merely providing equipment to the broadest market as possible. But non-plastic surgeons can not usually get surgical privileges in hospitals or many surgery centers. Therefore, they are forced in most cases to do the procedures in their own office setting where IV sedation or general anesthesia is not available.

The choice of whether you do Smartlipo under local or other form of anesthesia is a decision between you and your liposuction provider. But not all Smartlipo can be done under local anesthesia. The use of local anesthesia is certainly a big draw for patients and it does result in no anesthetic-related recovery. But local anesthesia also limits how much liposuction can be done in a single setting and the time it takes to do it.

 For smaller areas of Smartlipo, such as the neck, arms, or lower abdomen, I find the use of local anesthesia a good choice as the size of the problem allows an effective and pain-free procedure to be done. But when you get into larger areas or more extensive fat removal volumes, the use of local anesthesia is not enough. It becomes an inefficient process and limits what can be done. One could do multiple areas of fat removal under local anesthesia in stages. But the thought of numerous procedures can tip the balance towards choosing a general anesthetic where larger fat volumes and multiple areas can be more efficiently done.

The use of Smartlipo does not mean a liposuction procedure can or should be done under local anesthesia. It merely indicates that certain areas of fat removal can be effectively done without being put to sleep. Whether your Smartlipo treatment areas are amenable to local anesthesia or need a different type of anesthesia is an important issue to discuss in your presurgical consultation.  

Dr. Barry Eppley

Indianapolis, Indiana





Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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We offer discounts on plastic surgery to our United States Armed Forces.

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