Smartlipo, also known as laser liposuction or laser lipolysis, is the newest development in liposuction technology for getting rid of unwanted fat. The concept of using laser energy to literally melt fat makes an otherwise traumatic procedure a little more ‘gentler’, but allowing the heat to replace some of the ‘elbow grease’ used in the past. Patients definitely do report less pain and bruising after a Smartlipo procedure.
Smartlipo is often advertised as being capable of being done under local anesthesia and this, for many patients, is an additional attraction point. But it is important to remember that one of the primary goals of any surgical procedure is…comfort first and foremost. Not only from the experience of the patient’s perspective but also in allowing the plastic surgeon to perform the procedure as completely and thoroughly as possible so the patient can get the best result. There is a delicate balance between these goals and you never want to compromise results exclusively because of comfort…unless that a decision that the patient has made.
Small fat areas can definitely be done with Smartlipo under local anesthesia. I like to think of each treated area as a region. Two and sometimes three regions can be done under local anesthesia if they are not too large. But never more than three and I usually prefer only two regions. More than three regions, or any region if it is large, should be done under IV sedation or general anesthesia. It is simply a matter of comfort and being able to get off as much fat as is possible. Examples of areas that can be comfortably done under local anesthesia would include the lower abdomen, bilateral flanks and hips, the neck, the outer thighs, small inner thigh regions, and the knees….provided they were done in isolation, keeping to the two region rule.
Another practical reason for this approach is to consider the cost of the procedure. While using an anesthesiologist is an expense, liposuction can be done faster when the patient is asleep and the issue of comfort is removed from consideration. While more than three regions can be done under local anesthesia, it takes at least twice or three times as long and one must consider the expense of using the operating room or the doctor’s procedure facility. While cost varies greatly around the country, you may not be saving money by doing a procedure under local anesthesia that takes considerably longer than one that can be accomplished in a much shorter time under general anesthesia.
Another option for a large number of fat regions, if one is determined to do the procedure under local anesthesia, is to do it in stages. Break down the assignment into a series of small procedures. Or do all of your fat concerns in one setting under general anesthesia.
Dr. Barry Eppley
Indianapolis, Indiana