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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

Indianapolis, Indiana

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