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