Smartlipo, or laser liposuction, is touted to have the dual effect of fat removal and skin tightening. There are considerable discussions and debates on the internet, plastic surgery meetings, as well as other venues about whether this claim of skin tightening is real and can be verified.
While much ongoing clinical and scientific work is being done to evaluate the skin tightening claims, compelling scientific evidence that is independently verified does not yet exist. This in no way means that the skin tightening effects are not real, but the technology is a little ahead of the science which is very common in new medical advances. Very often definitive scientific evidence follows years of being on the market. This may not be what the public wants to hear, but is far more common than not. This is particularly true when the end point of evaluation is difficult to measure. That would certainly apply to skin tightening which is about as difficult to measure in humans as pain. There are so many variables in each patient (amount of fat, type of skin, amount of skin elasticity, presence of stretch marks, etc), and even amongst skin areas in the same patient, that measuring how much skin has contracted is not easy.
While the debates about skin tightening with Smartlipo will not be settled soon, the more important issue is how patients perceive skin tightening…which is often overlooked. In my observation, patients either have concerns that their skin will not tighten enough or that it will tighten up just fine. Either way, patients are not good estimators in many cases of how their skin will respond to liposuction. Suffice it to say, they are often optimists or overly hopeful about their contouring outcomes. That is why seeing an experienced plastic surgeon who has all options available to properly diagnose and treat one’s ‘fat problem’ can avoid loose skin issues after.
While the marketing claims of Smartlipo will eventually be defined (and I believe they will validate that a skin tightening effect is real even over one’s natural skin contractility), the device is not magic nor is it a scalpel. It still requires a skilled eye to determine the candidacy of any patient and properly managing their expectations. It would not be surprising that some of the disappointing results that one reads about on the internet are a selection issue and not a primary problem of device capability.
On a practical basis, it is difficult to imagine that the heat generated by Smartlipo in the subcutaneous space does not provide better skin contraction than non-thermal liposuction. However, substantial skin contraction (to the level that some patient’s anticipate or hope for) requires a dermal burn injury that would result in undesireable scar contracture. It is not a question for me as to whether Smartlipo provides a skin tightening effect, it is question of how clinically significant it is over traditional liposuction.
Dr. Barry Eppley
Indianapolis, Indiana