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