Liposuction continues to be one of the most popular plastic surgery procedures. Due to the abundance of numerous fat sites for treatment, its widespread use shows no sign of slowing down. With this popularity has come numerous methods to improve this body reshaping process. Technologies have largely focused on more efficient methods of fat extraction by which the fat can more easily be suctioned out.
One of these new innovations has been Smartlipo or laser liposuction. Using a small probe, laser energy is delivered to the fat areas which results in its partial emulsification. Many benefits are espoused to this approach including improved fat removal, less bruising, decreased pain, and some degree of skin tightening.
One of the benefits of Smartlipo highly touted and marketed is the ability to do the procedure under local anesthesia. The allure of having fat removed without needing to be put to sleep is understandably of great interest to potential patients…probably more to some than even whether the method is more efficient at ultimate fat removal or results in a quicker recovery.
The association of Smartlipo and local anesthesia has lead in my experience to several misconceptions about this liposuction procedure. One of the biggest perceptions that many patients have about Smartlipo is that it is a less invasive procedure than ‘regular’ liposuction. Some even believe that it is a non-invasive procedure. In reality, Smartlipo is every bit as invasive as regular liposuction. The amount of trauma that occurs under the skin is the same no matter what form of liposuction is done.
A second common misconception is that it requires less recovery than other forms of liposuction. The use of local anesthesia conveys that it is less of an operation and that there is less pain and a quicker return to activities. Some patients believe that they will be returning to their job or working out in just a day or two. This is an obvious fallacy as the degree of invasiveness with Smartlipo is no different.
Because of the promotion of local anesthesia with Smartlipo, many patients believe that they can walk in, have it done, and drive home on their own. This perception is not dissuaded by many touting it as a ‘lunchtime’ procedure or a weekend body shaping experience.
While Smartlipo can be done under local anesthesia, it is not in my opinion often the best way to do the procedure and get the best result. Local anesthesia does not allow one to be as aggressive or as thorough with the fat removal as the patient’s comfort is the limiting factor. Some practitioners will certainly say that they can do the same quality work whether the patient is awake or not. For other than small areas, this is simply not true in my experience.
Given the limitations of what can be done under local anesthesia, what is the origin and prevalence of this association with Smartlipo? While I don’t know the exact percentage, it is my perception that many laser liposuction machines in this country are not owned by plastic surgeons. A significant number are owned and operated by other medical specialities. Many do not have hospital or operating room privileges and, as a result, work within their own office. In this setting, any form of IV sedation or general anesthesia is not available. This makes the use of local anesthesia and oral sedation as the only available option. This leads to a lot of marketing and advertising, both locally and across the internet, as promoting Smartlipo under local anesthesia…and suggesting that it is both better and less invasive as a result.
What I caution patients about when considering local vs general anesthesia for Smartlipo is to remember…the operation is about fat removal and not about the anesthetic.
Dr. Barry Eppley
Indianapolis Indiana