I have been to two doctors, one wants to do smart lipo and one is a plastic surgeon and said smart lipo is not as good and performs only traditional liposuctions. How can I decide which is the best choice?
Liposuction Vs. SmartLipo ~ Which is Better?
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SmartLipo vs Liposuction: SmartLipo has advantages for the right patient.
The question of whether SmartLipo is better than Liposuction has been a topic of much debate but I can say confidently that it is NOT just a marketing tool and can offer advantages to patients compared to liposuction alone. As with any procedure patient selection is paramount to having good results, no procedure is right for every individual.
I have been doing Liposuction for almost 17 years and SmartLipo for 7 years and ahve seen the technology go through now 7 generations of change ending now with the SmartLipo TriPlex with Cellulaze. When SmartLipo was first FDA approved in November, 2006 it was a single laser, low energy system that worked well but did not always give the expected tightening. This was do to the misunderstanding that it was not the amount of energy delivered to the tissues but rather the temperature achieved that determined final outcome. Dr. DiBernardo and Dr. Katz published a number of articles showing improved tightening skin tightening with SmartLipo compared to Liposuction alone supporting these statements.
The SmartLipo TriPlex uses 3 high powered lasers to melt fat, coagulate blood vessels and tighten skin in the areas being treated. The improved skin tightening seen with the laser may also reduce the need for additional more invasive skin reducing procedures. This then allows improved results, especially in areas of greater skin laxity like the neck, arms, inner thighs, as well as excellent results in all areas.
The take home message is that in the right patient SmartLipo can definately improve patient outcome. Whether or not that is you lies in the knowledge and experience of the surgeon you choose.
Is Smart Lipo better than Liposuction?
Your outcome and safety depend on finding a Board Certified Plastic Surgeon- NOT on the machine used...
There is an abundance of information on this question already available on RealSelf, and I highly recommend you read as much of it as you can. A pattern will quickly appear to you.
In general, you should be very worried when any professional spends their time and energy telling you why the machine they are going to use is so important to your outcome.
Think about how silly this is... If you went to see an architect or lawyer and they told you they were your best choice because they had the best book or computer program, or a hair stylist who told you they were the best because they had great scissors, you would probably laugh... just before leaving.
This is really no different- please do not allow yourself to believe that the machine is what is going to keep you safe or give you the beautiful outcome you dream of.
Here's the low-down:
Tumescent liposuction, VASER Lipo, Smart Lipo, Cool lipo, Pro Lipo, Slim Lipo, Water Jet lipo...
What does this all mean? If I don't get Smart lipo does that mean I'm dumb? If my surgeon recommends Slim Lipo does that mean he/she isn't a "Pro"? It truly is a ridiculous situation we have come to with regard to liposuction and the number of people trying to cash in on America's desire to be rid of its collective fat.
In well motivated patients, body contour improvement can be a very healthy endeavor, but how is an otherwise intelligent and well-adjusted person to know the difference between a responsible provider of aesthetic services offering them safe options for help with their body contour and a poorly trained and inexperienced provider more interested in their wallet than in your outcome and safety?
It is first important to realize that all of these devices will require you to undergo a liposuction procedure. The only difference is the approach to the treatment of the fat prior to its removal.
Because they all involve liposuction, and this is in fact a surgical procedure, it is very important that you "do your homework" and find a surgeon certified by The American Board of Plastic Surgery who has the years of training in liposuction necessary to give you the safe experience and superior outcome you deserve and desire. Behind the amazing number of machines now available to remove your fat, there has followed an army of their sales representatives and an equally impressive number of providers marketing themselves as "liposuction experts".
What has made them "liposuction experts"? In almost all cases, a few days or weekends training with the salesman for the device or with someone more experienced in the procedure. It is their promise that if you have the device in their possession brought to bear on your behalf, your fat will be gone, your skin will miraculously shrink away, you won't need any anesthesia because the device allows painless removal of the fat, and it can be done on your lunch hour. The only thing I am surprised by at this point is that they don't promise you'll get rich and be more sexually alluring after the procedure too.
Selling the particular device to patients is not unlike someone saying to you that because they will give you access to Tony Stewart's racing car that you will be able to win this weekend's race and make a million dollars. Tony Stewart wins races because he is a great racing car driver AND he has a great car...This is no different.
Getting the best outcome from a body contouring procedure depends most on finding a well-qualified and experienced surgeon, and much less on the device used.
Most of these people are so aggressive in their marketing of these questionable devices because they are, in fact, not trained plastic surgeons but rather are either not physicians at all, or they are doctors with core training which would not have prepared them to do liposuction. Many have read recently about a death in my home state of Florida after a healthy 40ish year old mother had liposuction performed by a rehabilitation medicine doctor. Amazingly, I know of eye doctors (!!) doing liposuction as well- and yes, they market themselves as "liposuction experts".
The particular device used can affect the overall experience, however.
Despite the claims of the manufacturer and the practitioners who plunked down the large sum the device costs, Smartlipo has never been proven to shrink skin better than tumescent liposuction. SmartLipo, SlimLipo, Prolipo, and Coolipo all use a laser to destroy the fat cells, allowing them to be removed by liposuction. My problem with these is that, first of all, as a scientist and doctor I am offended when false claims of benefit are made, and that because the lasers will burn whatever you point them at, I worry that your nerves, blood vessels, muscles, and skin may be injured by the laser.
Bottom line (and in my opinion) -- there is no benefit to these devices, they are expensive (meaning that the cost to you, the patient, will be higher as well), and the risks are higher.
Tumescent liposuction is the gold standard to which all other techniques must be compared. It has been proven to be safe and effective over many years (provided that it is performed by a well-trained surgeon). It involves the injection of a fluid into the fatty tissue layer that causes blood vessels to shrink and the fat to expand, making it easier to remove and lowering the risk of a complication.
VASER lipo involves an additional step, in which the fat (after injection of fluid but before suction is applied) is treated with ultrasound energy. Unlike the laser filaments used in SmartLipo and the other devices mentioned above, the VASER probe is blunt and the ultrasound energy it uses is much more specific for fat, so that the risk of injury to the blood vessels and nerves, as well as the muscles and skin are much lower. This is seen in the patient experience of reduced swelling and bruising.
Each time a new (revolutionary!) liposuction machine comes out, I think the most important questions to ask are not "Does it work?", but rather, "Does it work better than what is already available, is it less expensive (not more), and is it safer than what is already available?"
The VASER (in my opinion) passes this test, while the laser based devices do not.
Having said all of that, I would emphasize that it is the education, training, experience, and skill of the surgeon at the end of the liposuction device that will make the greatest difference in your outcome and safety. There is not substitute for the years of training Board Certified Plastic Surgeons receive in liposuction, directly supervised by other Board Certified Plastic Surgeons. A well trained and Board Certified Plastic Surgeon would be more than capable of achieving a better outcome through tumescent liposuction than any eye doctor with a Water Jet. As in the analogy of Tony Stewart above- a great professional with a great tool (like the VASER) would only make those results and their safety even greater.
Please know that I have no financial relationship with any of these companies and have personally tried each of the discussed technologies myself on patients.
Wow, lots of different ideas, but what are the facts?
#1 - Tumescent anesthesia - describes the infiltration of fluid into the area to be suctioned. The fluid has a local anesthetic as well as adrenaline to reduce bleeding and prolong the anesthetic effect. Almost everyone is using tumescent anesthesia, whether you are a plastic surgeon or not. Whether you do it under general anesthesia or not is unimportant. Many doctors choose to perform it under general anesthesia because it hurts to inject the large volume of tumescent fluid. Some doctors put their patients into a twilight sleep for the injection and then wake them up once the anesthesia has taken effect. This allows them to ask for patient cooperation for standing up to see all aspects of the patient while creating a symmetrical result. I find this to be the safest and most comfortable way to perform the procedure. If a patient wants to be awake for the entire procedure then great, but expect to have more discomfort.
#2- Read many of the reviews below and everyone espouses a particular treatment based on which machine they own. The facts are these;
a) a study done in Europe demonstrated that skin contraction was directly propotional to the number of remaining fascial attachments between the skin and underlying tissues after the treatment. That makes sense because these bands add to the overall structure and rigidity of the skin.
b) the study then looked at the number of remaining fascial attachments after Laser Liposuction (Coollipo, Smartlipo, Slimlipo), Ultrasonic Liposuction (Vaser), Power assisted liposuction (a mechanism creates small precise back and forth movements for the cannula) and traditional liposuction.
The order from best to worst for fascial attachments was - Power-assisted liposuction, traditional liposuction, ultrasonic liposuction and in last place was laser liposuction. You decide!
#3- Both laser liposuction and ultrasonic liposuction has the added risk of burning the skin. Also a higher risk of fluid collections under the skin.
#4-With regard to small areas, all techniques described above are able to aspirate small areas in a precise manner. It is the size of the cannula that matters, and there are small cannulas for all techniques. Remeber that both laser and ultrasonic liposuction requires traditional liposuction to remove the destroyed fat after treatment.
So based on the above, you decide.
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Smart lipo is all marketing
Liposuction has become mainstream and is one of the most common procedures Plastic Surgeons do. "Smart Lipo" is a new gimic to allow more advertising and promotion. The most important thing is the skill of the surgeon, not the machine they use. My liposuction machine has been working for years and is great. I went to the exhibition of the "Smart Lipo" machine only to find out that I would need to spend over $140,000 to get a machine to replace one that is working well. The results I saw were no better than what I get and the costs the doctors charged (inorder to pay for the machine) was much more than I charge.
In my opinion, this is a gimic and a fad, in less than 5 years these machines will be in the junk pile and my old lipo machine will be chugging along.
If I were looking for a doctor, I would want the doctor to be smart, not the machine.
Smart Lipo vs Traditional Liposuction - What is best?
As with many of these questions and topics there are usually no easy and simple answers. First it is important to understand the differences. The biggest differentiating factor is that SmartLipo uses a high energy laser to emulsify or destroy fat cells. Then the lipid that is released from the cell is reabsorbed or can be removed with a special suction cannula. Traditional liposuction works by applying suction to a hollow metal cannula or tube which pulls the fat into the tube and the sharp edges then evulse or rip out the fat, along with associated fibrous connective tissue, and tiny nerve fibers and blood vessels.
Readers will note that there are advocates for either approach which seems to be largely dictated by what they use in their practices. Those who have invested in SmartLipo technology (and want to see a return on their investment) claim it is superior. Those who have not invested in it try to tear it down as they fear their patients will all flock to SmartLipo providers. Ultimately it is more about the skill of the physician using the device than the device itself.
I have been doing all types of liposuction for over 18 years and have used almost every type of liposuction device developed. The results that one achieves are a combination of multiple factors including the skill and experience of the surgeon, the effectiveness if the device in removing fat, and the degree and quality of skin retraction which is effected by the person's skin quality, but can also be effected by the device used. Currently I use the VASER ultrasonic device as well as the SmartLipo laser device. Both I feel offer some relative benefits, and are performed under Tumescent technique which is used in virtually every form of liposuction today.
The VASER device uses ultrasound to break down the fat cells, the contents of which are then removed by a specially designed minimally traumatic cannula. The benefit of this device is that it preserves the fibrous connective tisse between the skin and underlying muscle fascia. This enhances skin retraction and redraping after the fat removal, thus potentially enhancing the result. Adding this technology usually increases the time of the procedure and hence it's cost. SmartLipo uses a high enery Laser light to break down fat cells which can then be removed with the special cannula. The primary benefit of SmartLipo is that the Laser probe is very small and precise. This allows it to work better in areas where greater precision is needed, such as the face. It also allows the probe to be used very close to the under surface of the skin which results in heating of the dermis and stimulation of collagen production resulting in better skin retraction on average. Dr. DiBernado has published compelling research demonstrating this benefit.
Part of the confusion arises from the extravagant marketing claims of the amazing benefits of SmartLipo usually made by physicians who are not certified by the American Board of Plastic Surgery and who usually not experienced in doing liposuction but are try to carve out a new place for themselves in the body contouring market. They make unrealistic claims and overpromise on the benefits, and patients are usually disappointed. So on must do their homework.
In summary, I believe the Smartlipo device offers some real benefits in terms of improved skin retraction and that this is significant component to the quality of the final outcome. This is particularly true for patients with diminished skin elasticity (patients over 40), and Smartlipo has allowed me to achiieve better outcomes particularly for patients with diminished skin elasticiy.
Liposuction vs SmartLipo - Facts vs Fiction
Since Drs. Illouz and Fornier first brought liposuction to the United States in 1982, when I was beginning my residency, there has been really only two game changing developments in the use of liposuction.
The first was the addition of Tumescent fluid dilution, a very dilute concentration of Lidocaine and Adrenaline in a saline solution to expand the area to be treated. This dramatically diminished bleeding, the need for extensive fluid replacement, and for patients to donate their own blood prior to the procedure.
The second was the addition of power to the procedure, which made it much easier on both the surgeon and patient. It was less traumatic and allowed for the utilization of much finer cannulas as opposed to the thumb sized ones of the early days. Everything else has really had only incremental changes on the ultimate outcome of liposuction whether it be the addition of ultra sound or the use of the laser.
Ultimately it comes down to the surgeon and not the tool. Experience, allows the surgeon to refine his techniques so that the procedure is less about liposuctioning and more about lipo-sculpture. Also judgement is crucial in that some patients are less than ideal candidates no matter what technique is utilized and should be given proper advice in that regard. That being said, traditional Tumescent power assisted liposuction, particularly for larger areas, remains the gold standard. As with all new procedures, after the initial hype settles down, the indications for Smart Lipo will diminish.
Remember when laser lipo first came on the scene, it was touted as a stand alone procedure. When the initial results were less than ideal, then secondary traditional liposuction was added to the procedure. In certain areas there may be some advantage with skin tightening, but again as I have seen over the years, if properly performed, in the properly chosen patient, excellent results can be achieved through traditional liposuction.
Find a plastic surgeon who does both....
One can imagine that if you only have one technique to offer, then you might advertise it as best. The docs (often not plastic surgeons) who offer smartlipo and tell you to "make sure you are having tumescent lipo done" are clearly missing the point here. How can the dermatologist who answered this thread say that smartlipo is the better procedure? Some people are going to benefit from Smartlipo and some people are going to benefit from traditional liposuction. You need to find a plastic surgeon who can offer you smartlipo, ultrasound lipo, power assisted lipo, and traditional lipo. Only when you have a doctor sitting across from you who routinely performs all types of procedures can he/she tell you why one particular method is best for you. A plastic surgeon trained in body contouring who not only does liposuction but also tummy tucks/lifts etc can tell you what will work best and give you the most honest advise. In my practice I offer all types of liposuction as well as other surgical options. Many ladies come in asking for smartlipo and they just are not good candidates for the procedure. I can educate them as to what will work for them and why and let them make an educated decision. A few miles down the road from me the emergency room doc who does smartlipo will offer it to just about anyone. The general surgeon offering smartlipo in the town next to me will offer it to just about anyone. I believe this is why you see the scores of patients unhappy with the procedure on this website. It all comes down to patient selection and educated decision making.
Smart Lipo: The Newest Device Is Not Always Best
The explosion in medical aesthetic technology has resulted in a market that is literally flooded with new products, devices and procedures, like Smart Lipo, all claiming to be the ‘latest and greatest’ or the ‘next big thing’. A great deal of dedication (and caution!) is required to sort through all of the new (and often not-so-new) technology which is marketed simultaneously to aesthetic professionals and to the public.
I have not seen a single study that shows any advantage of Smart Lipo to traditional liposuction. But, there may be increased risk of complications, particularly since it seems this device is used by many physicians with absolutely no formal surgical training who and are just entering the world of aethetic medicine.
Liposuction is the most commonly performed surgical procedure each year in the United States. Surprisingly, the majority of physicians performing liposuction in the United States are not plastic surgeons; in fact, many do not have any formal surgical training whatsoever. It seems hard to believe, but many physicians performing liposuction or Smart Lipo have had no more training in liposuction than a 'weekend course'.
I fear that some practitioners, and now consumers view liposuction as a 'simple' surgery, since it does not involve making large incisions, and it requires little, if any, suturing. Nothing could be further from the truth. Liposuction, in my mind, is a very challenging operation that requires careful planning and preparation, and a great deal of care and finesse when it is actually performed. It requires a three-dimensional understanding of the layers of human anatomy, an understanding that is second nature to a surgeon alone. I think that it is often an inadequate understanding of anatomy (and, perhaps, of the body's response to surgery) which leads to the poor results in liposuction and body contouring that unfortunately are so often seen.
Although many aesthetic cosmetic surgery procedures are not performed in hospital operating rooms, the fact that a hospital has granted a surgeon privileges for a given procedure ensures that the surgeon has met an accepted standard of competence. It also means that your surgeon will be able to take care of you at a hospital should any complications from cosmetic surgery arise.
If you are planning to have any type of cosmetic surgery performed, you should do your due diligence to determine if your surgeon has the appropriate credentials and experience.
Talk to several patients
A common question is which is better - traditional liposuction or smart liposuction. If fact, both procedures are good - it all depends on the desired results, patient's body composition, and the skill and experience of the surgeon. My recommendation is to go to a few consultations and ask to talk to former patients who have undergone either of the procedures.
David Shafer, MD
New York City
Tumescent Liposculpture with Microcanulas will beat them any day of the week!
Any doctor can be good at any procedure if they do enough of them. Tumescent liposculpture with microcanulas is the golden standard now days. Smart lipo can do fine but can also cause some unwanted puckering of the skin or permanent nerve or skin damage. The amount of skin contraction from the microcanulas verses laser liposuction would be a good study to see if there is one which is better than the other. I suspect not. Traditional liposuction with the medium to larger canulas and under general anesthesia is no longer done by those of us who have extensive experience. It had its day back 20 years ago.
Expect to pay more for the tumescent technique liposculpture with the microcanulas since it is more time consuming and technique dependent. It definitely is worth the extra money though for better results. Not only is it safer but recovery is quicker and less painful. Expect to pay about $5000 -7000 for abdomen and hips as an example.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.