Considering Smart Lipo or Vaser Lipo for my Abdominal Area

Hello- I had 4 children- all vaginal births- in 5 years. I am fit and around my normal weight. I am considering smart lipo/vaser lipo for my abdominal area. Will the skin be tight after the procedure? I have stretch marks on the lower part under my belly button. Also- how long does swelling last? And when can you go to the gym again? I go 5 days per week for various activities. I am 45 years old and physically fit. I eat well and exercise 5 days per week. The dr. that I talked to said he would do a combo of smart lipo and vaser lipo and then I would follow up with 10 sessions of Tri active laser massage.

Doctor Answers 7

Abdominal Liposuction?

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Thank you for the question.

Although not possible to give you good advice without direct examination,  your description of body type and history of 4 pregnancies in 5 years is concerning.  Most patients with these characteristics benefit from tummy tuck surgery, not liposuction surgery.

Please make sure you are consulting with well experienced board-certified plastic surgeons.

Best wishes.

Will Smartlipo or VASER give me better skin tightening?

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Hi there-

There is NO liposuction procedure that will give you a pleasing outcome if you have a simultaneous excess of skin and the quality of that skin is poor (stretch marks).

I also agree that the way you were advised raises concerns... I would verify that your doctor is a surgeon certified by The American Board of Plastic Surgery.

Even if you DID see a Board Certified Plastic Surgeon, you should always be very suspicious when a doctor spends more time selling you on the machine they are going to use and why your outcome will be so much better because of the machine- instead of offering you sincere options and an explanation of their credentials.

In the end, there can be no doubt that the surgeon is going to make a MUCH bigger difference in your safety and outcome than the machine used..

Please find a surgeon certified by The American Board of Plastic Surgery and discuss your goals with them.

Here's some help finding one you like and can trust:

In a previous entry, I described how common it is for patients who contact my Orlando plastic surgery center to make the mistake of thinking that:

Anyone offering a plastic surgery procedure MUST be appropriately trained and certified to perform that procedure; this is, unfortunately, not the case.

All plastic surgery training is equal, and so shopping for the best price is the best way to choose a surgeon

In that previous entry, I explained how not all people offering plastic surgery are Board Certified Plastic Surgeons, and in fact, many are not even plastic surgeons! There are now many doctors in other specialties offering to perform plastic surgery procedures without the benefit of the years of training a plastic surgeon receives, convincing their patients that a few weeks of training is sufficient for them to learn what we learn in YEARS.

I explained the potentially dangerous error of choosing based on price.

Finally, I explained how to properly choose not only a surgeon, but also the importance of choosing the facility in which the procedure will be performed and also the anesthesia provider.

For today's entry, we'll assume a healthy understanding of these issues. Having done your homework, and ascertained that the surgeons you are considering are all plastic surgeons Board Certified by The American Board of Plastic Surgery, the facilities in which they operate are all certified by the AAAASF or JCAHO, and the anesthesia providers are all well-qualified, how do you make the final decision?

Here are my recommendations:

Consider the relative quality of the surgeon's medical school educations. While it is true that most medical educations will cover the basics, there is a reason that some institutions grow international reputations and perpetually fight for the best students.

A medical school education among these "Best and Brightest" students and educators could reasonably be expected to produce (and historically has produced) America's finest doctors and surgeons. Ranking lists of medical schools take these things into consideration and are a useful resource. The most respected list, from US News and World Report, can be found here:

Find out where the surgeon completed his/her Plastic Surgery Residency. This is the critical and years long process of going from a medical student to a qualified plastic surgeon, where we learn to do plastic surgery by gradually taking on more responsibility under the watchful eyes of other, already trained and experienced surgeons. Just like medical schools, not all training programs are equal in the breadth, intensity and quality of training offered.

Generally speaking, those programs associated with the best medical schools also provide the best training, as they will be able to attract and retain the best, most experienced and reputable professors of plastic surgery- and the quality of our training will depend on the quality of those training us. For example, I completed my own Plastic Surgery training at Washington University in St. Louis, one of the top 5 medical schools in the United States- and it also happens to be the birthplace of American Plastic Surgery.

It bears repeating that you should be absolutely sure that the surgeon you are considering is Board Certified by The American Board of Plastic Surgery. This is easily done at the Board's site:

Know that surgeons who claim to be "Board Eligible" in plastic surgery are NOT board certified. This may be because they simply have not taken the examinations- but this is doubtfully the true explanation, as The American Board of Plastic Surgery specifically prohibits claiming ANY status with The Board until and unless you have passed all examinations. Much more concerning is the possibility that they were unable to pass the examinations (or simply never took them), but realize they may lose patients if they don't find a way to fool them into thinking they have status with The Board. Are you starting to understand that not all doctors have integrity?

Spend some time thinking about the interactions you have had with the surgeon and his/her staff. You should realize that having a plastic surgery procedure is NOT a singular interaction, like buying a new handbag, in which once the bag is purchased (or the surgery completed) the interaction can be considered to be complete. Rather, you are choosing to enter into a very important relationship with your surgeon, the critical portions of which should be expected to last at least a few months beyond the date of your surgery, as you recover and heal. This very important relationship should therefore be approached with the same care you would give any other... think about whether you think the surgeon will be responsive to your needs and concerns, whether your personalities will allow healthy interaction, the approachability of his/her staff, etc...

Remember- you don't only want to have achieved a great outcome when all is said and done... you want to have had an uplifting and positive experience you can look back on and smile! You can have this in the best practices.

Finally, never forget that what you are really looking for is the very best OUTCOME you can achieve. Sometimes when I'm asked by friends and family how to sort through all the claims some surgeons make of being the best choice because they (the surgeon in question) were voted "the best" by some magazine, or because the surgeon simply says they are "the best", I am reminded of the first Clinton presidential campaign, in which the slogan "It's the economy, stupid" helped Mr. Clinton win the White House. Once you've done the homework outlined above, it's all about the OUTCOME...

Ask to see photos of the surgeon's previous work- and ask yourself if you would be pleased if you looked like the photos they show you. Think about how many good photos they show you. Do most of the outcomes just look funny, with only a few that you think are attractive and natural, or are most of their results pleasing and attractive, even if every one may not be what you specifically want? If the surgeon can't show you at least a few outcomes you find attractive and pleasing, you should look elsewhere.

Be sure to ask directly whether the photos you are being shown are the surgeon's own work (believe it or not, some actually do try to attract patients by showing them the work of others!)

I also always recommend communicating with a few of the surgeon's prior patients who have had the same procedure they are recommending for you. You can ask the surgeon's staff for a list of patients who may have agreed to be called, or find testimonials online at one of the many plastic surgery websites now available. My favorite, because it is objective, free (surgeons cannot pay to be listed higher, so more credibility exists), and allows you to get a feel for the surgeon's manner and personality, is RealSelf:

I know it seems like a huge amount of work, but after you've read this (as well as my prior post) a few times, you'll have a great understanding of the best way to proceed, and it will feel very comfortable and natural to you. Use the resources I've outlined, and use your gut- there are many great surgeons out there- with these guidelines you should be able to attain the outcome and experience you desire.

You won't be "tight" from liposuction

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At 45 years of age and after having 4 children and with stretch marks in the lower abdomen, there is no kind of liposuction that will give you a "tight" result. Please read all the information on Smartlipo on Real Self. The loss of elasticity in your skin from multiple pregnancies and aging cannot be overcome by any laser lipo technology. So, you can do lipo if your expectations are to lose some fat but NOT that your skin will be tight.

The only way in your situation to get a tight flat abdomen is with a tummy tuck. I am concerned that your doctor didn't make that clear to you. Are you sure they are a Board Certified Plastic Surgeon? The treatment proposed to you sounds like it came from a non-plastic surgeon who can't offer all treatments and will steer you toward the only one they know and certainly the one you want to hear.

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Loose abdomen and Smart Lipo

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Given your description and prior pregnancies, you would not seem to be a good candidate for Smart Lipo but could potentially be an excellent candidate for a tummy tuck.  Skin quality is the best determinant of successful liposuction.  If you have stretch marks, that is an indication that your skin was stretched to its limits.  Once skin has been stretched to its limits, it rarely returns to its pre-stretch configuration.  The only way to rid your self of those stretch marks is a surgical excision.  Obviously, a physical exam will be necessary to validate this statement.  In the end, the most important thing is that you are able to achieve the results that you desire.  How you get there is a matter of discussion between your board certified plastic surgeon and you. 

Better Tummy Skin Tightening -- Laser Lipo or Tummy Tuck

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When it comes to skin tightening NO liposuction method (VASER, Laser (SmartLipo,SlimLipo,ProLipo etc)) EVEN in the best of hands comes even close to the MUCH better skin tightening obtained by a well executed Tummy Tuck. (Moreover, liposuction will NEVER fix the muscle separation (diastasis) nor remove the lower abdomen stretch marks both of which a tummy tuck will).

In your case, I would suggest you seriously consider having a full Abdominoplasty, the results would be vastly superior to VASER / Laser lipo results.

Dr. P. Aldea

Peter A. Aldea, MD
Memphis Plastic Surgeon

Tightening after liposuction

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Don't expect miracles after either Smart Lipo or Vaser. Yes, there is probably going to be a bit more skin contraction with smart lipo or Vaser as compared to traditional liposuction, but Vaser probably more so than Smart Lipo. Neither one will be miraculous if you have significant laxity. I would expect no more than 10-15%. If your skin is really loose, then you probably need a full tummy tuck. Remember, when you own a hammer, everything looks like a nail!

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

You will get some tightening from Smartlipo

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I used to be a non-believer in Smartlipo. However, I have been pleasantly surprised with the results that I have obtained in my patients. There really is skin tightening if the Smartlipo MPX is used correctly. However, don't be misled. It is not the same as having an abdominoplasty, but there is some tightening. I do not understand your surgeon's suggestion to combine Vaser and Smartlipo and then Tri-active. It sounds like he is trying to pay for all his fancy machines. Good luck with yoru procedure.

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.