Thank you for your interesting question.
Smartlipo was first invented in Italy and introduced in to the UK in 2005 by a company called DEKA.
The hypothesis behind it was that the sound of the laser (going phut phut phut....) burst the fat cells and the fat absorbed through the lymphatic system!! If one was only removing a fist sized amount there was no problem metabolically etc.
It soon became evident that it was the heat from the tip of the laser fibre melting the fat cells.
Also it became apparent that the energy required was higher than had been stated and the endpoint was clinical (ie when the lump of fat you were treating was gone, you were done) not some preconceived number of shots to be fired in to the area.
As the safety of the device was proven it became increasingly accepted practice to suction the melted fat from the area. This meant that larger areas could be treated. Also the results became instantly visible and certain.
Smartlipo prepared the way for the widespread adoption of Vaser in the UK. By 2008/9 certainly most people had dumped smartlipo system and moved on to better options.
2009 Bodytite arrived in the UK and really since then there has been no smartlipo of any significance done in the UK.
In the UK the standard is to break down the fat in one way or another and then suction it.
As I have said elsewhere it is odd that the USA is still using Smartlipo....
The suction debate has reignited with the introduction of external fat removal machines that freeze or heat the fat from outside the skin.
A lot of them don't work or do anything significant, some of them have odd and rather unpleasant side effects. The problem is just how much fat can you break down without causing other nasty problems and where does it go?
Does it go from the belly on to your thighs or on your chin? My thoughts are quite probably yes it does unless you are in calorie deficit.
I hope this answers your question rather fully so you can see through the fog that surrounds these things.
Dr Dinesh Maini