How Much Skin Tightening from Smart Lipo?

Many doctors are claiming that laser liposuction causes skin contraction, tightening the skin from below, literally shrinking the skin safely. Somehow a burning hot laser below the skin reduces pain and therefore the need for unsafe general anesthesia. The boiling of tissues from below with the laser beam somehow makes recovery quicker. Old liposuction, dumb liposuction, does not use the laser and is therefore primitive and backward.
Should we be worried about tightening the skin from below with a red hot laser?
The blood supply to the skin consists of perforators, or blood vessels, coming from deep down, usually the muscle (musculocutaneous perforators) or sometimes through the fascia (fasciocutaneous perforators), from the deep artieries of the body, feeding into the skin. Plastic surgeons are very familiar with these perforators because they perform skin flaps which rely on their presence. If you kill the perforators, the skin dies. Skin can only "breathe" through these vessels, not through ambient air. Underneath the skin, there is a network of vessels which supply blood and oxygen to the skin. These vessels are located just below the skin in the subdermal plexus. They are critical to the blood supply of the skin. If you burn too many of them, the skin will scar, contract in a deforming manner, change color to a mottled blue appearance, and possibly die. What is the effect of a laser beam on perforating vessels? What is the effect of a laser beam on the subdermal plexus?
An experienced plastic surgeon will evaluate your skin elasticity and perform the liposuction conservatively enough so that excess skin is kept to a minimum. Claims of skin tightening with below the skin laser liposuction bring back bad memories of aggressive liposuction of the skin from below, a now disgraced technique. This technique did indeed cause skin tightening when it damaged the subdermal plexus, the blood supply to the skin, but also caused irreparable irreguarities and permanent changes in skin color. The scar tissue it formed simply deformed patients. In many patients who had aggressive subdermal liposuction, the entire arms now have a mottled cellulite appearance.
My patients will need to wait until the safety profile and effectiveness of laser liposuction are documented before I perform it on them given the checkered history of aggressive subdermal procedures in the past.
One telephone call, and any doctor with a medical degree and a pulse becomes a laser liposuction specialist. Patients should be aware of both sides of this coin, and of the underlying biology.

Smartlipo is laser-assisted lipolysis which can induce modest amount of skin tightening in addition to the fat removal. The amount of skin tightening varies person to person. In general, I see about 15 to 20% improvement with skin tightening. On occasion, I see more skin tightening up to 25 to 30%. It’s best to have a qualified plastic surgeon assess your abdomen to determine the best treatment option.

Sincerely,
Stewart Wang, MD FACSBoard Certified Plastic SurgeonMedical Director, Wang Plastic Surgery & Med Spa

We have found that smartlipo and laser liposuction are excellent methods to reduce unwanted fat and tighten the skin. Best, Dr. Karamanoukian

The amount of skin tightening experienced through smartlipo varies but generally I have found it to be from 15% to 40%.

The short answer is that you can expect to see more skin tightening after laser liposuction with Smart Lipo than you see from traditional liposuction. I have found clinically that the exact amount of tightening varies from patient to patient and also from area to area. I have found that the most significant predictor for successful skin tightening is the preexisting quality of the skin and the condition it is in. So if the area to be treated has a lot of stretch marks and is extremely lax, no form of liposuction will completely tighten this.  Because of that I encourage patients to keep their skin well hydrated with topical moisturizing creams before and after liposuction of any kind. The key to your success will be working with a board certified Plastic Surgeon who will evaluate your area and be honest about whether they can meet your expectations. Good luck

Properly done liposuction should always tighten the skin. One of the important aspects to this though is knowing how much tightening to get in a particular area and how to work the skin to achieve that. In general, lipo tightens the skin in two ways. First of all, in areas that are gravitationally prone such as the arms, by reducing the weight that is dragging the skin down by removing the fat, their is less weight to pull it down. Secondly, and more importantly is how the superficial fat layer is dealt with by the surgeon, especially the undersurface of the skin. The more elastic the skin is the more tightening it will tolerate. As the elasticity reduces, the surgeon has to be more conservative in how much tightening the are trying to achieve. If the skin has lost too much elasticity, then lipo along with skin tightening by lipo itself can create worsening skin texture and irregularities, regardless of smart lipo, traditional lipo or Vaser. This is a common mistake, to always go for maximal skin tightening. When I am tightening the skin with liposculpture I am always thinking about creating an even sheet of connective tissue under the skin to tighten it without any irregularities. I commonly use a flat tipped spatula cannula to accomplish this. But a lot of it is also technique in knowing how to work the skin to make it do what you want it to. Retaracting the skin tightly during surgery and never poking or jabbing it is very important to a smooth result. Technique and judgement are the most important factors. Smart lipo uses thermal laser energy to accomplish this, and having extensive experience with both traditional liposculpture and smart lipo I can say that the smart lipo in the right hands can achieve better potential skin tightening. In the wrong hands, it can cause worse skin irregularities or burns.

I completely agree with Dr. DiBernardo.  The skin tightening with the SmartLipo Triplex is significant and noticeable for our patients. It occurs because the dermis is heated up to 42-47 degrees in a controlled manner that causes collagen denaturation and shrinkage.  The tightening goes on for six months.

We know this is true also because the 3D color coded imaging done for the Cellulaze studies show improvement going on with reduction of contour depressions between three and six months.

This has been my clinical observation with Cellulaze patients, whose skin continues to tighten as the months go by.

Since the abdomen is the area that we most would like to see skin tightening, we apply the laser energy under the skin to achieve the sub-skin temperature that tightens the skin. This is done in a controlled manner with the Thermal Guide, a computer-controlled device that measures the temperature at the tip of the laser cannula, provides that information to the computer in the laser, and alerts the surgeon when the temperature is reached. It is set to shut off the laser energy if it exceeds 47 degrees centigrade.  Thus the therapeutic temperature is reached and excess energy and burns are prevented.

A further refinement for those plastic surgeons who have the side-firing Cellulaze laser technology, is that the finishing touches to abdominal lipoplasty can be done with the Cellulaze fiber to specifically target the undersurface of the skin at the end of the procedure. While this is more time-consuming, it is a great way of precisely putting the energy into the skin.

While Smart Lipo does do some skin tightening, it is not enough to avoid a mini-tuck or a full tuck.  When we are able to remove 3-6 inches of skin to make you tight with a mini or full tuck, there is just no way a laser is going to accomplish that. 

All types of liposcuction tighten the skin. In my professional opinion and from the results at that I have seen from smart liposuction, I don't believe that smart liposuction tightens abdominal skin any more than other types of liposuction. In my experience liposculpture tightens the skin the best.

I have found that the amount of skin tightening with Smartlipo is variable, and depends somewhat on the health and quality of your skin. It's difficult to know what your chances are at a significant improvement without examining you, but my recommendation would be to have a consult with a Board Certified Plastic Surgeon who performs the procedure regularly. It's important to get an honest evaluation of your particular situation as in some cases the only good answer for tightening or flattening the abdomen will be a tummy tuck, not conventional lipo and not Smarlipo.