How Much Skin Tightening from Smart Lipo?

I'm 48 years old, 5' 2" tall, and weigh about 127. I currently have a small amount of loose skin and not a lot of fat. I have a lot of muscle, am very active, and I lift weights 4 times a week. I am wondering, how much skin tightening can I expect after Smart Lipo? I don't want to end up with sagging skin.

Doctor Answers 28

Be careful what you wish for

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.

Beverly Hills Plastic Surgeon
4.9 out of 5 stars 178 reviews

Quest for Proof of Skin Tightening

I have read the several comments on the request for evidence of the tightening process. As the research center fot the SmartLipo MPX, we have conducted several blinded IRB studies to definitively document and determine skin tightening or NOT.

We used 2 instruments to measure numerically the results:

1) the change in skin laxity by measuring tattoo marks in the skin with the 3D camera to measure "skin shrinkage " over 1 and 3 months and;

2) a highly sensitive device to measure changes in skin elasticity at 1 and 3 months. Both measurements showed significant results in skin tightening.

Furthermore, to detemine whether there is a difference in skin tightening and changes in elasticity in regular liposuction vs laser assisted liposuciton, we used the same measuring methods in 10 patients with laser on one side and liposuctoin and laser canula movement on the other side. Again, there were highly significant differences showing more skin tighening (up to a 15% differnce at 1 month and a 59% difference at 3 months) on the laser side as compared to the liposuction side alone. Each patient served as their own control. The study was blinded and measurement analysis was detemined by an independent source.

This information will be presented at the American Society for Aesthetic Plastic Surgery meeting next week in Las Vegas as well as being accepted for publication in the Aesthetic Surgery Journal. Laser guided liposuction safety and physics foundation data is in press for publication in the Journal of Cosmetic and Laser Therapy.

I hope this answers the request for scientic data with respect to LAL and I encourage others to do more studies in the area.

Barry E. DiBernardo, MD
Montclair Plastic Surgeon
4.1 out of 5 stars 50 reviews

Lets look at the anatomy

Skin gets saggy because:

1) We loose elasticity over time. Aging, genetics, skin color, pollution, smoking, the sun and anything else that promotes free radical production will cause skin to lose elasticity. We have nothing to reverse this progress.

2) We lose skin thickness over time for the same reasons described above. Peels, Retin-A, Dermabrasion and the original CO2 laser all added collagen production to increase the thickness of skin.

3) Skin will also sag because of the stretching of the fascial attachments to the skin. These attachments are the wires that support the skin and hold it adherent to the muscle underneath. These wires will stretch with age, large weight shifts (stretch and then shrink), genetics and gender (men have a better and more diffuse distribution of fascial bands, which explains why they have less cellulite).

4) The health of the skin is dependent on fighting all of the above insult. To fight these insults, blood brings necessary nutrients, vitamins and oxygen. The blood supply travels through blood vessels that create a web just below the skin and pass through the muscles below. Laser Lipo will injure the fascial bands and blood supply more than conventional liposuction, power assisted liposuction or ultrasonic liposuction.

The best way to sculpt your body is to:

A) Maintain a stable, healthy weight.

B) Treat your skin the best way possible: avoid smoking, avoid the sun, use Zinc Oxide sunblock, apply Retin-A and Antioxidants, apply moisturizers.

C) Choose a liposuction technique that maintains good blood supply and does not destroy the fascial bands - Power assisted liposuction is best. Forget all the Hype!!! Robert M. Freund, MD, FACS

Robert M. Freund, MD
New York Plastic Surgeon
4.8 out of 5 stars 33 reviews

It varies a ton.


Having done over 100 Smart Lipo cases in the last year, I can say it varies quite a bit. It will not tighten your skin like a tummy tuck would, but of course you will not have the same extent of surgery either.

It is a trade off, plain and simple.

John P. Di Saia, MD
Orange Plastic Surgeon
5.0 out of 5 stars 27 reviews

Results vary

Smartlipo and traditional liposuction are both effective by reducing fat AND tightening the overlying skin. This two part process is what provides patients with the beautiful results. Exactly how much your skin will tighten is difficult to predict. As a general rule, the younger the skin the more elastic it is. Elastic skin tends to tighten better than loose, thin skin.

You describe not having much fat and being very fit. Smartlipo could likely provide you with skin tightening and it may be an excellent option if it is done properly and conservatively. Perhaps you should consider other options as well. Thermage has several new tips for body contouring/tightening. these are performed as non-invasive treatments with no healing time and help provide modest skin tightening.

The best advice is to see a trained cosmetic physician who performs a variety of procedures so that your skin can be examined and appropriate treatment options can be discussed.

Edgar Franklin Fincher, MD, PhD
Beverly Hills Dermatologic Surgeon
5.0 out of 5 stars 1 review

How Much Skin Tightening with Smart Lipo?

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.

Robert M. Lowen, MD
Mountain View Plastic Surgeon
5.0 out of 5 stars 49 reviews

Smart liposuction skin tightening effects

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.

Sean Younai, MD, FACS
Beverly Hills Plastic Surgeon
4.4 out of 5 stars 49 reviews

No sure answer

Smart lipo or laser lipolysis is promoted as offering skin contraction from the ehat generated by the laser that is placed underneath the skin. However, there are no scientific studies to supprt or refute this concept. Therefore, I can not give you a definitive answer. Let's just say that the patients I have seen that debated over thaving a tummy tuck versus just liposuction and were better candidates for a tummy tuck, still needed a tummy tuck after have the Smartlipo.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Smartlipo skin tightening is variable

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.

Shahram Salemy, MD, FACS
Seattle Plastic Surgeon
4.9 out of 5 stars 149 reviews

Smartlipo and skin contraction

From what you describe, a small amount of fat and minimal loose skin, you should be able to get some skin tightening with smart lipo in the right hands. A lot of loose skin is a recipe for disaster with any technology.  A well trained and experienced plastic surgeon should easily be ble to tell you what you can realistically expect!

M. Dean Vistnes, MD
Bay Area Plastic Surgeon
5.0 out of 5 stars 48 reviews

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.