Smart Lipo Under General Anesthesia on Multiple Areas

Question

Can Smart Lipo under general anesthesia be performed on multiple areas? What are its advantages and disadvantages?

David Shafer, MD, FACS · Answer

One of the benefits of Smartlipo is that it can easily be performed under local anesthesia (awake) with minimal discomfort in small or localized areas. If you want multiple areas treated or "total body liposuction," then you would need to be under general anesthesia. However, if you are going to be under general anesthesia, then I would suggest Power-Assisted liposuction which is great at removing large areas of fat. Good luck.

Peter A. Aldea, MD · Answer

Regarding: "Smart Lipo Under General Anesthesia on Multiple Areas
	Can Smart Lipo under general anesthesia be performed on multiple areas? What are its advantages and disadvantages?"

	I wholeheartedly agree with my colleagues Drs. Rand and Law on the supposed value of SmartLipo. Despite being in the market for over 5 years we have YET to see a SINGLE scientific, double blinded study which conclusively demonstrates any benefits over all other modes of Liposuction. All such claims are commercial hype.

	As our economy continues to suffer, less and less people are willing to have Cosmetic Surgery and many are looking for cosmetic salvation. If you look at the history of paranormal fascination, mediums and communicating with the dead, it is always high at times of national stress; The Civil War, WWI, The Great Depression, WWII, Vietnam and even now.

	American now more than ever WANT to believe in the impossible. In operations that do not exist. The idea that a "laser" can be slipped under your skin, moved about painlessly and - poof - the fat is gone, the skin is tight and smooth and, most importantly, there are no major potential complication associated with this is sheer fantasy.

	As the number of plastic patients has shrunk, some of our colleagues in Plastic Surgery and many non-Plastic surgeons who literally practice plastic surgery have adopted these "magical" techniques to attract patients. These machines are expensive (around 150,000) and the cost must be recovered by additionally expensive touting their superiority to a believing audience which is eager to entrust their bodies and fat to the most recent "laser magic".

	In real life, ALL liposuction procedure start by infusing the fat with a swelling (Tumescent) solution and end by passing a a hollow steel tube (cannula) hooked to high vacuum to rip and remove fat. The ONLY fundamental difference (beside which cannula's are used and the way they are used) is what is done BETWEEN the swelling solution and the lipoSUCTION.

	- In standard Liposuction, there is no intermediary procedure.
	- With the VASER LIPOSELECTION, the fat is broken up by application of ultrasound.
	- With Laser Liposuction (SmartLipo etc), the fat is literally cooked with a hot laser fiber (as are other structures that are found in it such as nerves, lymphatics and blood vessels). In other words, wherever the laser goes, it cooks everything in its path without preference or selection. (Which in itself should raise a lot of question about what happens to these coagulated structures and their impact on healing and the ability to fight infection).

	Ethically, Plastic surgeons should choose the liposuction technique and the anesthesia technique best suited for each patient. Such choices are not available to non-Plastic surgeons performing liposuction because no free standing outpatient or hospital same day surgery facility would credential them to operate within their walls where the full range of anesthesia options are offered. (No certification by The American Board of Plastic Surgery - No Plastic Surgery operating privileges).

	Anesthesia for liposuction should be that which best suited for THAT particular patient. It should NOT but commonly is a one size fits all matter when you are only offered either local (tumescent) anesthesia with or without sedation. Just because the non-Plastic surgeon performing liposuction is not allowed to operate in outpatient surgery centers or hospital, his patients should not have to endure local anesthesia or local anesthesia with sedation REGARDLESS of the size of the area(s) to be treated. So - choose your Plastic surgeon carefully.

	Because real board-certified Plastic surgeons can operate in ALL facilities and can therefore offer their patients the full range of anesthesia options, from local or local with sedation (for a small area) to general anesthesia, if the patient so desires and the doctor agrees, for large or multiple areas of liposuction.

	As regards your options - you know who you are and how much discomfort you can tolerate. Make sure you are open with your surgeon and make sure your requirements and needs are followed.

	Good Luck.

	Dr. Peter Aldea

Michael Law, MD · Answer

I am not a fan of SmartLipo. I have not seen a single peer reviewed study that shows the advantage of Smartlipo vs. Other lipo. I do use traditional (tumescent lipooisuction) I also use Power assisted liposution for more ease for the physician and less trauma to the patient and recently I troduced vaser to my practice. The vaser is a form of unltrasonic lipo that works for fibrous fat in areas like the back and it is alos excellent for gynecomastia for laser skin reduction where skin contration ncan also be helpful.

	Liposuction, is the most commonly performed surgical procedure each year in the United States. Here's a statistic that you may not have heard: 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 have had no more training in liposuction than a 'weekend course'.

	I fear that some practitioners 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.

	Liposuction can be performed with either local anesthesia or general anesthesia. The important thing to ask is whether or not your plstic surgeon has hospital privileges. Without them, a patient many not be able to me admitted to the hospital if a concern or complication arises. Hospitals have access to information the general public does not. If a hosptial will not grant privileges to a physician that may be cause for concern,

Richard P. Rand, MD, FACS (retired) · Answer

Often, the doctors who do liposuction only under local anesthesia are doing it because they aren't Board Certified Plastic Surgeons and can't get a Board Certified anesthesiologist to work with them.  Dermatologists frequently do this.  Unfortunately, they actually promote this as "safer" to the unsuspecting patient.  Too much local anesthesia can be dangerous and can be much more risky than a general anesthetic by a physician anesthesiologist.
Any liposuction can be done under general anesthesia especially if it involves multiple areas and a reasonably good volume of aspirate. 
Remember, the final result you get is much more dependent on your body and your skin's ability to shrink plus the skill of the surgeon than on what "kind" of liposuction you have.  Smart lipo has never been shown to be any better than any other kind of liposuction .

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