Who Can Perform Smart Lipo?

Can any certified MD perform Smart Lipo? How do they get certified to perform the procedure?

Doctor Answers 7

Smartlipo best done by plastic surgeons experienced in all techniques of lipo & body contouring

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It is my opinion, that Smartlipo is best performed by plastic surgeons experienced in all techniques of liposuction & body contouring. A great plastic surgeon has a vast experience in all techniques of body and facial/neck contouring and will use his/ her judgment in assessing an individual patient to come to the best decision as to what procedure or procedures are the best options. The surgeon should listen to the patient's concerns, assess if they are realistic, examine the patient and through this thorough assessment, arrive at an operative plan as to what is the best procedure for the patient's desired outcome and physical findings.

Surgeons who perform liposuction must have a vast knowledge, not only of "fat", but of the "soft "tissues (skin, fat, fascia, muscle) and "hard" tissues (bone, cartilage) of the entire body. For example, if one is considering liposuction and Smartlipo of the abdomen (belly), the plastic surgeon will examine the abdominal wall assessing the skin laxity (upper abdomen, lower abdomen, upper and lower abdomen), presence of a lower abdominal apron (loose, saggy, lower skin above the pubis) skin texture/thickness, skin striae (stretch marks), skin folds (waistline folds, lower folds of skin above the pubis), color of the skin, presence or absence of old abdominal scars from previous surgery, fat of the abdomen (thickness, location in upper or lower abdomen and hips), integrity (tautness) of the abdominal muscles (lax muscles with stretch, or strong, hard muscles that are tight).

All of these aspects of the abdomen must be considered before discussing liposuction versus other abdominal contouring techniques such as a full upper and lower abdominoplasty (tummy tuck), or a lower (mini-) abdominoplasty. All techniques of liposuction can be used on the abdomen. In my practice, I have found that Smarlipo is superior in that I am able to emulsify the fat as I did when I performed ultrasonic liposuction (a technique I used from 1998 until 2008 when I added Smartlipo to my practice), but with much less trauma, bleeding and discomfort. The Smartlipo is performed using a small fiberoptic cable that delivers laser light or heat to the fatty layer and melts the fat. When the suction is perfomed, following the fat emulsification and the skin tightening portions of the procedure, the fat comes out with very little red (little blood staining).

Smartlipo is very efficient due to the heat and also, the heat coagulates or seals the blood vessels so there is less bleeding and ultimately bruising. For years, I have used a laser to perform eyelid lifts for the same reason, as there is less bruising and swelling and patients recover quickly and are back to work sooner. The Smartlipo MPX has 2 laser wavelenghs of light that permit blending of the laser light such that the treatment can be tailored not only to safely heat and emulsify the fat, but the laser blend can be changed to permit passage under the skin to heat the dermal collagen and promote changes that permit the skin to tighten. However the procedure to emulsify the fat and heat the skin with the Smartlipo MPX takes longer, as the tissues must be heated to a certain temperature in grid-like sections (like a hopscotch pattern) to be certain small areas are heated to a temperature high enough that the skin can contract, but safe enough that no tissues can be overheated and thermally damaged. This requires great skill, judgment, and patience.

I have found that the technique is refined enough with the fiberoptic laser that patients can have one area or two smaller areas treated at the same time under local anesthesia with tumescent fluid with lidocaine and oral analgesics and mild sedatives. The patients are comfortable and able to tolerate the procedure, have no after effects of stronger medications necessary for general anesthesia, and go home (someone drives them home afterward), but most go to work the next day after they visit me in the office the first postoperative day.

The advantage of Smartlipo is the ablility to tighten the skin in areas of laxity, especially in the mid-abdomen, lower abdomen, inner thighs, back, arms and neck. However, there are patients who are poor candidates for Smartlipo skin tightening (it is not a magic wand for moderately severe to severe skin laxity anywhere in the body), and they will need the more sophisticated and extensive body contouring procedures, such as abdominoplasty (tummy tuck), necklift, face and neck lift, arm lift and other body lift procedures. That is why a potential patient seeking advice and consultation should see a board certified plastic surgeon who is trained in all of these body and facial/neck contouring techniques. "If your only tool is a hammer, the whole world looks like a nail" as the saying goes.

Smartlipo is a technique that the surgeon must love to do to get the best outcome for the patient in terms of skin tightening. For the surgeon, it is an investment in both money (the Smartlipo MPX technology is very expensive for the surgeon to purchase) and time (the surgery per body area is longer since the best Smartlipo surgeon will be focusing and treating both the fat and the skin), the surgery pricing is higher due to this technology and surgery time. However patients are happy to undergo a surgery with less risk in terms of anesthesia and faster recovery due to the use of more refined technique, which in my experience, has resulted in a much quicker recovery-to the point that more than once I have a patient who feels so great that they are reluctant to come for their office visit the first day postop! There have been occasions when we had to call and insist that the patient return as they felt so good they went back to work tne next day, back to driving their children to school and going to school meetings and so on.

Since I have used Smartlipo my staff and I have to make a point to tell patients that they must come back no matter how good they feel that next day! The patient wears a surgical garment for an average of 1 week to 10 days, and then is advised to wear a "Spanx" for female patients or continue with a very sleek and supportive comfortable surgical garment for the male patient.

I have been very impressed with thte outcome of the Smartlipo procedures especially in the correctly selected patient. The results in the arms are impressive and are certainly better than the obvious "seam" scars of an arm lift. It is great in the abdomen, neck, hips, thighs and back. I have used it with outstanding results under the arms and in the treatment of lipomas (fatty benign tumors under the skin).

I hope that in the future there will be even better technological advances in skin tightening, since skin laxity is really the rate-limiting step in body, facial/neck contouring. For now, in my hands and experience, and from the feedback of the patients in my practice, the Smartlipo technique has been a great addition to my liposuction contouring procedures.

Los Angeles Plastic Surgeon
4.3 out of 5 stars 23 reviews

It is not a question of who can but who should be doing Smartlipo

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my answer is going to upset some fellow physicians but so be it. as the above physicians have pointed out, anyone that has an MD can do anything legally. however it begs the question, should they?? i found it very interesting that not one plastic surgeon answered the question above- one was a dermatologist and the other 2 were drs. As a plastic surgeon, the biggest reservation i have with non-plastic surgeons doing Smartlipo, is that they are in the position of having to offer either Smartlipo or nothing. The reason that is important is that over 80% of the patients that come to me for Smartlipo are not good candidates for Smartlipo in my opinion. They would be better served by either a Tummy tuck or ultrasonic liposuction - both done in the OR under general anesthesia. however, only a plastic surgeon should be doing these latter 2 techniques (and perhaps Smartlipo, though obviously that will be debated). if you have only a hammer than everything you see tends to look like a nail. this is not to say, that non-plastic surgeons doing Smartlipo will be more open to doing patients who may be better served with another technique, but it is certainly a higher risk because they lack all of the tools that a plastic surgeon has at his disposal.

david berman md
plastic surgeon
northern va.

Any MD can perform Smart Lipo - But should they?

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There are many physicians out there who offer this procedure and many other cosmetic procedures that are done. You have to be very cautious and do your investigation.

To become a plastic surgeon many of us endure many years of surgical training. In my case it was 5 years of General Surgery, and then 2 years of Plastic Surgery. Surgical training is very intense and builds and develops the manual dexterity as well good sound surgical judgement. Board certification basically solidifies these things.

There are physicians out there that feel a weekend course or a video presention is all that is needed to perform these procedures, including Smart Lipo.

Smart Lipo is simply traditional liposuction with a twist and strong marketing scheme to attract the patients. So don't be sold on the hype, I don't offer Smart Lipo by choice, because it really does not add much to the surgical tools that are out there.

Just my $0.02

Hope that helps.

Farbod Esmailian, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 88 reviews

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Smart Lipo Is OK, but not the answer for everything.

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I have done a few hundred Smart Lipo procedures for a local medical group over the last year. It is a little better in some patients than regular tumescent lipo, but a lot of the attraction is hype and not borne out by results. Any doctor can perform Smart Lipo and it is pretty easy, but it does not produce tummy tuck-like results. Skin tighening is really not so great particularly in older patients. Just be careful of the B.S and hype.

Best Regards,


John P. Di Saia, MD
Orange Plastic Surgeon

Any physician can perform Liposuction

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Any physician can legally perform liposuction. This does not mean that all physicians have equivalent training. In fact, most doctors performing liposuction are not board certified plastic surgeons, and in fact, some physicians performing liposuction have had absolutely no surgical training whatsoever. My observation is that most physicians who have embraced "Smart Lipo" are not plastic surgeons.

As a plastic surgeon, it is legal for me to perform ANY surgery. The idea of physicians with no surgical training performing liposuction or other plastic surgery procedures is as absurd (and dangerous) as a plastic surgeon performing a C-Section. Sadly for consumers, one cannot rely exclusively on what is legal when selecting a plastic surgeon. Much research must be done before trusting your health, well being, and appearance with a physician.

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 123 reviews

Buyer beware: SmartLipo is being performed by many unqualified 'physicians'.

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Anyone can run a laser if they know how to push a button - the truly important thing to know is whether they actually know what they're doing and have any particular skills or just have cobbled up enough money to purchase a laser (or rent one) and buy a brochure or two. That's what is so scary about this field at this time.

Having performed liposuction for over 13 years now with literally thousands of cases of both tumescent liposuction and now SmartLipo, the best kernel of advice I can give is to go to someone who has been doing liposuction for many years and preferably does the tumescent method in addition to the SmartLipo. While SmartLipo is fine, it is actually not the workhorse of the procedure that will actually get your fat out - the part that is actually doing it and will determine whether you have good results or a disaster is the actual suction part. SmartLipo merely is the preparation and initial melting of the fat.

When people start to do SmartLipo, there is absolutely no training other than a weekend course on that aspect of it and sometimes even less if the laser salesperson is desperate for the sale and wants the 'physician' to be 'trained'. That's why you see so many 'physicians' which means they have little or no training in cosmetic surgery as SmartLipo doctors.

So, if you want the best advice, go with a core cosmetic surgeon (dermatologist, plastic, etc) and skip the non cosmetic field trained physicians. Lastly, make sure they are doing the tumescent method with it or you will have a much longer recovery time than if you don't have that method.

Joel Schlessinger, MD
Omaha Dermatologic Surgeon
4.9 out of 5 stars 50 reviews


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Special training is required to be able to safely an effectively perform Smart Lipo. T he equipment itself has many built in safety mechanisms. Deciding what to do and how much can be done well requires experience as this new technique evolves

David A. Bray, Sr., MD
Los Angeles Facial Plastic Surgeon

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.