Who Can Perform Smart Lipo?

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.

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.