Smartlipo FAQs

A very small cannula, approximately 1.0 mm or so, in diameter containing a laser fiber is inserted into the skin. The cannula is moved back and forth delivering the laser's energy to the fat cells, causing them to burst and drain away. The laser energy also interacts with the dermis it resulting in collagen shrinkage.

Due to the cannula's small size, Smartlipo is a minimally invasive procedure and can be performed under local anesthesia. The laser causes small blood vessels to coagulate immediately on contact.  This effect results in less bleeding, swelling and bruising, and quicker recovery time.

If you have areas of fat that will not respond to diet and exercise, then you’re a candidate for SmartLipo. Ideal candidates are in good health, of normal body weight and have realistic expectations for the results.

Minimal downtime

Some of our patients return to work immediately. We normally advise a day or two of rest.

Minimal discomfort

During the procedure, there is no pain. After the anesthesia has worn off, you feel an ache rather then pain that follow a vigorous workout. The bruising is much less common with Smartlipo.

Less traumatic

The 1-2 mm fiber-optic cannula is inserted through a small puncture in the skin usually along creases that conceal the minimal scar. As the laser melts the fats, it also coagulates the loose ends of small blood vessels. Compression garments are optional as the area will not bleed very much after the laser is removed.

Almost "normal" skin after 3 - 6 months

It would be very hard to find the insertion points that any liposuction has ever been done. Skin contracts and looks tighter then before

Laser lipolysis is done the same way as traditional liposculpture, but adds some unique features that make it different.

The technique of tumescent infiltration normally used to prepare the fat. 

Once the hot tumescent infiltration has been made, we insert the probe with 300-600 µ of optic fiber that conducts the laser’s energy by means of a very thin cannula of 1 mm diameter and we sweep the whole area with the probe in order to dissolve the body fat.

In order to understand why the swelling happens, it is important to understand how the procedure is done. 

First, before any SmartLipo is performed, the area of the body that needs to be treated is injected with a fluid that contains electrolytes, lidocaine, and epinephrine or adrenaline.  Epinephrine or adrenaline are designed to tighten up the tone of the blood vessels and decrease bruising and swelling, as well as prolong the effect of lidocaine and decrease its absorption into the system.  It also provides an additional safety guard for rapid lidocaine absorption.  Lidocaine is used to decrease the pain and increase comfort during the procedure and immediately after.   

There are several techniques of liposuction, regardless of whether the laser is used or not and it depends on the amount of fluid that is injected.  Depending on the amount of fluid that is placed under the level of the skin and the liposuction could be considered wet, super wet or tumescent. 

The word tumescent means that the fluid is injected to the extent to allow for appropriate tissue tension or turgor.  Then, the fluid is left in the body for 10 to 20 minutes to get the full effect of vasoconstriction and analgesia. 

Then, the liposuction cannula or SmartLipo cannula is inserted and the liquefaction or laser lipolysis or liposuction is done.  Whenever the fat tissue is destroyed by liposuction or laser lipolysis with SmartLipo, additional residue of the dead fat cells is intermixed with the tumescent solution, so after the procedure, the area under the skin contains not only residues with fat cells but also residual fluid and before we see the results, both the inflammation and swelling from surgery as well as resorption of the fluid that has been injected prior to the procedure has to happen. 

Usually, the swelling continues to increase for the next three to four days.  Some physicians use Medrol packs for the patient.  Medrol packs are short-term steroid tablets that are designed to decrease the swelling and inflammation.  Some physicians do not use them.  Regardless, it will decrease the amount of swelling but it does not necessarily eliminate it. 

The majority of the swelling will go away within two to three weeks.  The most dramatic results will be seen after day 3 or 4 when the peak of swelling has been reached; however, it is not the final outcome.  The swelling will continue to go away for the next two to three months and then slowly decrease for another six months or so.  That is why revisions after liposuction, Liposculpture, or SmartLipo are done not earlier than six to nine months out.  At that point, the physician and the patient really know what the final outcome is.  So before the swelling goes away, all the fluid in the subcutaneous area has to absorbed. 

Some areas have a tendency of holding on to the swelling or to the fluid longer than the others.  For example, the chest, or the male chest, has the tendency of keeping the swelling for up to about nine months.  That is why if SmartLipo is performed for gynecomastia, the garment is usually worn for at least six months, at least in our practice.  Some areas have a tendency of getting rid of swelling earlier. 

If the patient has the liposuction or SmartLipo done in the abdominal area, flanks, or inner thighs, it is quite common that the groin area becomes very swollen.  It is very difficult to provide adequate support for the groin area.  If you have liposuction yourself or you know someone who had liposuction, you would probably know that most surgeons will recommend wearing a postoperative garment for a while, and the protocol for the garment theory varies quite a bit; however, regardless how comfortable the garment is, it is very difficult to create the equal amount of tissue compression on the groin area and that is why the groin usually becomes swollen and stays swollen for a bit longer than the other body parts in the vicinity.  The patient who is having the surgery or procedure performed in the vicinity of the groin be that inner thighs, pubic area or abdomen, it is important to realize that this was one of the side effects, not complications, but side effects of having swelling in this area.

All of the above-mentioned techniques are different weapons so to speak in the plastic surgeon's war chest.  It depends on the plastic surgeon's training and personal experience with various techniques.  Unfortunately, a lot of us were trained only in the basic techniques.  A lot of the latest developments in cosmetic surgery have come about a few years after the training has been completed and the studies that are out there support or oppose different statements but not universally consistent.  The traditional liposuction that was introduced in the mid-70's by Dr. Klein and actually brought from Europe utilizes a technique that is called a tumescent liposuction.  Nobody is doing standard liposuction anymore, so when we talk about tumescent liposuction this is the most common technique utilized.  The term tumescent means that prior to performing liposuction of any kind with any equipment, a fluid containing electrolytes, adrenaline, and lidocaine, sometimes other additives, is injected under the level of the skin to allow for analgesia for pain reduction and vasoconstriction to reduce the bruising and bleeding during the procedure.  All the other techniques are based upon this method.  The power-assisted liposuction uses the vibrating cannula and some people feel that it results in sort of jack hammering effect to the fat cells.  I do not know whether we have the data to support just passing the vibrating cannulas to the tissue results in fat separation, but it definitely eases the work of the plastic surgeon and allows better result at least in my hands because of better maneuverability of the cannula; however, in the smaller areas of the body or with the smaller fat pockets, it actually can be a detriment, because it may create additional difficulty in more precise positioning of the liposuction cannula so it actually can create more irregularity and therefore the traditional tumescent liposuction without vibrating cannula is very helpful.

Ultrasonic liposuction was introduced a few years ago and it had its peak of popularity which went down and now on the rise again.  The benefit is that prior to performing suction, a cannula with the ultrasonic energy is passed through the tissue.  When the cannula touches the fat, it liquifies and then it does not require as much of the suctioning power to remove the residual tissue.  The downside was that the ultrasonic energy can also create burns of overlying skin, additional drainage to the blood vessels, hypothetically increased risk of skin death and increased risk of subcutaneous fluid collections.  Since then, the technology has been modified to decrease those complications and a few surgeons swear by it, a few other do not like it.

In 2006, a laser lipolysis with SmartLipo was approved by FDA and the purpose is to break the fat cells before suctioning them out of the body that is performed with a very small fiber that in passing in the subcutaneous tissues creates less damage than a traditional cannula or ultrasonic probe.  The goal is to create more of a controlled limited amount of fat cell death compared to ultrasound.  To which extent it is possible, it is difficult to say; however, a surgeon with appropriate experience with liposuction and alternative techniques can always use a combination of techniques to achieve the desired results.  Some of the reports are more anecdotal.  Some of them are supported by the studies.  In my mind, I follow this rule.  I believe that anything less than tumescent liposuction is inappropriate.  For the larger areas, I believe in a benefit of power liposuction.  In the smaller areas, I believe it is a detriment; however, I do believe that SmartLipo or laser lipo technology can improve the precision of the outcome especially in the areas of the neck and especially in lean patients with smaller areas of fat deposition.

So, in selecting your plastic surgeon and selecting your procedure, it is important to follow who you uses what machine, but who has more experience in doing the procedure.  The results of liposuction are not as technology dependent as operator experience dependent.

Majority of nonsteroidal antiinflammatory medications like Motrin or ibuprofen and aspirin result in thinning of the blood and that is why they are not recommended even before or after the surgery.  We usually advise the patients to stop taking aspirin and aspirin-containing products or ibuprofen or Motrin at least two weeks before and a week after the procedure.  Even though there are no studies that I know of that demonstrate any significant complication/risk increase with taking Motrin or aspirin, the reasonable thinking is that early after the surgery, the friction of the tissues can cause damage to the small blood vessels.  If the blood is thinned out, it can result in more bruising, more swelling, and prolonged healing.  Tylenol is a good alternative because it does have the effect of decreasing inflammation and pain but it does not have the same effect on platelets.  In a similar fashion, Celebrex is found to be quite effective without the side effect of blood thinning.

In summary, I believe Tylenol is a safe alternative to narcotic pain medications; however, two weeks before and a week after, I would not suggest taking other over-the-counter pain medications like Motrin or aspirin for the risks of prolonged swelling, bruising, and bleeding.

SmartLipo is a technique where the small laser fiber is passed through the fatty tissue resulting in the fatty tissue destruction and liquefaction of fat, so after the laser passes, the fat turns into a liquid form, similar to the effect of the ultrasonic energy.  

Majority of plastic surgeons today believe that the fat needs to be suctioned out.  The reason is because in essence, it is a dead fatty tissue that is located under the surface of the skin. Even though most of it may be absorbed by the body, it is an irritant that can cause the irregularity or bumps under the surface of the skin as well as becomes a media or a location for bacterial growth.  The difference between the suction after SmartLipo and the suction done during the traditional liposuction is the amount of negative pressure or the strength of the suction required.  The traditional liposuction is usually performed at a higher suction rates because it has to be able to suck the fat cells inside of the cannula.

The fatty residue after SmartLipo is in the form of liquid, so the amount of negative suction or power required to remove it is much less, I believe that is why that removal in many cases can be performed with even a handheld syringe with a small cannula.  Majority of plastic surgeons would agree that utilizing post SmartLipo suction at the low setting results in decreased swelling, decreased pain, better results, and a decreased amount of inflammation.

The goal of the plastic surgeon is to place the scars in such places that can be hidden from the obvious view. it would be inside of the belly button for the abdominal liposuction, behind the ears for neck liposuction, in the fold of the chin for neck liposuction, in the hair-bearing portion of the pubis or the groin, where the scars heal better. However, the number of scars, their location and size is a function of the number of areas treated, the amount that needs to be removed and the judgment of plastic surgeon that is performing the procedure.  If the plastic surgeon feels that to achieve a better result it is required to place another small incision, usually would do so for the sake of the result.  Because the SmartLipo usually uses smaller cannulas or microcannulas, the size of the incision is usually smaller.  Some surgeons put a small stitch.  There are some people who put a Steri-Strip or butterfly. Some surgeons do not sew it up at all.  That allows for the fluid to come out and hopefully, the swelling to resolve faster. However, regardless where the scar is placed, the scar would be slightly red for a period of several months and usually, the scar goes through the stages of early healing and then maturation, and as the scar matures, it turns from the pink-looking scar to a more of a whitish scar.  During this transitional period, it is very important to avoid sun or use appropriate sunblock protection.  As the scar becomes sun sensitive and as a matter fact even the liposuction areas become sun sensitive, they can discolor being exposed to UV light.  It can happen on the beach.  It can happen in the tanning booth.  It can happen just being outside with clothing that does not have any UV protection and allows the body to tan underneath the clothing.  Therefore, for the first six to nine months, we recommend using SPF 30 on the areas of liposuction scars.  The process of scars being sensitive to the sun or to the UV light is called solar tattooing where the scar becomes darker, looking like a darker tattoo.  That is why it is very important to use a sunblock protection.

Some patients have a tendency to develop thicker scars, also known as hypertrophic scars or keloids.  Before, it was more common in patients with darker complexion or darker skin types.  It is very important for the patients to discuss their history or their family history of keloid scar formation with the surgeon prior to the procedure.  Any scar in any location can become hypertrophic or thickened.  In this case, additional procedures, treatments, or surgeries may be necessary to result an improvement; that may include steroid injections, excisions, use of different suture materials, or radiation or use of silicone gel sheeting.

In the majority of our patients, we did not see those problems.  The small temporary thickening of the scar can occur and  usually related to swelling, and the swelling can be improved with direct massage or lymphatic drainage or just pressure.  Some of the more susceptible patients may require prophylactic use of silicone gel sheeting or Scarguard.  Fortunately, we do not see too many problems with significant scarring after liposuction or SmartLipo.

There is no specific age restriction for the use of SmartLipo.  There are reports of physicians treating patients anywhere from teens to patients in their 70's.  The same is true for traditional liposuction.  The main thing is to make sure that regardless of the technique of fat removal that is used, appropriate workup and safety precautions are taken.  Even though the SmartLipo appears to be more of a lunchtime procedure, it is still a surgical procedure and has to be taken with appropriate seriousness and preparation.

SmartLipo is only one of the techniques that can be used to reduce fat deposition.  Right now, we have several techniques to address fat.  One is a traditional or power liposuction or tumescent liposuction, the other is ultrasonic-assisted liposuction, third is laser lipolysis, and the fourth technique is the laser-assisted lipolysis.  Incidentally, the rumors are out there that the external ultrasonic fat removal machines are on the way with some promising results in Europe and Canada, but that is yet to be determined.  My take on the SmartLipo is following:

The SmartLipo uses microcannulas, a couple of millimeters in size and they are quite a bit smaller than traditional liposuction cannula.  If the traditional liposuction cannula is inserted in the very small area of fat deposits, even with criss-crossing, which is considered to be the standard technique right now and multiple points of access, it is very difficult to create an even result.  Therefore, we usually recommend additional massage and lymphatic drainage or LPG of the area afterwards, starting from week #2.

SmartLipo has been approved in 2006 by FDA for laser lipolysis.  What it means is that it will destroy the fat in the area where the laser fibers pass.  Because the laser fiber is quite a bit smaller than the cannula and it requires many more passes through the area to result in a fat reduction, the hope is that it will produce more even results.  The physicians who utilize actively SmartLipo technology state that this is indeed the case.

The second statement is that the skin is supposed to create more collagen and therefore, retract better.  Any damage to the skin will produce some form of collagen formation; be it a peel, laser resurfacing, Fraxel, microdermabrasion or appropriate skin care. 

The question is, to what degree the SmartLipo can improve the collagen tissue formation?  There are no studies to support that SmartLipo is better in skin retraction though the physicians who utilize it report that.  I would not do the SmartLipo only because of the hope of better skin retraction.  If you have a younger skin, your skin will retract better.  If you have older skin or more weathered skin, it will retract less.  The problem is the difficulty with measuring or quantifying the skin collagen formation. 

After the laser we can perform biopsies but after the liposuction, it is very difficult to do and there are no other reasonable methods of measuring the collagen formation in the skin besides that; so my belief is that the SmartLipo may be a better choice for the patients with the smaller fat deposits because it is able to produce more even results in the smaller areas where larger cannulas used can result in waviness, bumpiness, lumpiness, and irregularity of the surface. 

Also, because the SmartLipo can cauterize the smaller blood vessels that it passes nearby or is able to maneuver around the larger blood vessels a little better, it may produce less bruising and less swelling.

The lymphatic drainage is an alternative medicine technique that is designed to improve the circulation and decrease the amount of swelling.  It can be beneficial though somewhat controversial. 

My approach to that is as following:  Numerous patients that were treated have reported an improvement in swelling after having massage or lymphatic drainage procedures and I think it has to do not only with physical aspect of milking the fluid in the subcutaneous tissues, but also some of the psychological aspect of utilizing additional technique to decrease the swelling. 

The amount of damage that the procedure of lymphatic drainage and massage creates is truly minimal except for the early discomfort and pain.  Given that, doing it earlier in the first or second week would be difficult because it can stir up early bleeding, especially after larger liposuction procedures. 

So in our practice, we do recommend massage or lymphatic drainage after liposuction or SmartLipo procedure.  We believe that it reduces pain, decreases swelling, and does not create any undue effects to the patients.  Even though the plastic surgery literature at this time does not support it and evidence is anecdotal, because the procedure does not carry any inherent risks, I believe it is fairly safe to be performed and the patient's satisfaction appears to be fairly high.

All of the above-mentioned techniques are different weapons so to speak in the plastic surgeon's war chest.  It depends on the plastic surgeon's training and personal experience with various techniques. 

Unfortunately, a lot of us were trained only in the basic techniques.  A lot of the latest developments in cosmetic surgery have come about a few years after the training has been completed and the studies that are out there support or oppose different statements but not universally consistent. 

The traditional liposuction that was introduced in the mid-70's by Dr. Klein and actually brought from Europe utilizes a technique that is called a tumescent liposuction.  Nobody is doing standard liposuction anymore, so when we talk about tumescent liposuction this is the most common technique utilized. 

The term tumescent means that prior to performing liposuction of any kind with any equipment, a fluid containing electrolytes, adrenaline, and lidocaine, sometimes other additives, is injected under the level of the skin to allow for analgesia for pain reduction and vasoconstriction to reduce the bruising and bleeding during the procedure.  All the other techniques are based upon this method. 

The power-assisted liposuction uses the vibrating cannula and some people feel that it results in sort of jack hammering effect to the fat cells.  I do not know whether we have the data to support just passing the vibrating cannulas to the tissue results in fat separation, but it definitely eases the work of the plastic surgeon and allows better result at least in my hands because of better maneuverability of the cannula; however, in the smaller areas of the body or with the smaller fat pockets, it actually can be a detriment, because it may create additional difficulty in more precise positioning of the liposuction cannula so it actually can create more irregularity and therefore the traditional tumescent liposuction without vibrating cannula is very helpful.

Ultrasonic liposuction was introduced a few years ago and it had its peak of popularity which went down and now on the rise again.  The benefit is that prior to performing suction, a cannula with the ultrasonic energy is passed through the tissue.  When the cannula touches the fat, it liquifies and then it does not require as much of the suctioning power to remove the residual tissue.  The downside was that the ultrasonic energy can also create burns of overlying skin, additional drainage to the blood vessels, hypothetically increased risk of skin death and increased risk of subcutaneous fluid collections.  Since then, the technology has been modified to decrease those complications and a few surgeons swear by it, a few other do not like it.

In 2006, a laser lipolysis with SmartLipo was approved by FDA and the purpose is to break the fat cells before suctioning them out of the body that is performed with a very small fiber that in passing in the subcutaneous tissues creates less damage than a traditional cannula or ultrasonic probe.  The goal is to create more of a controlled limited amount of fat cell death compared to ultrasound.  To which extent it is possible, it is difficult to say; however, a surgeon with appropriate experience with liposuction and alternative techniques can always use a combination of techniques to achieve the desired results.  Some of the reports are more anecdotal.  Some of them are supported by the studies. 

In my mind, I follow this rule.  I believe that anything less than tumescent liposuction is inappropriate.  For the larger areas, I believe in a benefit of power liposuction.  In the smaller areas, I believe it is a detriment; however, I do believe that SmartLipo or laser lipo technology can improve the precision of the outcome especially in the areas of the neck and especially in lean patients with smaller areas of fat deposition.

First of all, before considering liposuction in general or any cosmetic surgery procedure in general, it is very important to attempt to lose the weight first.  Majority of surgeons would agree that they would not perform any cosmetic procedure on the patient at least for six months after delivery of the baby or for at least three months after the weight has been stabilized.  If you have been slightly overweight before, now you have a baby, and you are not planning on having one in the very near future, it is very reasonable to have a cosmetic surgery to improve your appearance, sort of mommy makeover. 

SmartLipo is one of the ways to remove the unwanted area of fat deposits.  Remember, this is not a miracle cure and it may need to be used with more of a traditional liposuction or power liposuction techniques for better result or if the areas of concern have more fatty tissue.  The improvement of the skin tone and skin tightening is somewhat controversial.  The preliminary studies demonstrate the skin tightening in the range of 16% to 32%, but for most surgeons it is still quite anecdotal.  So, I would consider the skin tightening as the bonus, but not necessarily the main reason to have liposuction or SmartLipo procedure. 

Just remember that SmartLipo will not improve the stretch marks and if you have a significant amount of extra skin, a tummy tuck in combination with a suction procedure may be necessary, but it needs to be discussed with your plastic surgeon and it depends specifically on the body shape, amount of excess skin, amount of weight that was gained and lost and so forth.

Usually, we would recommend maintaining the active lifestyle but avoid excessive exercise routines for about a week, more or less, depending on the extent of the surgery, areas treated, any unforeseen complications, garment, and so on.  It is very important to maintain the preoperative diet and exercise routine to assure the longevity of the SmartLipo results.

There is no simple answer to this seemingly simple question.  The jury is still out.  A lot of surgeons traditionally prefer liposuction or post liposuction garment after traditional liposuction, ultrasonic liposuction or SmartLipo procedure.  The goal of the compression is to decrease the swelling, create a gentle pressure on the subcutaneous tissues allowing the attachment of the underlying structures and collapse of the tunnels where the liposuction cannula or SmartLipo fiber passed.  The majority of the surgeons would recommend wearing the garment continuously for one to two weeks and then intermittently up to 12 to 16 hours a day for the next six weeks.

On the other hand, the garment especially in the area of the lower extremities can result in compression of subcutaneous tissues that is somewhat excessive and can promote hypothetically, blood clotting below the garment level.  Also folds in the garment can create scar tissue ridges of fibrous attachments of the skin to the underlying muscle layer or residual fatty tissue creating ridges.

The patients who had liposuction usually comment that the liposuction garment gives them some form or support and feels more comfortable.

Even though this is not the universal rule, in our practice, we recommend following:  We recommend wearing the garment for the first week until the first postoperative visit continuously.  We ask the patients not to remove it to take a shower even though the garment may appear to be pretty dirty from oozing of fluid or small drops of blood. 

The importance of it is that removing the garment or the shearing effect on the skin can promote new bleeding and swelling in the area where the Liposculpture, liposuction, or laser lipo was performed.  At that time, we do not have a vasoconstrictive or vessel-tightening effect of epinephrine and that can result in subcutaneous blood accumulation or hematoma. 

We usually recommend patients to wash the garment after the first week and make sure it is not tight.  Depending on the area that is treated, we recommend wearing the garment for the next six weeks, the exception being the patients who developed prolonged swelling or males who have gynecomastia surgery performed.  In that case, we recommend wearing it for up to six months but usually, we tell the patients to stop wearing the garment whenever they feel they do not need any additional support.

While they are wearing the garment, it is important to make sure that the garment does not cut off the circulation to the legs, arms, or create a fold.  The fold can be created usually on the abdomen, the groins, or along the zipper lines.

The discussion about wearing or not wearing the garment will mostly depend on the experience of your plastic surgeon with the garments and the appropriate measurements performed prior and after the surgery.  Some patients incidentally will require several garments over the course of recovery for the purpose of improved and continuous gentle tissue compression.

There are alternatives to the surgical garments though.  Some Spandex attire is as good as a compressive garment.  It can be purchased in a sport stores and utilized in that purpose also.

The prices of SmartLipo vary quite a bit and depend on the geographic area, experience of the physician, the cost of the laser to the physician, cost of supplies, and the number of areas treated. 

On average, the first area cost between $2,000 and $4,000 with each additional areas costing between $1,500 and $3,000. 

Depending on the number of areas treated, the cost vary from low $3000  to over $15,000, but on average across the country, the cost of the procedure is about $5,100 according to the realself.com. 

The SmartLipo costs sometimes more and sometimes less than a traditional liposuction.  Sometimes, it can be combined with traditional liposuction for the further improvement of the outcome and that is why the additional $1,000 or $1,500 charge per area may be applied to the cost of traditional liposuction. 

That is why it is very difficult to tell exactly how much the surgery will cost.  Again, the best candidate for SmartLipo are people with very small fat deposits who are in good shape; they are excellent candidates for SmartLipo and usually are not very good candidates for traditional liposuction because the area of extra fat could be too small for traditional cannula to address and that is when SmartLipo becomes the only option.

The SmartLipo, just like traditional liposuction, can be performed under local, twilight, and general anesthesia.  It depends on the comfort of the surgeon, the health conditions of the patient, the available resources at the surgery center or in office procedure or surgical suite, on the number of areas treated and possibly the combination with other procedures.  Regardless of the location performed, it is very important to monitor the amount of lidocaine that is injected, but it is true for the patient regardless of what type of anesthesia is used.  It appears the the majority of plastic surgeons use a SmartLipo under twilight or local anesthesia; however, it can also be performed under general anesthesia.

The advantage of the local anesthesia is that recovery period after anesthesia usually is shorter and the risks of nausea, vomiting, and other anesthesia-related complications is diminished; however, it also carries disadvantages, which are inability to address multiple areas, increased discomfort during the procedure, possibly the need for more significant amount of local anesthetic to be used for the patient's comfort. 

The twilight anesthesia appears to be accumulating the benefits of both the general and local where more areas can be treated with more patient's comfort; however, it still has its own limitations as to the patient's comfort issues and it has a slightly increased risk of nausea and vomiting due to sedation or twilight agents.

General anesthesia is traditionally used and for multiple areas, it may not require as much of local anesthetic lidocaine load as the others because the patient is completely out; however, it does have increased risk of nausea, vomiting, cardiopulmonary, and blood clotting complications.

It is difficult to say whether SmartLipo is necessarily better than traditional liposuction.  Liposuction and all its variations including power liposuction, tumescent liposuction, ultrasound-assisted liposuction, and SmartLipo are different tools in the surgeon's armamentarium that can be used for the patient's benefit.

There are definitely certain advantages of both and that is why it is very difficult to say that the one is universally superior to the other.  Traditional liposuction has been used from the mid-70's and has a very good record of safety consistency and results; however, it does have some shortfalls.  For example, the patients who are very athletic and thin and desire to have more of an etching procedure or the patients with a small localized areas of fat deposits that need to be removed are difficult to treat with traditional liposuction.  The reason is because in the traditional liposuction, a small cannula is inserted under the surface of the skin, so if the patient is pretty thin, the cannula size even in the smallest size can create irregularities and waviness of the contour and in some areas overlying well-developed muscles, it could be visible.  Because the laser fiber is significantly smaller than the smallest cannula, it allows for more even fat destruction than liposuction with a cannula.  Given that, it is very much operator dependent and using SmartLipo requires significantly more patience on the part of a physician.  It is noted by many surgeons that the recovery period after SmartLipo is shorter than during the traditional liposuction.  It may relate to the advantages of the laser.  It may also relate to the fact that the areas that are treated are smaller and therefore, even if traditional liposuction would have been performed, the recovery could have been significantly shorter by itself.

SmartLipo is not very effective in removing large areas of fat deposits because the large areas cannot be addressed with a really tiny 1-mm fiber or it will require an extensive period of time prolonging the risk of local anesthesia, twilight, or general anesthesia.  That is why for the patients desiring more significant fat removal, a combination of traditional and a power liposuction or laser liposuction is performed.

The statements about the skin shrinkage appeared to be two fold.  The physicians who have SmartLipo usually confirm the tightening of the skin.  The physicians who do not have SmartLipo, usually are pretty resistant to the idea.  It may relate to their own experience and obviously, both groups are biased to some extent.  Obviously, the physicians who have the Smart Lipo equipment would want to use it and the people who do not have it are trying prove that not having it is still adequate; however, there is something to be said about the satisfaction rate of the patients.  With 81% satisfaction rate, I think there is something behind the improved skin tightness as if reported by the patients also.  Overall, I think SmartLipo is a good additional modality for both physician and patients.  I think it allows us to address the areas that could not be adequately addressed with the traditional liposuction technique, though I do believe that some statements regarding the effectiveness and some miracle features of SmartLipo are overstated.  The decision of whether to use or not to use SmartLipo is between the physician and the patient, and it is important to receive their opinion not only from the surgeons who do not have the equipment but also from the physicians who do have it.  If the cost is not a factor, and in many cases it is not, because the price could be similar, I would always suggest utilizing the SmartLipo in addition to, because I do believe that it creates additional benefit to the patient. I have to state though that objectively, there are no studies that can adequately support that statement and it is solely based on experience.  Knowing that this is an operator-dependent procedure, I think it is very important to make sure that the provider of laser services or SmartLipo is adequately trained not only in SmartLipo but also in traditional liposuction techniques because in my practice, very commonly, we have to utilize both for the optimal result.

Depending on how the procedure is performed, the results can be seen as soon as in a couple of weeks or it may take up to six months to see the results.  It all depends on the number of areas treated, on the amount removed, on exact technique used, and amount of laser energy provided to the fat tissue.  Let us look at two scenarios.

In one we removed about 10 pounds from the patient or about a little bit of over 4 L.  Usually, we use a combination of techniques of traditional or tumescent liposuction or in our practice, power-assisted liposuction and SmartLipo.  Because such a significant amount of fatty tissue is removed, the improvement in the body shape will be noticeable pretty much within the first week or two.  As the swelling continues to subside, the shape and the final definition will continue to improve.  Any liposuction surgeon knows that the final results from liposuction will not be visible until three to six to sometimes nine months after the procedure.  The same is true for SmartLipo, so with the larger liposuctions, I would expect the results to be seen earlier and then continue to improve for the next six months or so.