News & Features


Liposuction -- With No Suction! Staff Report
Medically Reviewed by Jeffry B. Schafer, M.D.

CONSUMER BRIEF: The newest generation of liposuction machines uses lasers to melt -- and not suction -- fat. Some experts predict laser-based liposuction machines will entirely replace current technology. Others aren't quite so sure. But one thing is for sure -- the nation's most popular invasive cosmetic plastic surgery procedure has seemingly just taken a giant leap forward.

When 53-year-old "Tay", an airline employee in Atlanta, Georgia, went to see cosmetic surgeon Marcia V. Byrd, M.D., she, Tay, wasn't quite sure what procedure to ask for. (“Tay” is not her real name; the patient asked for medical privacy.)

Although Tay worked out hard four to five days a week, she still had love handles and thighs (pictured) that just would not give up the pockets of fat she considered unsightly.

That changed last December when Dr. Byrd recommended she receive Smartlipo, a new type of surgical fat removal process, to take off the love handles along with fatty areas on Tay's lower back.

"I could have gone back to work the day after the procedure, but I took a day or two to just rest," Tay told "I was able to start working out again two weeks later and now look like I never even had love handles."

53-year-old "Tay," shows her problem area in the left picture and the results of laser liposuction in the right hand picture taken one month after the procedure. (Photos, courtesy of Marcia Byrd, M.D.)

Laser Liposuction

Recovery from Smartlipo is much quicker and easier, experts say, because the exceptionally thin, laser-tipped tube, or cannula, seals blood vessels while dissolving fat cells.

"Smartlipo is a very minimally invasive procedure," says Dr. Byrd from her Roswell, Georgia, practice. "The laser constricts blood vessels as it works, so virtually no bruising is created. Plus, the cannula inserted into the treatment areas is the size of an 18-gauge needle. That is a thickness equal to two pencil lines drawn next to each other."

The stubbornness of human fat, or adipose tissue as it's known to doctors, can never be underestimated. Take the case of 37-year-old Colleen Donovan, a Long Beach, N.Y. esthetician. She runs triathlons, trains four days a week with weights and spends her weekends doing aerobics, biking, hiking and other active sports. Nonetheless, she also could not get the slim shape she desired.

"In a word, I had saddlebags," Donovan says. "And they just would not go away. I know Dr. Katz professionally and volunteered to take part in his study on Smartlipo. After the procedure, I noticed the difference within 24 hours. The saddlebags are now gone, leaving me loads of room the legs and seat of my jeans."

The Smartlipo machine came to America after Dr. Byrd, while traveling in Italy a year ago, happened to see a procedure with the new machine and took some training while there. Later, the manufacturer called to ask if she would like to have one of the first devices earmarked for the United States. Since early December 2006, Dr. Byrd has done about 75 Smartlipo procedures.

"The laser on the Smartlipo is one we surgeons have been using for years to remove hair and veins from skin," Dr. Byrd says. "I now use tumescent liposuction to remove large amounts of weight and then Smartlipo afterwards to tighten the skin. That usually means no return trips to the cosmetic surgeon for touch-ups.

In tumescent liposuction, saline, pain killers and other medications are injected into the fatty area being treated.

Recently People Magazine reported on Smartlipo, asking "Has fat has met its match?" Perhaps so. The procedure is certainly popular enough. According to the American Society for Aesthetic Plastic Surgery (ASAPS), almost 500,000 people in the United States had surgical fat removal via standard liposuction during 2005, the most recent year for which statistics are available.

Plastic Surgery

According to the medical literature, 12 to 15 percent of patients receiving standard liposuction must return for touch-ups. Statistics gathered in Italy, Brazil and Singapore -- where the device has been used for five years -- reveal the rate for Smartlipo is only one percent.

When Bruce E. Katz, M.D. of the Juva Skin and Laser Clinic in New York City started performing procedures with Smartlipo, he noticed that the laser seemed to cause collagen growth under his patients' skin. Collagen is the most abundant substance in skin, tendons and connective tissues, and is often injected in a pure form by plastic surgeons to plump up sagging areas and remove wrinkles.

"The company later asked me to organize a study on the machine's effects on collagen so we can now say, yes, the heat from the laser stimulates more collagen growth during a Smartlipo procedure," Dr. Katz says. "Moreover, the effect continues working for three to six months after the patient leaves the office."

Dr. Katz is additionally a professor of dermatology at New York's Mt. Sinai School of Medicine and has been performing liposuction since 1982.

According to Drs. Byrd and Katz, the melted fat often oozes from the incisions which are so tiny they require no stitches. In some cases, the surgeon uses a small suction cannula to remove the liquid fat. Any other fat that remains is absorbed and eliminated by the body's lymphatic system, experts say, but does not enter the bloodstream.

Plastic Surgeons

While the device was approved by the FDA. on October 31, 2005, the Italian company making the machines has been slow to deliver its goods. Nonetheless, plastic, cosmetic and dermatological surgeons are lining up in droves to learn how to do the new procedure.

"Another plus is that the doctor can see the red laser light working under the skin so he or she sees exactly where the cannula is working," says Dr. Katz. "For the surgeon, it's as easy as running a hot knife through butter."

Standard suction-based laser machines are often equipped with power assisted handles because pushing a cannula back and forth through large areas of fat can be arduous on the surgeon.

"There are some cases where suction-based liposuction actually makes an area worse by removing the fat and leaving loose baggy skin," says Dr. Katz. "Now we can do both -- remove the fat and tighten the skin."

Adds Dr. Byrd: "The Smartlipo is great on the neck, the ankles, the knees and other smaller spaces. The surgeon can also extend the laser tip out of its holder while under the skin and bend it around curving places in the body. Before, you were pretty much limited to pushing and pulling the cannula in a straight line."


Additionally, thanks to minimal anesthesia, surgeons can safely ask their patients to stand during the procedure to make sure the enhancements are symmetrical and balanced. Most procedures require only 45 minutes to an hour; patients still must wear compression garments after the operation. The area where fat cells have been zapped will never gain weight again. If you do pick up some pounds later on, the fat will be deposited elsewhere in the body.

Todd K. Malan, M.D., a board-certified, cosmetic gynecological surgeon at Innovative Cosmetic Surgery Centers Arizona is so far the only physician in his state -- and one of the first in the U.S. -- to offer the procedure. Since December 2006, he has treated 86 patients and is perhaps one of 18 centers in the United States equipped to offer it.

"From where I sit, the laser-based Smartlipo device is going to completely replace the suction type machines," Dr. Malan says. "That has already happen in Italy, Brazil and a few other nations where Smartlipo is used."

Dr. Malan also trains other physicians who want to learn the ropes on the device.

But in areas of the nation where there are no weight loss gurus or any liposuction devices, you can always heed the immortal words of comedian Rodney Dangerfield and manage to look thin by choosing to only be seen with fat people!

Editor's note: Medical reviewer Jeffry Schafer, M.D. of New Image Cosmetic Surgery in Coronado, California, is the only physician on the West Coast trained and equipped to deliver Smartlipo. He has performed suction-assisted liposuction for 15 years and currently performs 40 to 60 liposculpture procedures monthly.

Links to addition articles about liposuction:

Doctor Performs Liposuction on Himself

Liposuction, Massage and Good Vibrations

Redefining Shape with Ultrasonic Liposuction

Liposuction Tops the Plastic Surgery Charts ...Again

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