Liposuction vs. SmartLipo - which procedure is better?

You've gotten a lot of opinions on this thread, from real, board-certified plastic surgeons and non-plastic surgeon cosmetic practitioners.  If you decide to have a procedure performed with a fancy device, make sure you understand that there is no magic to plastic surgery.  The old adage applies: If it sounds too good to be true, it probably is.  Many non-plastic surgeons are spending big bucks buying hot new machines in an attempt to break into the cosmetic market.  Make sure you feel comfortable with the surgeon you choose, and make sure they are not selling you a service in order for them to make payments on their expensive lease.  If all else fails, see a number of surgeons certified by the American Board of Plastic Surgery, and go with the one you feel most comfortable with.

A common question is which is better - traditional liposuction or smart liposuction. If fact, both procedures are good - it all depends on the desired results, patient's body composition, and the skill and experience of the surgeon. My recommendation is to go to a few consultations and ask to talk to former patients who have undergone either of the procedures.

David Shafer, MD
New York City

It's not the machine that will give you a better result, it is the artist using the machine. Go with the doctor who has been trained better, has more experience, and has great results.  Also, make sure that the doctor you choose can treat your complications as well.

The different techniques and machines involved in surgery may enhance the results however they are still operator dependent.  The skill level of each surgeron varies.  Decide which doctor you trust more and go with him or her.  My suggestion is not to base your decision on the technique. 

#1 - Tumescent anesthesia - describes the infiltration of fluid into the area to be suctioned. The fluid has a local anesthetic as well as adrenaline to reduce bleeding and prolong the anesthetic effect. Almost everyone is using tumescent anesthesia, whether you are a plastic surgeon or not. Whether you do it under general anesthesia or not is unimportant. Many doctors choose to perform it under general anesthesia because it hurts to inject the large volume of tumescent fluid. Some doctors put their patients into a twilight sleep for the injection and then wake them up once the anesthesia has taken effect. This allows them to ask for patient cooperation for standing up to see all aspects of the patient while creating a symmetrical result. I find this to be the safest and most comfortable way to perform the procedure. If a patient wants to be awake for the entire procedure then great, but expect to have more discomfort.

#2- Read many of the reviews below and everyone espouses a particular treatment based on which machine they own. The facts are these;

a) a study done in Europe demonstrated that skin contraction was directly propotional to the number of remaining fascial attachments between the skin and underlying tissues after the treatment. That makes sense because these bands add to the overall structure and rigidity of the skin.

b) the study then looked at the number of remaining fascial attachments after Laser Liposuction (Coollipo, Smartlipo, Slimlipo), Ultrasonic Liposuction (Vaser), Power assisted liposuction (a mechanism creates small precise back and forth movements for the cannula) and traditional liposuction.

The order from best to worst for fascial attachments was - Power-assisted liposuction, traditional liposuction, ultrasonic liposuction and in last place was laser liposuction.  You decide!

#3- Both laser liposuction and ultrasonic liposuction has the added risk of burning the skin. Also a higher risk of fluid collections under the skin.

#4-With regard to small areas, all techniques described above are able to aspirate small areas in a precise manner. It is the size of the cannula that matters, and there are small cannulas for all techniques. Remeber that both laser and ultrasonic liposuction requires traditional liposuction to remove the destroyed fat after treatment.

So based on the above, you decide.

Robert M. Freund, MD FACS

New York, NY

Traditional liposuction is usually performed by plastic surgeons under general anesthesia. The anesthesia is the riskiest part of the procedure and as a result, speed is of the essence. So large cannulas are utilized to quickly aspirate large volumes of fat. Unfortunately these larger instruments and time constraints can lead to poorer results. Traditional lipo is best done when another procedure such as a tummy tuck is done at the same time. Smartlipo utilizes tumescent anesthesia which is done while awake using smaller cannulas. It takes longer and is more precise. The laser also adds a tremendous component of skin tightening not seen seen in traditional lipo. In general, Smartlipo is safer, offers better results and skin tightening and is the future of liposuction. Plastic surgeons have not embraced the procedure due to the cost of the laser. A properly trained physician can perform this procedure as well any plastic surgeon or dermatologist. Make sure you meet your doctor and check his background and results. There are good and bad doctors in all specialties.  The funny thing is that many physicians who don't use Smartlipo, will still espouse the use of lasers to tighten facial skin!  Why does it tighten the face and not the tummy?  Heating the skin with a laser will tighten the skin anywhere on the body.

Do your research!

SmartLipo definitely provides excellent results with less down-time than 'traditional liposuction' or even tumescent liposuction (which is probably what the plastic surgeon that you went to wants to perform). Just look at the satisfaction stats on this website.

SmartLipo takes longer to perform properly than traditional liposuction.  Traditional liposuction with microcannulas can come close to SmartLipo for results, but the skin-tightening effects of SmartLipo cannot be matched by basic liposuction.

At our office, we use the TriActive device before and after liposuction (SmartLipo and tumescent) to help improve outcomes and healing.

Ultimately, you need to make sure that the physician you go to performs many different techniques and can guide you to the one that is right for you. To quote a quote, "If you only have a hammer, everything looks like a nail."

Finally, beware of the bait-and-switch ... many physicians have sold patients on SmartLipo and/or traditional liposuction with microcannulas and then perform the procedure as a 'lunchtime' procedure in 90 minutes.  They 'pass' the SmartLipo through and/or use a few microcannulas then switch to standard cannulas to finish quickly.

Make sure you get what you want AND need.

Good Luck

One can imagine that if you only have one technique to offer, then you might advertise it as best. The docs (often not plastic surgeons) who offer smartlipo and tell you to "make sure you are having tumescent lipo done" are clearly missing the point here. How can the dermatologist who answered this thread say that smartlipo is the better procedure? Some people are going to benefit from Smartlipo and some people are going to benefit from traditional liposuction. You need to find a plastic surgeon who can offer you smartlipo, ultrasound lipo, power assisted lipo, and traditional lipo. Only when you have a doctor sitting across from you who routinely performs all types of procedures can he/she tell you why one particular method is best for you. A plastic surgeon trained in body contouring who not only does liposuction but also tummy tucks/lifts etc can tell you what will work best and give you the most honest advise. In my practice I offer all types of liposuction as well as other surgical options. Many ladies come in asking for smartlipo and they just are not good candidates for the procedure. I can educate them as to what will work for them and why and let them make an educated decision. A few miles down the road from me the emergency room doc who does smartlipo will offer it to just about anyone. The general surgeon offering smartlipo in the town next to me will offer it to just about anyone. I believe this is why you see the scores of patients unhappy with the procedure on this website. It all comes down to patient selection and educated decision making.

Any doctor can legally do any procedure in his or her office. Hospitals will generally limit privleges to procedures that the doctor has been trained to do. Only Plastic surgeons have adequate training to assess and treat all areas. They are also more able to treat any complications adequately.

If in doubt ask if the doctor can do liposuction in a hospital.

There is a new technique available which I believe will make both SmartLipo and conventional liposuction nearly obsolete. It is called SlimLipo. The SlimLipo device uses a 920 nm wavelength administered with a clear flexible rod. This wavelength appears to be very good at selectively melting fat. It also delivers a second wavelength that is very good at causing tissue contraction of the loose skin that is present after removing the fat.

The SmartLipo uses a different wavelength that works by heating the water that is present in the fat. The heat generated by the SmartLipo does not appear to be selective for fat which may increase the risks of damaging overlying skin.

Conventional liposuction does not use a laser to remove fat. Instead, it uses a high powered suction to remove fat with a hollow tube called a canula. This technique seems to cause more bruising and longer recovery.

Smart lipo is simply a relatively new technology in which laser heat is applied to the fat, blood vessels, and the undersurface of the skin in combination with traditional liposuction techniques. The idea is that it can cut down on bruising, perhaps create a more even and symmetrical final result, and tighten the skin. In some circumstances, it can be performed without a general anesthetic or even IV sedation, and for this reason, many practitioners who are not Plastic Surgeons (ie general surgeons, ear nose and throat surgeons) or not even surgeons (internists or dermatologists) are adding it to the services they offer.

I personally use it in select patients and have been very happy with the results, when properly applied. However, it is very important to remember that it is still a surgical procedure with real risks, perhaps even more risks than traditional liposuction in that the surgeon must understand how to use the laser properly, and so I would highly recommend a properly qualified and trained Board Certified Plastic Surgeon in your area who is familiar and comfortable with the technology.

Finally, either Smart Lipo or traditional lipo can give you excellent results, but it depends on the surgeon and your specific anatomy. It can be done safely and effectively either in a hospital OR or in an Ambulatory surgery center, with multiple types of cannulas, and with different types of sedation. The critical thing though is that you must be evaluated by someone who understands the strengths and limitations of each type of procedure, understand surgical principles in general and the art of liposculpture in particular, and be able to understand your anatomy and specific goals. In this way will you give yourself the best chance at an excellent result!

Dr. S