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CosmeticSurg Blog

Dr. Rodriguez discusses Plastic Surgery, Medicine, and Stem Cell Research

New liposuction technologies: How smart is Smart Lipo?

Smart lipo is a new technique for liposuction.

Smart Lipo and Ultrasound Lipo do not suck the fat out

Dr. Rodriguez

New techniques usually have a period of intense excitement by media and surgeons, fueled by the promise of better results. It takes time before we get enough experience to know what are the true pros and cons of the technique. We went through this cycle with ultrasound lipo, but ultrasound hasn’t caught on in a major way. It remains to be seen whether Smart Lipo catches on.

Smart Lipo gives poor results

Smart Lipo gives poor results in this patient. Oval outlined area has lumpy and bumpy skin.

Like proponents of Ultrasound lipo, Smart lipo proposes that the energy given off by the cannula (the long cylinder) melts fat cells and helps tighten skin. The process is supposed to be less traumatic and give better results. But does it, really?

Recently,  I saw a patient who came to me because she was unhappy with her Smart Lipo results which were performed by another physician. She had Smart Lipo several months ago and her photos (after Smart Lipo) are shown to the left. She is unhappy because she has, in her own words, lumpy bumpy skin below the belly button, and a pocket of fat on the right of the belly button. She had one revision already and she feels her skin, if anything is looser now. She also states she had a lot of pain after surgery, and still has pain, although it is much better. Finally, she asked if there was anything I could do to fill in the wrinkles in her back.

To help you understand her concerns better, let’s discuss the difference between the traditional liposuction techniques and the new laser techniques. The word liposuction means literally sucking fat. Traditional liposuction does just that, it sucks the fat. It is a mechanical effect which is performed with a long cylindrical tube called a cannula. Smart lipo and Ultrasound do not suck the fat out. Instead, these technologies perform lipolysis, which means to cause the death of the fat cell by destroying the cell membrane.They do so using heat energy , instead of the manual effort of sucking the fat out.

The problem with these laser lipo techniques is finding out how much energy to use. Results vary dramatically according to the amount of heat energy used. The learning curve with ultrasound technology has been to diminish more and more the field of energy given off by the cannula. The pioneers in Laser lipo are in the process of fine tuning how much energy to use to get the best results. I know, because they present the data openly and honestly at our  annual ASPS (American Society of Plastic Surgeons) meetings.  Moral of the story: These technologies are not there yet.

smart-lipo-marked-back1

White Rectangle area shows wrinkled skin  .  White circles show marks from multiple cannula entry sites.

To me there are three problems with Smart Lipo. The first has to do with the fat that is left behind. How much has been injured, but not lysed, and how will this injured fat heal? This problem is like what happened to skin laser technologies. We can’t really predict how the injured tissues will heal. The initial excitement of laser skin resurfacing was damped by the unpredictable and varied results. I believe that ultrasound liposuction does not offer predictable results.

The second issue with Smart Lipo  has to do with the promise of skin tightening. The skin tightening seen with Smart Lipo is temporary and has to do more with swelling and immature scar formation than a permanent change. The same promise was made with ultrasonic lipo and it was not shown by experience. This patients back view picture demonstrates this clearly. Whether too much fat was taken off or the fatty tissue destruction was unpredictable, there was no skin tightening in this patient.

The third concern has to do with the issue of pain. The cells (Schwan cells) that protect the nerve fibers are filled with fat that acts as an insulator. This fat is also lysed by the lipolysis techniques (Ulatrasound and Smart Lipo). The fibers are then raw for a while. This is why there can be more pain with Smart Lipo compared to traditional liposuction with thin cannulas.

Having also seen poor results with Ultrasonic liposuction, I will wait until this Smart Lipo technique is refined, and will spare my patients the giant experiment going on to figure out what the right dose of energy is for Smart Lipo.

In the meantime, there is already a technology that has had multiple refinements and has stood the test of time (decades) for safety, reliability, and predictability. It is fine cannula liposuction. It is hard to do, because it is manual and takes stamina, but it pays off.  I am sure there are surgeons that get great results with Smart Lipo, but it is because of their skill and knowledge, not because of the technology.  With Smart Lipo–It’s the tennis player, not the raquet, that wins the match.

Traditional liposuction with thin cannulas still offers the best consistently good results .

By Dr. Ricardo L Rodriguez
Board Certified Plastic Surgeon
Baltimore, Maryland
Ricardo L Rodriguez on Google +

Posted in Body

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44 Comments

  • wrote
    August 6, 2014 at 10:17 pm

    I have practiced for 26 years and have seen lot of techniques come and go.
    I do not think Aqualipo has anything special going for it. It is less damaging to the tissues that Ultrasonic lipo or Smart (laser) lipo.
    But the gold standard remains small cannula lipo.
    And finally, as they say, it’s the tennis player, not the raquet, that wins the game.

  • wrote
    August 4, 2014 at 1:45 pm

    What are your thoughts on Aqualipo? Any better than laser or ultrasound lipo or the same?

  • wrote
    May 18, 2014 at 1:44 pm

    Emini:
    How have things turned out? has the pain gone away? Did you get the results you wanted?

  • wrote
    April 18, 2014 at 11:29 pm

    Hi Doc,

    Well I have been reading your post and others comments. I feel like your the best person to ask this. I recently purchased a couple of ultrasound cavitation s. So I got my first one last week and I got sick afterwards with sstomach cramps. I went to my regular doc’s both general and gyn… To check me out. Every thing was fine. I had my second treatment today and I realize it’s the same pain again afterwards. Please comment. I’m thinking it’s the ultrasound technology. Is it to late to prevent damage?

  • wrote
    April 3, 2014 at 3:15 pm

    Hello Doctor:

    I got a traditional abdominal liposuction 2 years ago. I am relatively fit and work out a lot but I needed some extra help.
    The It appears as if the surgeon “sucked too much fat out of the left side of my belly button, its a bit “dented”. A doctor told me I might need a fat graft there so it even out with the right side.
    And, On my sides bilaterally I have what appears to be cannula prints, over my ribs on both sides I could notice irregularities of my skin, it almost looks like cellulite. I didn’t have this before my surgery.
    Both of these problems make me regret getting the lipo.
    I’m a man, 27 years old, and in pretty good shape. Any recommendations?

  • wrote
    March 2, 2014 at 12:25 pm

    Carol:
    People deposit fat in different parts of their bodies according to their genetic disposition. Some people accumulate fat in the area you mention.
    Breast tissue is an outgrowth from the nipple and is not normally found in the axilla. It can be displaced to the axilla when you lay down and the entire breast slides over, but it is not attached to the axilla or arise from there. Several years ago I did a study with women in prone position (on their stomach) with breast hanging and got CT scan images. The breast tissue segregated very nicely from the axillary fat pad.
    We do a lot of liposuction to the axilla and the results are very good. We simply shift the breast medially while liposuctioning the axillary area. As long as you use a small cannula with small holes you are not likely to injure anything.
    We have also liposuctioned the breast and got good results.
    Contact Kelly at kelly@cosmeticsurg.net we’d be glad to help you get rid of those bothersome fat deposits.

  • wrote
    February 28, 2014 at 1:53 pm

    I am not really overweight (high normal) but have bothersome fat deposits in the armpit and upper back. I have heard that armpit fat in women is sometimes actually displaced breast tissue. Can it be breast tissue if there is no accessory nipple? How to you test to see if it is breast tissue vs. fat? Is it even important to know? (I.e., is the treatment for it any different, or do you simply suck out that material along with the regular fat through liposuction?) Also, does the proximity of delicate lymph glands make it more risky to perform liposuction in the underarm area?

  • wrote
    September 13, 2013 at 7:36 am

    Angela:
    You probably have a lot of scarring around the nerves.
    Scarring is not usually permanent. I advise you to wait until 18 months have gone by to see if this is a long term issue or not. If it is a problem then I would recommend you consider fat grafting to the affected areas. Fat grafts have stem cells in them and that may help regenerate some of the nerve tissue.
    Fat grafts with the stem cells in them can be very helpful against scarring.
    Keep us posted!

  • wrote
    July 26, 2013 at 11:25 pm

    Hi Dr. Rodriguez,
    I had a smart lipo done a little more than 5 month ago on my tummy and love handles. since then, I have no more feeling in those area’s. I do around 200 sit ups (more or less) every day and I don’t feel my musles at all. no aches. the worst part is that I don’t feel anything during intercourse with my husband. no sensation what so ever. I’ve seen a neurologist and he told me I could be nerve damage, temporary or permanent. He said only time will tell. the clinic where I had it done, keeps telling me that this is normal numbness. but nobody told me before that anything like this could happen, other wise I would’ve never ever signed up for that. so he recommended, keep doing my sit ups, also my husband massages the area every night with arnica cream, i’m also taking advil twice a day and vitamin B6. all on doctors orders. so far nothing has improved. can u help me please????

  • wrote
    June 2, 2013 at 7:23 pm

    Irma:
    I am so happy that you have found some comfort.
    These techniques (ultrasound, laser) that are energy assisted do affect the nerves and leave a lot more damage than people realize.
    In your particular case the conventional lipo probably released a lot of nerves that were bound up in scar, or released scar tissue that was adhered to muscles.

  • wrote
    May 30, 2013 at 5:16 pm

    I had Smart Lipo done 2 years ago by an Opthamologist & I hated my results, many ripples under my skin & I had pain throughout my body & I was always exhausted. I visited with a plastic surgeon & had traditional Lipo done on the 24th of May. He informed me that I had a lot of scar tissue due to my previous Smart Lipo procedure. I can tell you, I feel so much better having had traditional lipo done and I can finally stand up straight without pain.

  • wrote
    May 19, 2012 at 12:16 pm

    Shan:
    If I had a dollar for every Smart Lipo complaint I hear I’d be a rich man.
    You will need fat grafts done carefully under the skin to restore some of the skin integrity.
    We do a lot of fat grafting and get patients from all over, including England. If you are interested call Kelly at kelly@cosmeticsurg.net

  • wrote
    May 19, 2012 at 11:52 am

    Jana:
    I personally know one of the Plastic surgeons who pushes and lectures about Smart lipo.
    He just uses it a little in the beginning to break up the fat then moves on right away to normal liposuction. That should tell you something. Laser Lipo may work in some cases, but the healing phase is just too unpredictable.

    The gold standard is still thin cannula lipo, but it is not as popular because it is a lot of hard work for the surgeon. All I can do is show my results and let people decide on their own. I have not done a lipo revision in years, but I get a loot of consults to deal with the after effects of laser lipo.

  • wrote
    May 10, 2012 at 7:11 pm

    Hello Dr. Rodriguez. Thank you for making your knowledge so easily accessible. I have read all the comments/questions and your responses below and understand that you still prefer “thin cannula lipo” over Smart Lipo technology.

    I am looking into getting something called the TriSculpt process done and would like your opinion as to whether it is indeed the thin cannula type lipo you recommend or is it really Smart Lipo in disguise?

    In their description of the process they mention Power-Assisted Liposuction in which the physician “uses power-assisted technologies with micro cannulas and gentle suction to effectively remove the majority of unwanted fat.”
    And Micro Laser-Assisted Liposuction which is “special laser-assisted equipment used for the finishing touches. A tiny micro cannula with a low powered laser fiber gently warms the fat cells. The micro-laser is so tiny that it can contour small areas that were more difficult to treat in the past, such as upper arms and under the chin. This technique smoothes out the work done with the power-assisted micro cannulas and stimulates collagen formation which can help the skin tighten, producing a smooth final appearance to the treated areas.”

    Please let me know what your opinion is on this TriSculpt process. I have set up a consultation to ask more specific questions about the procedure/results and am gathering as much info as I can before going to the consultation.

    Thanks again for sharing your knowledge with us.

    Sincerly,
    Jana

  • wrote
    April 25, 2012 at 12:24 pm

    I had smart lipo done in harley street , I had the procedure on my lower abdiment and it has left me with loose wrinkled skin , I just wanted to know if their is any type of botox or filler that can just simply fill in the wrinkles.

  • wrote
    March 16, 2012 at 1:56 pm

    Ethel:
    Glad you went to see a specialist to rule out a digestive problem.
    The pain and burning are called paresthesias, which means abnormal sensations. It means the nerves in your belly have been scarred or are trapped by scar tissue. This is a problem when you use energy modalities of liposuction such as laser (Smart Lipo) or ultrasound (Lysonix).
    The answer may be what I described before, a tummy tuck, or fat grafts to the area.

  • wrote
    March 16, 2012 at 1:52 pm

    Ethel:
    I am sorry to hear about your experience. It is not the first time I hear about problems with Smart Lipo. That may not be related and I recommend seeing a gastroenterologist (specialist in diseases of the digestive tract) to make sure nothing else is going on.
    As for the rest of your symptoms, I have treated patients that have had smart lipo and have ended doing tummy tucks on some to lift the skin and free up the scarring underneath, and in other patients I have injected fat tissue because it contains stem cells that help break up the scar.
    Give us a call if you want us to evaluate you- contact Kelly at kelly@cosmeticsurg.net

  • wrote
    March 15, 2012 at 9:06 pm

    i went to my dr and he checked me for a ucler, i did not have , i burn bad some times, i dont know what to do ..

  • wrote
    March 15, 2012 at 8:57 pm

    i had smart ;ipo done 8 months ago. have burned and hurt in middle of stomach and on left and right side of navel.. when i eat it hurts like crap. is there any thing i can do to help this . when i drink coffee it kills me , some times when i sleep the pain wakes me up burning sos bad…

  • wrote
    December 19, 2011 at 10:06 pm

    Sandra:
    Smart lipo liquefies fat cells. The cells covering and protecting nerve cells are Schwann cells, which are a modified fat cell. They also can get destroyed by “Smart” lipo.
    Your nerves will recover, but right now they are raw. You will need to continue wearing compression garments and do massage of the area to prevent scarring around the nerves.
    Neurontin is a pain medication that helps with irritated nerves. Analgesic patches over the skin of the affected area can also help. They are”over the counter”, so you can get them at any large pharmacy.
    I have had that problem 2 times in 21 years of practice, both times associated with ultrasonic liposuction, which I haven’t done in over 10 years.

  • wrote
    December 8, 2011 at 5:24 pm

    Dr. Rodriguez,

    I had smart lipo done August 5, 2011. My results are mixed, while my saddlebags and banana rolls have improved, my inner thigh and knees show little results and the skin although does not sag is “soft”. However, the reason I am writing is you mention pain as a factor in your view of smart lipo. Since the procedure, when I lay on my side, I have had intense pain in my right hip abductor/outter thigh. This pain is excrutiating and wakes me up in the middle of the night. I have an extremely high threshold for pain and experienced no down time with my procedure. In fact, I did not feel the need take the prescribed pain meds and was out shopping hours after the procedure. I did take advil when needed but it was rare. My question, is this problem common? And, is there anything I can do to alleviate the pain? According to my doctor, it “should” get better with time; but, to date, it has not.

    Thank you for your time. It is most appreciated.

  • wrote
    October 30, 2011 at 3:16 pm

    Kevin:
    You work for a laser lipo company so I can understand your enthusiasm for the technology.
    The problem is inherent to the technology. The laser energy damages tissue around it, and not all the damaged tissue is removed. The damaged tissue is then processed by the body, and that is unpredictable, and varies with every patient. Furthermore the skin tightness seen initially collapses after 12 -18 months.
    Patient follow up over time is very educational, and I continue to be underwhelmed by the results of energy driven (laser or ultrasonic) lipo.
    Conventional thin cannula liposuction is very predictable, and like in a game of golf, predicting how the ball bounces after it hits the ground is far more important than hitting it far.

  • wrote
    October 17, 2011 at 7:11 am

    Have you noticed a change with the procedure now that the technology is more mature? Have you evaluated the lipo laser using gps guidance (lipocontrol)?

  • wrote
    June 26, 2011 at 9:54 pm

    Sam:
    There is a lot of room for interpretation in your question. The short answer is yes, we could help you. The long answer is that if we talked and I saw your pictures we could come to an agreement as to what are realistic goals.
    There are many options, but to get specific about this or that curve, I’d need to see pictures.
    Contact Kelly at kelly@cosmeticsurg.net, we’d love to hear from you!

  • wrote
    June 19, 2011 at 11:55 pm

    Hey Dr. Rodriguez,
    I’m considering getting some kind of fat removing surgery done. I’m 5’8 and 165lbs. I love my curves just not all of them. I have somewhat of a messy pear shape, but I just want a decent pear. Would you still recommend the fine cannula liposuction if I just wanted to loose the rolls and “extra” curves around my stomach but not necessarily shrink my overall size? If not what would you recommend?

  • wrote
    May 21, 2011 at 1:54 am

    The new technologies are really non-invasive like smart lipo and many more. These technologies have reduced pain and anxiety of patient indeed. Traditional procedures needs much effort both from surgeon and patient and the healing process will also take less time compared to traditional liposuction.

  • wrote
    April 2, 2011 at 2:54 pm

    Magdi:
    Scwann cells are modified fat cells that wrap themselves around nerve fibers to provide protection to the nerve cells.
    Traditional lipo can damage Schwann cells in very special circumstances, as with a “direct hit” if the cannula hits the nerve. But that would be a rare event and even then the cell may survive. Smart lipo works by literally boiling the cells.
    In practice patients complain much more of pain after SmartLipo than thin cannula lipo.

  • wrote
    April 1, 2011 at 4:10 pm

    Hi Dr.Rodriguez,
    You have spoken about injuring the fat cells that are incorporated into the Schwan cells, when performing SmartLipo, but how can you be sure that this doesn’t happen when perfoming a traditional liposuction with a thin canula?

  • wrote
    March 6, 2011 at 1:41 am

    Francia:
    Without seeing your particular case, I cannot make a recommendation.
    I suggest you contact Kelly at kelly@cosmeticsurg.net and she can set up a virtual consult so we can help you.
    We have treated many patients that have had “Smart Lipo” and we’d love to help you out.

  • wrote
    February 26, 2011 at 12:02 pm

    Hi Dr. Rodriguez.

    I did a Smart Lipo four years ago and I have now some bumpys skin. My abs are not flat. It same like I have celullite in my tummy, but is not. How can I corrige that?

  • wrote
    January 28, 2011 at 5:23 pm

    Lynne: I really would not feel right recommending anyone unless I had seen their work consistently.
    You are going to have to trust your own instincts on this. Be sure the surgeon has been board certified by the American Board of Plastic Surgery.

  • wrote
    January 26, 2011 at 11:06 am

    Hi Dr. do you have any suggestions as to which surgeons I should go to if I want to do LipoSmart?

    many thanks,
    Lynne

  • wrote
    January 24, 2011 at 12:41 pm

    Hi Dr.

    Thank you for your feedback.

    if I do need to have Liposmart, who woudl you recommend me to go then in order to minimise any negative side effetcs? I have been thinknig of Dr. Theodorou. Any suggestions?

  • wrote
    January 24, 2011 at 12:37 pm

    Lynne:
    I still don’t recommend Smart lipo, as I still keep seeing bad results from it.
    One of them, unfortunately, was from a surgeon who lectures extensively on Smart lipo.
    As far as time goes, ultrasound lipo has been around 1996, and never fully caught on. I realize technological advances are what makes medicine exciting, but there is something to be said for the tried and true. In this case, thin cannula lipo still rules.

  • wrote
    January 19, 2011 at 12:41 pm

    Hi Dr. ,

    having read your article above, would you now recommend lipo smart to me? Do you think the right dose of energy has been figured out as of 2011?

    Many thanks,
    Lynne

  • wrote
    December 12, 2010 at 9:37 pm

    Amber:
    I always see my patients at the initial visit. They only see my assistant Kelly after they have spoken with me at length, and then only to make decisions of a financial nature.
    Do not accept a situation where you speak to the surgeon after you have made a decision. That is really not my style. I think the surgeon is there to educate you as to what your options are. Think of it this way, for any medical type surgery, would you accept a consultant’s opinion BEFORE you met with the surgeon?
    I meet with many patients who change plans after holding a conversation with me.
    Good luck, but avoid having a consultant make your decisions. I don’t care how good the surgeon is, you are paying for the use of his brain and hands, not for some consultant’s advice (who may not be even an MD) and his hands.

  • wrote
    December 6, 2010 at 9:05 pm

    There’s a lot of clinics that offer many cosmetic procedures including liposuction. I’ve been looking at some where you have to speak with a consultant first as an initial consult…I wonder Dr. Rodriguez, do you speak with all your potential patients in initial consult prior to them making a decision? Or is it common for most doctors to speak with the patient only when the patient has made a decision to do the procedure? I find it hard to decide based on consultation with someone not doing the procedure rather than the plastic surgeon…how would I know if they are good?

  • wrote
    May 8, 2010 at 6:48 am

    Blair:
    Unfortunately, it is hard for me to know individual Plastic surgeons in other states.
    The best thing you can do is to go over the other blog posts I have on lipo and educate yourself well. Then when you go to the plastic surgeon, ask very specific questions.
    There are good resources to find who are the Board Certified Plastic Surgeons in your area, such as the American Society of Plastic Surgeons
    Also as important is to find out how available your Plastic Surgeon is going to be after surgery
    Finally, make sure you have good rapport with the surgeon. There are many well trained surgeons, go with somebody you like.

  • wrote
    May 6, 2010 at 4:54 pm

    I enjoyed your article; informative and to the point. Can you pls recommend a surgeon in the Tampa Bay area that performs traditional liposuction? 39 yr old male in great shape, however, just cant seem to lose these damn love hanldes. Thanks

  • wrote
    January 9, 2010 at 3:28 pm

    Lorane:
    To be honest with you, external ultrasound, as it’s called, is best used as an adjunct to liposuction. Even the plastic surgeons I know that are big fans of it do not use it alone.
    Believe me, if there was a good noninvasive alternative to liposuction, everybody and their grandmother would have had it done by now. Even I would get it done!
    Unfortunately, I don’t think we’re there yet.
    Happy New Year!

  • wrote
    January 7, 2010 at 11:16 am

    Dear Dr Rodriguez

    How do you feel about the non-invasive technique which uses ultrasound to break up the fat cells? I was thinking of it

    king regards

  • wrote
    November 4, 2009 at 2:40 pm

    Thank you for this information Dr. Rodriguez. I have been researching this issue on my own and find that most plastic surgeons agree with you. I would much rather do something with more predictable results.

  • wrote
    April 14, 2009 at 10:45 am

    The options are limited and not perfect, but something can be done to make things better.
    First option: Run a small cannula thru without liposuction to break up the tissues, and a second specialized cannula to free up scar tissue. Hopefully the tissues will set set in smoother pattern.
    Second option: A combination of lipo and fat injections. This can get expensive.
    Third option: Tummy Tuck or dermatolipectomy. This will give the smoothest option, but will leave a Tummy Tuck scar. A great option if the patient has loose skin.

  • wrote
    April 6, 2009 at 10:29 pm

    i read your posting about a patient who came to you with unhappy results from a SmartLipo procedure. The Lumpy, bumpy belly. What did you do to help correct that?
    Curious.
    Jennifer