Press about Charlotte plastic surgery

Traditional liposuction is one of the more traumatic procedures we perform as plastic surgeons.  The simple to and fro motion of a blunt liposuction cannula generates significant tissue trauma, swelling, and prolonged recovery.  Due to this fact, a lot of energy has been spent searching for kinder and gentler alternatives.  One potential alterative promoted in recent years involves lasers. 

The word LASER is an acronym for Light Amplification by Stimulated Emission of Radiation.  Lasers have many important applications in medicine, including the targeting of fat cells.  Beginning in the early 1990s, Deka, an Italian laser company, developed a 1064 nm Nd:YAG laser that targeted and ruptured fat cells.  Today, there are three FDA-approved laser-assisted liposuction systems available in the U.S., including SMARTLIPO (Cynosure), COOLLIPO (CoolTouch), and PROLIPO (Sctiton).  

The real question is this: Is laser-assisted liposuction better than traditional liposuction?  Information on the internet regarding lasers and liposuction is confusing for patients, and it is hard to carve through both the hype and cynicism and get to the truth.

Proponents of laser-assisted liposuction are often non-Plastic Surgeons who recently joined the field of body contouring after practicing other forms of medicine, including ENT, Dermatology, ER Medicine, Family Practice, and Obstetrics and Gynecology.  These practitioners often oversell the benefits of this technology since it is often the only arrow in their body contouring quiver.  Opponents of laser-assisted liposuction are typically Plastic Surgeons who have not used the technology and take a rather blunt and defensive posture.  As is usually the case, the truth  lies somewhere in the middle.  Here is some background to help you decide for yourself:

HISTORY
As mentioned previously Laser-assisted liposuction was developed in Italy by DEKA in the early 1990s.  The first clinical description of laser-assisted liposuction was in 1992 by Apfelberg.1  In 1996, a multi-center FDA trial comparing standard liposuction to laser-assisted liposuction was performed.  Laser-assisted liposuction possessed a shorter recovery time and less bleeding, but the clinical outcomes were equivalent and the sponsoring company, Haraeus Lasersonics, abandoned the technology.2  This study has played a significant role in shaping plastic surgery opinions about laser-based liposuction.  One critical point to make regarding this study is that it involved a laser whose tip was not in direct contact with the fat.  It was rather housed within a large cannula (between 4-6 mm), thus making it potentially much less effective than what is on the market today.   This is particularly true when it comes to treating the skin.

In 2005, Badin studied a 1064 nm laser whose fiber extended past the distal end of a 1 mm cannula, thus putting the laser in direct contact with adipose tissue.3 Badin found laser-assisted lipolysis was less traumatic than liposuction, due in part to the use of this much smaller cannula.3 In addition, he also noticed the Nd:YAG system improved skin retraction.3  Since then, other studies have followed, demonstrating coagulation of blood vessels, and coagulative necrosis of collagen, which leads to new collagen formation and skin tightening.4

HOW IT WORKS 
Lasers are focused light energy.  Depending on the wavelength of that light energy, it will be attracted to and absorbed by specific substances in your body.  For example, the Nd:YAG laser, the one used in SmartLipoTM, has a wavelength of 1064 nm.  This wavelength is attracted to water.  Fat cells and skin contain water.  When fat cells contact this laser, they absorb the energy, swell, and then rupture, draining their contents.  Once this occurs, an oily residue is suctioned away much like traditional liposuction. 

One of the key reasons that laser-assisted liposuction is gentler is that the energy is delivered through a very fine cannula (1 mm) which houses an even smaller laser fiber (around 300 microns in diameter).  This is in contrast to traditional liposuction, which uses mechanical energy generated by shoving a much larger cannula (3-6 mm) to and fro.  Due to its inherent gentleness, laser-assisted liposuction is easier to perform without general anesthesia.  Smaller cannulas and non-mechanical disruption of the fat cells means less trauma to the patient and a faster recovery.          

FDA CLEARANCE? 
There is a misconception that laser-assisted liposuction is a fringe, experimental technology that is not FDA approved for clinical use.  This is incorrect.  In the case of SmartLipoTM, a system I use at The Refine Institute, formal FDA clearance was obtained in November of 2006.  Prior to that, thousands of patients had been successfully treated in Europe, Asia, and South America. Since its approval by the FDA, SmartLipoTM has been shown to be consistently safe and effective when used by a trained Plastic surgeon. 

CLINICAL BENEFITS?
As has been shown in several studies and in general clinical experience, laser-assisted liposuction results in less swelling, bruising, and downtime.  In addition, the laser can heat the undersurface of the skin, causing skin contraction or shrinkage.  This means you can use the laser in areas of loose skin where the use of traditional liposuction would not be an option.  The clinical results clearly support this reality.

SMARTLIPO'S  ROLE IN BODY CONTOURING?
One of the most common questions patients ask is whether Smartlipo is a replacement for traditional liposuction.  The answer is specific to each patient and their needs.   Lasers can tighten skin and lessen trauma and downtime, but they are not currently an effective tool for removing large volumes of fat.  This is where traditional liposuction, particularly power-assisted liposuction, remains the gold standard.  Many plastic surgeons who have embraced laser-assisted liposuction use it in conjunction with traditional liposuction.  It is this hybrid approach that has the potential to provide optimal care and better patient outcomes. 

As a final clinical and ethical caveat, I believe it is extremely important to apply this technology with realistic expectations in mind and not to oversell its capabilities to patients.  I concur with Dr. Alberto Goldman, a Brazilian plastic surgeon and forefather of laser-assisted liposuction,  who made the following statement:

"SmartLipo is an advance, not a miracle."