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Traditional Liposuction vs. Laser Assisted Liposuction
February 16, 2009
Liposuction is a cosmetic procedure performed by certified surgeons, typically plastic surgeons however any surgeon with the necessary training may perform the service as well, to remove unwanted fat deposits. The surgeon utilizes a metal cannula, a hollow tube with holes at the tip that expels saline, epinephrine, and lidocaine, and suctions the emulsified fat. More often than not, this technique is desired to remove fat and help with body contouring; however, it may also be used to reduce breast size in males with Gynecomastia or to remove fatty tumors (http://www.fda.gov/cdrh/liposuction/what.html). The most common areas requested to be liposuctioned are the thighs, hips, and abdomen, but also the arms, buttocks, and neck are available services (http://www.fda.gov/cdrh/liposuction/what.html).
Benefits of liposuction include physically removing the fat cells that diet and exercise could never remove. Removing such fat deposits could cause an increase in self-esteem and consequently cause greater well-being, especially in such cases of men with Gynecomastia. Also, liposuction is minimally invasive comparatively to surgeries such as abdominoplasty (tummy tuck), brachioplasty (arm lift), and cervicoplasty (neck lift). However, liposuction does have its disadvantages; for instance, there is downtime after such as surgery. Numbness can occur in the various areas in which liposuction is performed, granted in most cases it the numbness disappears, but there is still the risk of permanent damage. With traditional techniques, general anesthesia is administered and the risks associated with such drugs, for example irregular heartbeat, stroke, and difficulty breathing, are always there (http://www.revolutionhealth.com/articles/risks-of-general-anesthesia-/str2506). Liposuction does not assist weight loss; it may remove the fat deposits and drastically change the appearance of the areas, but it does not stop fat from returning if diet and exercise are not continued. Also, because the fat cells are physically removed, any regained fat may not be evenly distributed across parts of the body.
As technology progresses, there are numerous new techniques for liposuction. One of the main competitors of traditional liposuction is laser assisted liposuction. Companies such as SmartLipo and CoolLipo (also the maker of the CoolTouch laser) market this type of liposuction and sell the equipment necessary for surgeons to purchase to incorporate into their practice. Laser assisted liposuction has just recently made its way to America, but it was previously extremely popular in Europe, China, and Japan. There are advantages and disadvantages to both techniques of liposuction. I hope to give insight into these pros and cons so that future patients may be adequately informed as to which procedure to choose.
“SmartLipo is by far the best kind of liposuction available today. It is a method that offers the best results with less trauma and less downtime. It has a fast recovery time and the cost is very competitive.” (http://www.smartlipo.com/TechniquesComparisson.php)
The company that markets laser assisted liposuction most heavily reports that this technique is head and shoulders above traditional liposuction. SmartLipo utilizes a laser to melt the fat without heating excess tissue and thus reduces bleeding (http://www.smartlipo.com/TechniquesComparisson.php). One of the main selling points that the company makes is that if the area in which laser assisted liposuction is applied is relatively small, additional suction may not be needed to achieve optimal results and the body is able to reabsorb the liquefied fat (http://www.liposuction4you.com/liposuction_history.htm). A fitness website claims that laser assisted liposuction is advantageous because it can be used on various parts of the body that traditional liposuction could not (http://www.fitness-equipment-solutions.com/laser-assisted-liposuction/). Companies promoting laser assisted liposuction stress the lower cost, increased safety, and the minimally invasive techniques to convince consumers to invest in their technique as opposed to more traditional techniques. The two most popular laser assisted liposuction pieces of equipment are the SmartLipo and CoolLipo (from the same company that uses CoolTouch). Both of these machines utilize the YAG laser, but at different wavelengths. The CoolLipo website claims that their machine targets the collagen specifically, through the alternative wavelength of laser used, which thus produces the skin tightening affect to the optimal degree (http://www.cooltouch.com/Lipolysis.aspx).
Laser Assisted Liposuction Machine- http://www.medgadget.com/archives/img/LipoLite-system.jpg
Scientific Studies Comparing Techniques:
Alberto Goldman, MD Study (2006)
In this study conducted by Goldman (2006), 82 subjects underwent laser assisted liposuction between March 1999 and November 2004. Each subject obtained a pre-operative examination, and it was determined that all of the subjects were not obese, non-smoking, and of normal health. Of the 82 subjects, 4 were male and 78 were female and ranged in age from 18 to 61 years old. The laser used in this study was a 1,064 nm Nd: YAG laser at 40-Hz frequency, 150-mJ energy, 6-W power, and 100-microsecond pulse duration. As stated by Goldman (2006), the laser produced light energy that was converted to heat energy and expanded the fat cells (adipocytes) and caused the cells to rupture and liquefy. A cannula that applied negative pressure to suction the liquefied fat was then utilized in the specific areas. The only cases in which the suction was not used, was if the area was small enough where the volume of liquefied fat was extremely small. After surgery, the subjects were able to leave immediately or after a couple of hours. After the day of surgery, the subjects were able to return to normal activity with only small discomfort. In some of the cases the subject was requested to wear a compression garment for a week. Only two of the 82 cases involved complications. These complications consisted of asymmetry. Forty days after the subjects underwent the procedure, they were checked out to see the results of the laser. Goldman (2006) concluded that the results were similar to that of traditional liposuction; however, there were clear increases of skin tightening after using the laser assisted method. He also noted decreased post-operative discomfort and also a decrease in “down time” after the procedure.
Progress Report on Multicenter Study of Laser Assisted Liposuction
David B. Apfelberg, M.D., Sheldon Rosenthal, M.D., Joseph P. Hunstad, M.D., Bruce Achauer, M.D., and Peter Bela Fodor, M.D.
The same YAG laser used in the Goldman (2006) study was used in the study conducted by Apfelberg, Rosenthal, Hunstad, Achauer, and Fodor (1994). There were 51 patients enrolled in the study, 38 female and 13 male, and most of the patients were in the 30-49 year old range. In this study they found that the surgeon “expends much less arm motion since the laser beams shears off fat resulting in a slower and smoother arm activity.” However, it was reported that the time of the procedure was not lessened through the use of the laser. It was also noted that the patient experiences less post-operative bleeding and diminished pain. Patients were able to return to normal activity after six days and were able to partake in “vigorous” exercise after sixteen days. A unique aspect to this study was that 15 patients underwent laser assisted liposuction on one side and traditional liposuction on the other. 10 out of 15 patients experienced little or no pain on the laser assisted side; whereas, only 6 out of 15 patients experience little or no pain on the traditional liposuction side. After eight weeks, the patients were asked again to rate their discomfort on either side; 15 out of 15 experienced no pain on the laser side and 2 out of 15 still experienced mild discomfort on the traditional liposuction side. Benefits of this procedure included more volume of fat removed and less blood replacement. Also, less fatigue of the surgeon and less pain and swelling of the patient are advantages of the laser assisted liposuction versus the traditional technique.
A Prospective, Randomized, Double-Blind, Controlled Clinical Trial Comparing Laser-Assisted Lipoplasty with Suction-Assisted Lipoplasty
Prado, Arturo M.D.; Andrades, Patricio M.D.; Danilla, Stefan M.D.; Leniz, Patricio M.D., Ph.D.; Castillo, Paulo M.D.; Gaete, Fancy M.D. (2006)
This study was executed between July 2004 and February 2005, where they operated on 25 subjects all female, all with healthy body mass index. A double-blind and randomized study was designed; which means that neither the surgeons that examined the post-operative reports nor the administrators of the study knew which patients were receiving which treatment and that the patients were randomly placed into the laser group or the traditional group. A SmartLipo laser liposuction machine was used during the study. After each patient received the allocated procedure, their post-operative reports and pictures were sent to the two blinded surgeons who then examined the reports and made comments as to the outcome of the surgery. These blinded surgeons looked at results from 3-5 days after, 12-15 days after, and 6-11 months after. The blinded surgeons reported that there was no cosmetic or aesthetic difference between the two techniques. There was higher postoperative pain after the suction liposuction rather than the laser assisted liposuction. The operation time was longer for the laser assisted liposuction technique. Overall, this study showed that the laser assisted technique may not have specific advantages over the traditional suction technique. Also, the laser assisted technique requires more time and requires the surgeon to learn the necessary technique and become certified, which may make this technique unappealing to the surgeon.
Advantages of Laser Assisted Liposuction
The previously mentioned scientific studies show real results of the laser assisted liposuction technique. Although the advantages of this technique may not be extremely profound, they are still apparent and should be taken into consideration when choosing surgical techniques. Laser assisted liposuction decreases recovery time to one to two days and decreases blood loss through optimal coagulation during the procedure (Katz 2002). This technique causes the small blood vessels to immediately coagulate resulting in reduction of bleeding; also, the post-operative pain was lower with the laser assisted liposuction (Mann, M., Palm, M., & Sengelmann, R. 2008). Laser assisted liposuction only targets the “yellow material”, or fat, in the body and emulsifies it, allowing the body to absorb up to 500 mL on its own without suction (http://www.liposuction4you.com/liposuction_history.htm). As displayed through the studies, skin tightening was an advantageous result of the laser technique; which could reduce the need in additional procedures such as abdominoplasty and “neck lifts” (Mann, M., Palm, M., & Sengelmann, R. 2008). SmartLipo advertises that the “melting of fat” without excessive heating makes the procedure safer than the traditional technique http://www.smartlipo.com/TechniquesComparisson.php). (
Disadvantages of the Laser Assisted Technique
Applying the laser to large areas of the body could be problematic because of the requirement of a more intense laser for a longer duration of time. This could result in burning of the skin, and consequently unwanted scarring. The previously mentioned studies also showed that duration of the laser assisted liposuction surgery is longer than that of the traditional technique(Mann, M., Palm, M., & Sengelmann, R. 2008). This could result in a rising of the price of the procedure, and thus becoming too expensive for the clientele. However, this could simply be the result of such a new technique; perhaps, the surgeons are not as familiar with this technique as they are with the traditional suction method. In the future, when surgeons are more familiar with the laser, the surgical time could decrease and thus become advantageous to both the patient and surgeon. Dr. Kenneth C Hui (2008) reported that there was more damage to adiposytes, the cells that make up fat, with the laser assisted technique; however, Hui also stated that there were no major clinical differences between laser assisted and traditional liposuction. Seroma, hematoma, and wound infection are more likely to occur with the laser because sufficient suction of the liquefied fat is difficult to attain as a result of the “minimally invasive” cannula (Hui 2008). A disadvantage to the surgeon performing the procedure is that the cost of the machine is more expensive and requires additional training time; also, if the device is not used properly and the laser becomes too concentrated in one area, or used at the wrong wavelength, burning of the skin can result (Parlette, E., & Kaminer, M. 2008).
Liposuction should only be utilized by people with a healthy eating and exercising regiment; it is not a cure for obesity. Laser assisted liposuction may reduce recovery time which is especially advantageous to people that may not be able to take weeks off of work. Also, this procedure could be advantageous to patients wanting relatively quick results (i.e. for a wedding). If only small areas are being treated, post-laser suction may not even be necessary which could reduce surgery time and costs. The laser assisted liposuction is most likely a more expensive procedure and may only be performed by certain surgeons. A patient may have to seek out the surgeon and may need to travel to receive his services. This is still a relatively new technique, especially to the United States, and you are always taking a risk when there are not sufficient amounts of information on the technique. Surgery always possesses certain health risks, but I don’t believe that the likelihood of these outcomes is strong. If the patient has bad reactions to general anesthetic, some procedures may only require local anesthetic. Liposuction will not “make you skinny” or change how you feel about your body, at least in the long run; so, make sure the choice to undergo such a procedure is carefully considered. If your diet and exercise regiment is on par and there are just a couple trouble spots that won’t disappear, then I would recommend laser assisted liposuction.
Apfelberg, D., Rosenthal, S., Hunstad, J., Achauer, B., & Fodor, P. B. (1994). Progress Report on Multicenter Study of Laser-Assisted Liposuction. Aesthetic Plastic Surgery, 18, 259-264. Retrieved February 15, 2009, from http://www.springerlink.com/content/hq66022n5v3104hj/fulltext.pdf
Goldman, A. (2006). Submental Nd:YAG Laser-Assisted Liposuction. Lasers in Surgery and Medicine, 38(3), 181-184.
Hui, K. (2008). Body Contouring by Liposculpture. The Hong Kong Medical Diary, 13(7), 20-23. Retrieved February 15, 2009, from http://www.fmshk.org/database/hkmd/mdjuly08fullpage.pdf#page=22
Katz, B. (2002). Cosmetic Therapies and Procedures. Retrieved February 15, 2009, from aad2008.omnibooksonline.com/data/papers/SYM-336-D.pdf
Laser Lipolysis - Why choose CoolLipo?. (n.d.). Retrieved February 15, 2009, from http://www.cooltouch.com/Lipolysis.aspx
Liposuction4you. (n.d.). History of Liposuction | Liposuction4You.com. Retrieved February 15, 2009, from http://www.liposuction4you.com/liposuction_history.htm
Lithony, L. (2007, December 16). Laser Assisted Liposuction. Retrieved February 15, 2009, from www.fitness-equipment-solutions.com/laser-assisted-liposuction/
Mann, M., Palm, M., & Sengelmann, R. (2008). New Advances in Liposuction Technology. Seminars in Cutaneous Medicine and Surgery, 27(1), 72-82. Retrieved February 15, 2009, from http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B75K6-4SK9CWR-G&_user=86629&_coverDate=03%2F31%2F2008&_rdoc=1&_fmt=full&_orig=search&_cdi=13170&_sort=d&_docanchor=&view=c&_acct=C000006878&_version=1&_urlVersion=0&_userid=86629&md5=f70883e34aa3d46
Parlette, E., & Kaminer, M. (2008). Laser-Assisted Liposuction: Here's the Skinny . Seminars in Cutaneous Medicine and Surgery, 27(4), 259-263.
Rea, C. (2008, February 4). Risks of general anesthesia - Revolution Health. Retrieved February 15, 2009, from http://www.revolutionhealth.com/articles/risks-of-general-anesthesia-/str2506
True, R. (n.d.). Techniques Comparison. Retrieved February 15, 2009, from http://www.smartlipo.com/TechniquesComparisson.php
Food and Drug Administration. (n.d.). US FDA/CDRH: Liposuction Information - What is Liposuction?. Retrieved February 15, 2009, from http://www.fda.gov/cdrh/liposuction/what.html
Aesthetics Centre. (n.d.). Smart Lipo Laser Lipolysis | Smart Lipo Fat Reduction Treatment | London, UK. Retrieved February 15, 2009, from http://www.wimpoleaesthetics.co.uk/wimpole-aesthetic-procedures/wimpole-smart-lipo.asp
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