Cosmetic plastic surgery is a $12 billion business, with nearly 11 million Americans getting fixed up in 2006, according to the American Society of Plastic Surgeons.
More than 4 million botox treatments last year alone demonstrate that the real growth is in minimally invasive procedures. Liposuction, one of the most popular surgical cosmetic procedures in the U.S., is the latest application to get a makeover.
SmartLipo laserlipolysis, also known as laser-assisted liposuction, just received approval by the Food and Drug Administration last November. This technology, pioneered in Brazil and Italy, literally sucks the suction right out of lipo by using lasers to melt fat away.
SmartLipo, developed by Cynosure, cannot totally replace traditional liposuction, but may be a promising alternative for many plastic surgery patients looking to remove small pockets of fat.
Dr. Richard A. D'Amico, president-elect of the American Society of Plastic Surgeons, advises that, while promising, this is no panacea for that spare-tire on your midsection.
"This is not going to replace the bread and butter, day in and day out liposuction in plastic surgery," D'Amico said. "Again because it's only good for small areas, and the laser generates heat."
Traditional liposuction works by inserting a tube, known as a cannula, to vacuum up isolated pockets of fat. This new lipo method also uses a cannula, but it is only 1 millimeter in diameter, compared with 4-mm cannula used in traditional liposuction.
"The way it works, we make tiny incisions, thread laser fiber under the skin, there's a little red light so we know exactly where it is, you can see that through the skin. When we fire the laser it melts the fat, it also tightens the skin at the same time," explained Dr. Bruce Katz, a clinical professor of dermatology at The Mount Sinai School of Medicine who is also director of the Cosmetic Surgery & Laser Clinic at Mount Sinai Medical Center and the Juva Skin & Laser Center in New York.
The laser actually ruptures fat cells, and that oily-substance is then removed by the surgeon. Removing the substance during surgery allows patients to see faster results.
Any remaining liquid fat is absorbed by the body and discharged through the lymphatic system. The liquefied fat could be left in the body, although D'Amico said there is a lack of data on what would happen if large amounts of it were left in the body. Because the incision is small, no stitches are needed.
The small laser can also seal blood vessels as it zaps fat, so there is less swelling, bleeding and bruising than with liposuction.
"There is much less trauma for the tissue, we tell patients to take off day after procedure, but then they can go back to work, or their regular routine after that," Katz said.
Patients only need a local anesthetic for this procedure, while liposuction requires general anesthetic. Katz noted that because there is no general anesthetic, SmartLipo carries fewer risks than traditional liposuction.
"The drawbacks are really minimal. There are much fewer side effects, with smart lipo we really haven't seen any major side effects at all. Bruising and swelling, it goes away a lot faster than with traditional liposuction," Katz said.
Although SmartLipo has been available in Brazil and Europe, D'Amico hopes more data will be available to doctors in the United States within the next two years regarding the risks and benefits of this procedure.
"We know from other technologies, like ultrasound, that the margin of error between scarring and tightening could be quite small, we just don't know enough yet," D'Amico said.
SmartLipo is promising, but can only treat areas, such as the face, neck, arms and breasts.
"The tummy, the saddle bags, the hips, its not going to get the job done," D'Amico said.
Traditional liposuction must still be used for larger areas, although SmartLipo can be used to smooth and tighten areas that have already been treated with traditional liposuction to improve appearance. Neither procedure is intended to treat obesity, but rather improve specific areas.
Beyond liposuction, SmartLipo may also be able to treat axillary hyperhydrosis — excessive underarm sweating. This condition has many treatments, including botox, but SmartLipo can actually destroy some of the sweat gland ducts.
Both liposuction procedures see results after only one session, but Katz said SmartLipo tends to be less expensive than regular liposuction because an anesthesiologist is not needed for the surgery. Cost depends on how many areas are being treated, but just a neck may cost $2,000 to $3,000. Because of the limitations of how much area SmartLipo can treat, a single treatment with traditional liposuction may still be a cost-effective option for patients looking to reduce large areas.
Lasers are doing more than just melting fat at the plastic surgeon's office. Katz said a precision laser called Sciton is revolutionizing treatments from facial peels to acne scaring.
"This is a really major advance. We can dial in the laser the penetration of the laser beam," Katz said. "So if we only want to go 10 microns [for a chemical peel], if we want to go deeper to 100 or 150, we can be that precise. It can be used for acne scaring, wrinkles. The nice thing about it, it can also be used on the chest, arms, hands — it really is a big advance there."
Similarly, lasers are offering effective treatment for people with spider veins, an often-painful condition.
"Cynergy laser is a new laser for treating spider veins. The big advance here is this is the first time we can fire two wavelengths down the same laser fiber. Really, two laser beams at the same time," Katz said. This laser can also treat rosacea, port-wine stains and broken blood vessels.
From wrinkles on the face to spider veins on the legs, lasers are revolutionizing cosmetic surgery top to bottom. While many of these procedures are offering faster, better results, all heat-technologies carry some risk. Any procedure should be performed by a trained, board-certified plastic surgeon that can speak frankly about the risks and benefits of laser treatments. Procedures such as SmartLipo are just the tip of the laser beam as technology offers new methods to zap people into the bodies of their dreams.
This article was reviewed by Dr. Manny Alvarez