smartlipoLaser Assisted Liposuction

In late 2006, the FDA approved a cosmetic surgery device by Cynosure, Inc that incorporated a laser into a liposuction device. This product is called SmartLipo and has swept the cosmetic surgery world over the past few years. The concept of SmartLipo is that a specific type of laser (Nd:YAG) at a specific wavelength of light (1064 nm) is used to zap fat cells. Some say the laser light energy breaks apart the cell membranes while others say the fat is simply vaporized on the spot. In truth it is most likely that a little of both takes place in a given session of laserlipolysis. The fat that is not vaporized is suctioned out with a modified liposuction cannula.

SmartLipo and its claims

Do we really need a new way to perform liposuction? If you have seen or experienced the skin laxity after traditional liposuction, proponents of laser assisted lipoplasty would say that laser energy is an integral part of fat removal surgery. The main reason that laserlipolysis is considered by many to be better than traditional liposuction is that the collagen within fatty tissue (the protein between the fat cells) is stimulated by the light energy. This stimulation causes the collagen and other extracellular proteins to contract and pull the skin closed after liposuction. The end result, the makers of SmartLipo devices claim, is better skin contraction through collagen contraction. But does the clinical science back this up?

Size matters

It turns out that several clinical studies of laser assisted lipoplasty have shown that lasers are effective in destroying fat. In fact, a few studies have found that when performed properly, laserlipolysis can be performed without liposuction.(1) Some studies have shown that laser assisted lipoplasty can promote enhanced skin tightening.(2-4) However not all studies show the same benefit.(5) It turns out that the wavelength of laser light is what makes all of the difference. Laser energy at virtually any wavelength can disrupt fat cells—of course so can traditional liposuction. However in order to get the skin tightening benefit of laser assisted lipoplasty, the Nd:YAG laser apparently must consist of two wavelengths, both the original 1064 nm but also a 1320 nm wavelength as well.(6) It just so happens that SmartLipo MPX (not traditional SmartLipo) contains lasers of both wavelengths which fire sequentially.

Is a third wavelength even better?

Cynosure now sells a laserlipolysis device that contains a laser that fires at three wavelengths (1064 nm, 1320 nm, and 1440 nm). This laser assisted lipoplasty is marketed under the name SmartLipo Triplex. While the makers claim that the additional wavelength provides “the highest absorption of fatty tissues,” clinical trials have not been conducted to assess these claims.

Is SmartLipo better than traditional liposuction?

The clinical evidence suggests that laser assisted lipoplasty with a device that contains both the 1064 nm and 1320 nm wavelength lasers is superior to traditional liposuction—not necessarily in its ability to detroy fat cells but in the speed at which the skin tightens afterwards. Look for SmartLipo MPX or SmartLipo Triplex rather than the first SmartLipo product. If you are not sure of the laser wavelengths, just ask your plastic surgeon.

Reference List
(1) Dudelzak J, Hussain M, Goldberg DJ. Laser lipolysis of the arm, with and without suction aspiration: clinical and histologic changes. J Cosmet Laser Ther 2009;11:70-73.
(2) Collawn SS. Skin tightening with fractional lasers, radiofrequency, Smartlipo. Ann Plast Surg 2010;64:526-529.
(3) DiBernardo BE, Reyes J. Evaluation of skin tightening after laser-assisted liposuction. Aesthet Surg J 2009;29:400-407.
(4) McBean JC, Katz BE. A pilot study of the efficacy of a 1,064 and 1,320 nm sequentially firing Nd:YAG laser device for lipolysis and skin tightening. Lasers Surg Med 2009;41:779-784.
(5) Prado A, Andrades P, Danilla S, Leniz P, Castillo P, Gaete F. A prospective, randomized, double-blind, controlled clinical trial comparing laser-assisted lipoplasty with suction-assisted lipoplasty. Plast Reconstr Surg 2006;118:1032-1045.
(6) Woodhall KE, Saluja R, Khoury J, Goldman MP. A comparison of three separate clinical studies evaluating the safety and efficacy of laser-assisted lipolysis using 1,064, 1,320 nm, and a combined 1,064/1,320 nm multiplex device. Lasers Surg Med 2009;41:774-778.