Monday, March 03, 2008

Is SmartLipo a smart choice for you liposuction? I'm sticking with "dumb lipo" (for now)

I had the chance to go to an educational event last month put on by Cynosure, manufacturers of the "SmartLipo" platform for body-contouring. Cynosure is a well respected company and has manufactured generally well designed laser platforms. SmartLipo's gimmick is to place a pulsed laser (a 1064nm Nd:YAG for tech geeks in the audience) on a fiber optic cable which is used like a liposuction cannula. The theory is that the laser's energy disrupts and emulsifies fat cells, thereby eliminating or reducing the need for conventional suction assisted lipectomy (SAL). Also promoted is enhanced skin contracture from the thermal energy adjacent to the skin.

I've got to say I was a little unimpressed with the results shown from this device with body contouring procedures. It just didn't produce dramatic results. The presenting doctor in this instance was an ENT surgeon, which I think may have something to do with this. Much like many pictures shown by Dermatologists who do liposuction, there sometimes seem to be an ignorance or indifference to the skin quality and underlying anatomy of patients. (in fairness, many plastic surgeons are guilty of this too.) So picture after picture gets shown of people with undercorrection of significantly fatty areas and lots of residual loose skin in patients who were poor candidates for SAL, SmartLipo, Ultrasonic Liposuction, VASER, etc.... in the first place.

When you read industry publications quoting paid investigators & consultants who are "hanging crepe" about patient selection and expectations, that's usually a code word to me it works best on people who arguably need surgery the least. That's what the expectations had been dumbed down to with the "thread lift" fiasco in 2005-2007 (see here for one of my first blog entries on it).

To get results with SmartLipo, you're still going to have to do traditional liposuction afterwards, begging the question of whether a $100K-120K laser platform that can't be used for other indications makes any sense. It may also be effective for small touch up liposuction cases, but that's an awfully flawed business plan for a doctor assuming that much overhead.

I did see some nice results with SmartLipo when used in the neck/face, and it makes sense that it would work better in those area. If you've got thin fatty layers (like in the neck/face), you may indeed be able to treat that and get skin improvement. Complicating my assessment was the fact that many of those patients had face or neck life surgery simultaneous, which makes it hard to sort the skill of the surgeon's techniques from any effect of the laser. Facial and neck procedures might be the better group for this, but blindly applying high thermal energy to tissue adjacent to nerves and the carotid artery could potentially result in catastrophic complications.

In a nutshell, there may be some applications for this technology but presently I still feel it's more of a marketing tool then revolutionary device.



Anonymous said...

Hi Rob-

I wanted to be sure that you were aware that this topic was covered in todays Wall Street Journal:

Anonymous said...

Dear Sir

First- your insinuation with regards to mentioning "ENT surgeon" is absurd and unprofessional. (and slightly ironic as you share office space with one)
Secondly if you are concerned about the carotid during submental liposuction even with this device then clearly you have not operated on many necks in your career.
I enjoy your blog- just find distaste in your snide comments regarding otolaryngologist.
And finally, just to comment on a prior self adulation you published (regarding the failure rate on Plastic surgery boards) The two most competitive residencies to obtain in 2005 and 2006 were #1 dermatology and #2 otolaryngology- ironic, again because you frequently denigrate these subspecialties. Moreover the 20% failure rate may be an indication of the pool of applicants and not- as you imply- the selectivity of the specialty.

Dr. Rob Oliver said...

Dear anon,

I think you

1. misunderstand the context of my comment re. Otolaryngology (ENT).

2. are not familiar with this specific energy source (smartlipo)

In this instance, I was referring to a event where I was presented number of patients who had abdomen, extremity, and trunk SmartLipo & liposuction surgeries by an ENT with no formal training in the procedures. I (and the 5 other people in the audience who actually were plastic surgeons) saw picture after picture of results that were underwhelming and suffered from patient selection problems. It's a strange way for the company to build credibility on this technology IMO.

If you noticed in my post, the fine results on the head & neck procedures this doctor presented spoke both to his fluency in head & neck surgery and better application of liposculpturing principles. Those procedures are well within the scope of practice of an ENT surgeon.

In re. to you suggesting it's difficult to cause catastrophies in cervical liposuction, I'd reconsider what you think you know. Esophageal & carotid sheath injuries from SAL have been reported for years. Particularly with the smaller cannulas (2mm) used, it's easy to inadvertantly go sub or transplatysmal. Now put an energy source on a 1.5mm tip that gets hot enough to cause full-thickness contact burn to the underside of the skin.... I'll let you connect the dots for yourself.

Anonymous said...

for you to say that you must perform traditional liposuction after using a yag laser for lipolysis is not true. you must not be familiar with the literature, such as a paper by Geronemus showing neck improvement with laser treatment alone. Also, the tissue effects of the laser have been well documented. Medicine has a long history of Nd:YAG use.

Dr. Rob Oliver said...

No I agree you don't have to neccesarily do evacuation, which wasn't the issue with facial/neck procedures with this device. The probe gets VERY hot adjacent to some vulnerable nerves and vessels. My point is that this isn't a benighn procedure and has the potential for catastrophic complications (which is also true for SAL or UAL as well).

I encourage you to educate yourself about how much there is skepticism on the claims and efficacy of this device however. Please see the Wall Street Journal article that came out the day after I posted this thread originally.

Dr. Oliver

Anonymous said...

Thanks for your smart vs dumb lipo comments. I am having breast aug and full abdominal vaser tomorrow morning and I've been scouring the net looking for a view on smart lipo that mirrors my own doc's. Are there other places I can find info like this instead of all the smart hoopla?

Dr Dina Eliopoulos said...

Interesting topic on
Smartlipo. Thanks for posting!

paulene said...

I believe the surgeons who should perform this procedure are those who underwent the proper skills training in order to see better results.