We’ve all seen those ads claiming to share their secret: “One Weird Trick to Lose Belly Fat - CLICK HERE”. Annoying, omnipresent and definitely weird, but of course we would never click on something that is so clearly a gimmick...
Yet smart and hard-working people clearly still struggle with getting their body into the shape they desire and are looking for help. Liposuction continues to be one of the most popular cosmetic procedures in the U.S. - second only to breast augmentation, if you were wondering (1). Not a day in the office goes by without a prospective patient asking me, “So, Doctor - what do you think about [insert name of the latest and greatest laser/heat/cold/supersonic device here]?”
I get it - we’re all looking for magic: some sort of procedure or device or pill or cream that will make the bulges disappear but without any scars, pain, side effects/complications, or downtime - and it has to be cheap, too. Medical technology for body contouring has advanced greatly in the last decade or two, but it is still far from perfect, and that is perhaps the most important takeaway for any prospective consumer and patient.
So let’s talk more about those procedures you see plastered across billboards and popping up on your mobile. The non-invasive and minimally-invasive body contouring devices generally fall into two main categories: laser(heat)-based (like SmartLipo™ and SculpSure™) and cryo(cold)-based (like CoolSculpting®).
Both types of procedures are usually done in the doctor’s office under local anesthesia (so you’re awake during the procedure) and claim to have less pain and a quicker recovery. Both can be performed by a nurse or other assistant - not necessarily the doctor. Laser liposuction typically uses small incisions, through which the laser breaks up the fat and a suction tube removes the fat. Cold-based liposuction does not require any incisions, so a handpiece with a vacuum pulls the skin up to cool the targeted fat layer beneath, and your body absorbs the byproducts of the destroyed fat cells over the next few weeks.
For the right patient - someone who is thin and in good health, with a small bulge or localized area of thickness - these non-invasive and minimally-invasive techniques can work really well. (2,3) A single in-office treatment with one of these devices can be relatively affordable compared to surgical liposuction.
But over the years, I have met a number of patients who may or may not have been counseled well regarding their suitability for laser- or cool-lipo. Some of them were simply disappointed by the lack of improvement they were promised.
Others had unsightly and even devastating results - extensive scarring and burns from laser lipo, hard and blocky chunks of fat left after cool-lipo. For patients who were told they needed multiple in-office treatments, the cumulative cost adds up quickly, and some ended up spending even more for corrective surgical procedures later.
Surgical liposuction in the hands of a board-certified plastic surgeon can provide patients with predictable results for just about any part of the body.(4) It can be done with either a local or general anesthetic. Small incisions are used to allow access for the narrow lipo tools (sometimes adding a power-assist or ultrasound-assist device) to mechanically suction out fat. Most patients have minimal discomfort postoperatively (due to the use of tumescent numbing solution at the beginning of the procedure) and return to work in a matter of days.
During the same liposuction surgery, the fat that is removed from an area that has too much thickness can be transferred to an area that needs more (perhaps as close to magic as we can get these days - more on fat grafting/fat transfer in a future blog post!).
2. McBean JC, Katz BE. Laser Lipolysis: An Update. The Journal of Clinical and Aesthetic Dermatology. 2011:4(7), 25–34.
3. Bernstein EF. Long-term efficacy follow-up on two cryolipolysis case studies: 6 and 9 years post-treatment. J Cosmet Dermatol. 2016;15: 561–564.
4. Tabbal GN, Ahmad J, Lista F, Rohrich RJ. Advances in Liposuction: Five Key Principles with Emphasis on Patient Safety and Outcomes. Plast Reconstr Surg Glob Open 2013;1:e75.
By Dr. Angeline Lim of Duet Plastic Surgery - Expert Plastic Surgeons
Angeline Lim, M.D. and Jennifer Weintraub, M.D. are the board-certified plastic surgeons of Duet Plastic Surgery, a boutique-style practice in Palo Alto, California. When not discussing the merits of various body contouring techniques with her smart and savvy patients, Dr. Lim may be found tackling a trail for her first half-marathon prep or hanging out at the playground with her kids.