Seattle Plastic Surgeon has been waiting almost 18 years for some additional real  research on laser-assisted liposuction. 

I recently read a letter to the editor in Cosmetic Surgery Times.  This glossy “journal” arrives in my mailbox monthly and is often fodder for this blog, especially when I am exposing misleading before and after photos. 

This month’s edition included a great letter from Dr. Peter Fodor about a multicenter clinical study of laser-assisted liposuction he and several other plastic surgery colleagues did way back in 1994.  They performed liposuction on a bajillion patients and used traditional liposuction (TL) on one side and Laser-assisted liposuction (LAL) on the opposite side and then, after healing, had the results assessed by a neutral observer and the patient, neither of whom knew which side was the TL side and which side was the LAL side.   This was a well designed blinded and controlled study.  

The results:  “The investigators came to the unanimous conclusion that LAL was not an advantageous trade for TL.  The results were not superior, while the expense, learning curve and cumbersome nature of the procedure were rather steep.  The company wisely withdrew the device from large-scale commercial distribution.”

Fast forward to 2011:  Currently availiable LAL devices include SmartLipo, CoolLipo, ProLipo/Plus, LipoForm, Lipotherme, SlimLipo, LipoPulse, Gold Lipo, SmoothLipo, and AccuSculpt.  Have any of these devices undergone the scrutiny of that LAL  device from 1994?  Noooooooooo.  Are these newer devices being aggressively marketed to every sort of doctor who wants a piece of the liposuction action (and sometimes marketed directly to prospective patients)?   Yesssssssss.  And are these devices and their often inexperienced users responsible for most of the poor and often untreatable liposuction outcomes?  Yessssssss. 

Dr. Fodor reminds us that:  ”Just as in playing tennis, other sports or music, it is not the racquet, musical instrument or surgical device that plays the primary role in the quality of the performance, it is the person in control that matters the most.”

Thanks for reading.  Dr. Lisa Lynn Sowder

I just returned from the annual meeting of the Northwest Society of Plastic Surgeons. The best presentation was a panel on new technologies – when, how and why or adopt them or, in many cases, not adopt them. A very interesting statistic was presented. Ninety-five percent of new technologies – meaning the latest and greatest, gotta have it, cannot survive without it – did not exist 5 to 6 years after it’s introduction. Wow, what a number. Laser liposuction was one of the featured new technologies that this panel of plastic surgeons did not think would make the cut. In fact, a recent survey of fully trained (as opposed to the imitation) plastic surgeons who had used laser liposuction, over 96% did not like it. This is the first time that I have heard that 96% of any kind of surgeons agree on anything. http://www.abplsurg.org/

One of the panel members, arguably the most laser friendly plastic surgeon on the planet, summed up laser liposuction with this comment: “Last time I checked, the subdermal plexus still existed.”

Stay with me; You are about to learn something important. Take a look at the illustration of your largest organ (the skin) above. See where the pink (skin) turns yellow (fat). That is the subdermis and that is the target of the laser in laser liposuction. After removing fat, the laser is used to heat up the subdermis in an effort to get the skin to shrink. I always get the image of bacon frying for some reason. Well, it’s not nice to heat this layer because the blood vessles that supply the skin live here. If a large enough area of blood vessles is fried, the skin will die. Dead skin is a very, very bad thing.

Non-laser liposuction spares most of the blood vessels because the intruments used (cannulas) are blunt and push the vessels aside rather than damage them. Because most skin has some elastic quality, the overlying skin usually shrinks to some degree once the underlying bulk is reduced.

I have seen my share of skin necrosis in patients who have heard the siren song of laser liposuction thinking it would spare them the necessity of a truly skin tightening procedure such as tummy tuck. I remain sooooo glad that I did not invest in one of these very, very expensive gizmos. It would be keeping our old furniture in our basement storage unit company.

Take a look at this “before” and “after”.

As promised, here’s the inside of the brochure that shows the “results” and you can be sure these are the best results the company could come up with. The “CoolSculpting” gizmo is promoted as a non-invasive body contouring procedure. I would say non-invasive and ineffective.

Most of the doctors that will purchase this device or one of the dozens similar to it are non-surgeons. These doctors do not know how to do an abdominoplasty (tummy tuck) so they offer this instead. I’m sure they go into it with high hopes but how can they not be disappointed at such a “result’? Once they have paid the $$$$$$ for the gizmo, they need to promote it to make sure they get a decent return on investment.

If any of my abominoplasty patients had a result like this, they would feel ripped off. I suspect the doctors using “CoolSculpting” are going to have some unhappy patients. Geez, everyone could have saved all that time, money and gnashing of teeth by referring those patients to me!

Like most plastic surgeons, I just love shopping for new instruments and gizmos but like most plastic surgeons, I am also quite skeptical of stuff that seems too good to be true – especially very expensive stuff that doesn’t work very well (VES-DW, for short). Behold, on the left, the lastest sales brochure occupying my in-box.

This brochure might make someone like me (a plastic surgeon who would love to deliver abdomens like the one on the left to my patients) buy a “coolsculpting” system for a couple hundred grand. If the “coolsculpting” system delivered the aforementioned abdomen, I suspect there would be a line outside my office door extending down 16 flights of stairs and out onto the street. But alas; there is the inside of the brochure. See my next blog for the “results”.

The Wall Street Journal recently ran an article about non-surgical fat removal using two different devices. One freezes the fat under the skin and the other zaps the fat with a laser than is focused under the skin. These two procedures basically kill the fat cells, they leak out all their fat and then the body removes the fat droplets, metabolizes and excretes the fat. Over weeks to months, the treated areas slim down.

Does that sound sweet or what??? But stop and think about it…………

The fat treated this way and with other techniques like liposuction, tummy tucks and body lifts is subcutaneous fat. It’s just the fat that resides under the skin and is harmless as far as overall health is concerned. Yeah, it’s unsightly and can get in the way but it’s harmless.

Visceral fat, on the other hand is bad news. This is the fat that is internal and encases and infiltrates the internal organs. This is the fat that causes the “beer belly” in many men and in some women. This is the fat that makes one an “apple” as opposed to hip and thigh fat that makes one a “pear”. Visceral fat produces all sorts of bad substances that lead to metabolic and cardiovascular disease and cancer.

Stay with me here. If subcutaneous fat cells are removed using fat removal methods and the patient gains weight, those fat cells are not around to enlarge and store the excess fat. Soooo….the amount of visceral fat may increase instead. A person may have slimmer hips or thighs or their lovehandles may be smaller, but their “beer belly” and all the health issues that go with a “beer belly” may increase.

It always bears repeating what I have been telling prospective patients for years. Liposuction and body contouring such as tummy tuck and lower body lifts is for patients that are at a healthy and stable weight. These procedures are not to be used as a substitute for diet and exercise. They are only for the left over, stubborn bulges and/or lax skin. Using these procedures as a weight loss tool will leave many patients disappointed and, if patients gain weight after surgery, at increased risk for obesity related diseases.