Problems with laser-liposuction: who's the Smart one now?

Over the last few months, I have seen an alarming increase in the number of patients that come in for a second opinion about poorly-performed liposuction (done elsewhere, I might add.) All of these casse have been performed with new high-tech liposuction machines, either laser-assisted (like the SmartLipo) or ultrasonic (like the VASER).

I've seen major skin laxity, uneven liposuction, and obvious over-resection of fat leaving major divots and dents. Many of these problems are very difficult to fix, even with fat grafting techniques.

Here's a few observations:

1. All of these cases were performed by physicians and surgeons operating way outside of their specialty. They were not done by plastic surgeons or dermatologists, who are trained during residency in this technique.

2. In the majority of these patients, physical examination of the patient revealed crummy skin tone and poorly elasticized skin. In other words, since this skin won't contract like we want it to after liposuction, it's completely predictable that the post-op results will be poor, with floppy, deflated areas, and a worsened appearance. A surgeon with any significant training or experience in liposuction would have recognized this - and would have avoided performing liposuction in these patients. It's the wrong tool for the job!

3. All of these patients were preoperatively told by their physicians, "This new wonder lipo machine will tighten your skin".

4. All of these patients now say, "Skin tightening clearly did not happen...now I look worse."

5. None of these patients have an easy fix for their issues. All will require complex and expensive revisional surgery.

Lessons:

A fancy hammer does not a good carpenter make. Any doctor can buy (or rent) a fancy lipo machine.

There is, as yet, no reliable scientific evidence that laser-assisted liposuction:
a) tightens the skin, or
b) works better than standard liposuction.
Any claims to the contrary are "spin" or marketing hype; consider the source and what they're selling.

That being said, the problems seen here were not caused by the type of liposuction machine - but by the doofus using it! While the concept of liposuction is easy, getting excellent results with liposuction takes significant skill.

Please be careful about whom you choose to perform your liposuction. Even if it's performed in an office setting, with local anesthesia, liposuction surgery is still SURGERY. Training, experience and credentials matter.

Fractional CO2 laser resurfacing

Every so often, a significant breakthrough comes along in Plastic Surgery - and this, I believe, is one of them. It's a new twist on a familiar theme. In this case, the new twist is a gadget called a "fractional laser scanner". This is an optical-mechanical device that manipulates an incoming laser beam, creating a polka-dot pattern of laser dots. Normal, untreated skin is left in-between the treated / lasered areas, rather than zapping the entire surface of the skin.

Since only a small fraction of the skin is treated, the technique is known as fractional resurfacing. It can be thought of as a kindler, gentler way to do skin resurfacing. It's not as dramatic a result as the traditional CO2 laser - but the recovery is also far, far easier. The down-time is about 3-7 days, with very little pain. I've been using a european machine, called the Ellipse Juvia, for my treatments since march 2007. (I believe we had the first Juvia unit in the entire South-East.) While laser resurfacing is not a replacement for a facelift, it does a nice job improving texture problems, fine wrinkles and clearing up sun damage.


There are about a dozen machines out there that use this fractional co2 laser technology - and to be honest, they are all fairly similar, whether they are called "Active FX", "DOT therapy", "mixto" or "Juvia". What's confusing for the consumer, however, is that the original "Fraxel" machine - isn't a CO2 laser. It uses a different, less powerful wavelength - so the results with the original Fraxel have not been as impressive.

There are also 2 machines - the Fraxel Repair and the Deep FX - that are designed for deeper treatments. The jury is still out on these...as the complication rate may be higher, and as yet, the treatment parameters have not been optimized.

If you decide to have this treatment done, make sure you go to a physician with plenty of CO2 laser experience. While fractional treatments can be done very lightly, all of these machines can be turned up to give a very intense treatment. They are by no means "goof-proof". Experience of the laser operator is the key to a good result.