Liposuction, Airsculpt, LaserLipo, Oh My!

We host a great Facebook group where Dr. Smith will answer questions from folks all over the world who want to know more about plastic surgery. Sometimes we'll include discussions from that forum here. To join and ask some questions of your own or learn from ongoing conversations, head over to:

QUESTION: “I'm just starting to look into getting upper-arm liposuction and am confused by all the options. I can't find anything that feels objectively written and don't have enough medical knowledge to pursue peer-reviewed studies, but I would love some help understanding the distinctions among regular and laser liposuction, "Coolsculpt," "Exilis 360," "AirSculpt," fat cavitation, ultrasonic treatments. ... My head is spinning. Can you point me to something journalistic or straightforward that explains all these treatments? Many thanks!”

ANSWER: All of these things fall under the category of "body contouring." The basic premise of body contouring is removing fat cells from the body in a controlled fashion to achieve desired cosmetic changes. There are two basic categories of body contouring treatment: invasive and noninvasive. Invasive techniques include liposuction and other surgical procedures like tummy tucks. Noninvasive techniques include things like Sculpsure, CoolSculpting, TruSculpt, and others. So, let's discuss invasive techniques first (I actually don't offer non-invasive techniques in my practice). Procedures designed to remove extra skin and fat like tummy tucks and arms lifts by definition achieve the most dramatic results but do cause scarring, because all incisions leave scars and we have to make incisions to remove skin. Skilled, board certified plastic surgeons are good at hiding scars in hard-to-see places and making them thin and in such a way that they often fade a great deal over time. Liposuction, on the other hand, is an excellent way to remove stubborn fat, and leaves only tiny scars (less than 1 cm). It is not a good option for people with severe loose skin. Many people with minor skin laxity will reasonably opt for liposuction paired with some form of energy delivery to the skin to shrink that skin (heat causes skin to contract- think of fish skin in a frying pan). Remember, though, that this only works well for folks with minor to moderate skin laxity. Of the MANY technologies available to do this, my favorites by far, are radio frequency and ultrasound. Moving over to noninvasive treatments: while invasive treatments physically remove fat cells, noninvasive treatments damage or destroy them so your body removes them on its own. These "set and go" technologies are not as effective or as customizable as invasive treatments in which a highly trained expert is sculpting your tissue by hand. In fact, they are not guaranteed to work at all. This is a lot of information; it is intended to help you cut through the copious marketing chatter that is out there. My advice is to ignore the fancy brand names, focus on the actual technology being offered, and find a board certified surgeon that you trust. Remember, four basic options for body contouring: a noninvasive option (usually-subtle fat removal); liposuction (for customized, most effective fat removal); liposuction + an energy treatment (for fat removal and skin tightening); a more invasive operation like a tummy tuck (to comprehensively address skin, muscle and fat). That's it. The rest is marketing. -DMS

Office of Darren M. Smith, MD

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