Know facts before removing your fat

/Home/Cosmetic Laser Treatments/Smart Liposuction/Liposuction Treatment

Know facts before removing your fat
December 23, 2007
By LISA GREENE,
St. Petersburg Times

TAMPA - The woman in the red bikini looms over Dale Mabry Highway, promising thinner thighs and a flatter tummy.

"Hi-def VASER," her billboard reads. "The smart liposuction choice."

Other ads for Vaser call it "liposelection, not liposuction."

Then there are the other options: SmartLipo, LipoDissolve, mesotherapy, ultrasonic liposuction, super-wet liposuction.

If you've got dreams of trimming down, it's hard to know what's the best Lipo du Jour.

With more than 300,000 Americans getting fat vacuumed each year, liposuction reigns as one of the most popular cosmetic surgeries in the country. The dizzying array of claims and names show how doctors and devicemakers compete to grab customers' business when privately paying patients, not insurers, call the shots.

"A lot of this stuff is just basically marketing hype," said Dr. William P. Adams Jr., a spokesman for the American Society of Plastic Surgeons. "It's kind of a trend in cosmetic surgery. People market things without any science really behind it, just because they can."

Tampa lawyer Steve Yerrid represents a woman awarded $30-million because she lost her fingers and feet after tummy-tuck surgery. People often treat cosmetic surgery as a fashion statement rather than a medical procedure, and don't ask enough questions, Yerrid said.

"The fact that it's elective surgery does not necessarily make it less hazardous," he said. "If you're pursuing a new look ... it's not a retail transaction, it's a serious decision."

Claims for improved fat removal fall into two groups: new types of liposuction, and new procedures. The latter is most often related to an old procedure called mesotherapy. Even that is getting a new name: injection lipolysis.

The lipolysis procedures, which include LipoDissolve and Lipostabil, are generating the most controversy. Practitioners inject patients with drugs or herbal remedies meant to break up fat. They say the body will then absorb and expel it. But FDA officials warn that such procedures aren't approved, and medical groups have issued warnings that the claims don't have studies or scientific proof.

"The problem is inadequate training in this country and no standardization," said Dr. Richard D. Klein, assistant professor of plastic surgery at the University of South Florida. "Everyone has their own recipe. You can get into big problems."

Reported problems with lipolysis include infection, chronic swelling and death of the injected tissues. Two national groups, the American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery, have warned consumers about the procedures.

However, LipoDissolve is now being performed in the Tampa Bay area. Dr. Lisbeth W. Roy said she has done LipoDissolve on several of her Spa Tampa patients with no ill effects. Two of her recent patients said Roy told them beforehand about LipoDissolve's critics, that they decided to go ahead anyway and that they were happy with the results.

"I didn't really believe in it, but I was willing to give it a shot," said Richard Crooke of Tampa. "I've had three inches off in the first two treatments. I'm very pleased."

Crooke has had two treatments on his love handles this fall and plans two more. Tampa resident Karen Conroy said she saw about a two-inch difference after one treatment, enough that she doesn't need any more.

"I was a little scared about going under anesthesia," she said, so she decided against liposuction.

But one prominent Tampa plastic surgeon said he studied how the procedure was done on a few patients and didn't like the results. The repeated injections are painful and patients were left with "hard lumpy bumps," said Dr. Daniel Greenwald, former chief of plastic surgery at Tampa General Hospital.

"I'm not a fan of dissolving this fat, not knowing how the body's going to handle it," Greenwald said.

The bumps are temporary, and usually occur only when doctors use too high a concentration of chemicals, said Roy, an osteopathic physician. She pointed out that liposuction has problems too, such as pockets of uneven tissue.

"I've done liposuction correction with LipoDissolve," she said.

Greenwald's not totally opposed to the method, but thinks it needs more study.

"It may turn out that a certain combination of chemicals may actually work for people," he said.

Adams thinks the same. He's working on a small study, funded by a cosmetic surgery research foundation, meant to be the first to document whether lipolysis techniques are effective.

Other fat removal procedures are newer ways to perform liposuction. While they promise better results or less recovery time than standard procedures, they offer essentially the same surgery, some plastic surgeons said.

"They say liposelection, but that's what everyone does," said Dr. John R. Leikensohn, a Bradenton plastic surgeon. "They select the fat they're going to remove."

Leikensohn was one of the first surgeons to start performing SmartLipo, which uses a laser. He thinks it's an excellent tool, with limits.

"For smaller areas, you do get less bruising and less swelling than with most liposuction," he said. "It does tighten the skin, but not to the extent they would have you believe. When you have people with big love handles or saddlebags, you need to do something else."

One of Leikensohn's patients, 42-year-old Sarasota resident Nora Guenther, had SmartLipo under her chin to remove a little pocket "about the size of a quarter" last year. She found recovery far easier than when she had standard liposuction on her thighs a few years ago.

"It had a simple Band-Aid for a few days," she said. "It was such a quick simple procedure, and it made me feel better."

But SmartLipo is a good example of the confusion over even the same procedure. Like more traditional ultrasonic liposuction, SmartLipo uses a laser to break up fat. Some doctors use the laser and stop there, saying the body will dispel the fat. Leikensohn and others use a small tube to suck out the liquefied fat.

"Basically, none of us know exactly what it's supposed to be because it changes here and there," Adams said.

Plastic surgeons have a universal recommendation for those considering fat removal: A board-certified plastic surgeon should perform the surgery.

Any doctor is allowed to perform all kinds of surgery, but plastic surgeons have had years of extra training in cosmetic procedures. Some doctors may start doing a new technique after a weekend course. Others advertise that they are "board-certified" without saying what medical board certified them.

"If you have a brain tumor, you're not going to go to your plastic surgeon," Adams said. "But people don't think twice about having their internist do SmartLipo."



Lots of Lipo

With so many ways being advertised to take fat out of the body, it can be hard to keep it all straight. Here's a look at some of the different procedures.

Liposuction

Nearly 303,000 people got liposuction last year, making it one of the most popular cosmetic procedures. Surgeons use a thin tube to suck fat out of localized deposits, from jiggly bellies to saddlebag thighs.

Cost: Varies, but the national average surgeon's fee is $2,750, plus anesthesia and other charges.

Risks: Can range from poor results, such as uneven contours or saggy skin, to other rare problems, such as infection or nerve damage.

Features: It's the oldest and most proven way to remove localized areas of fat. Traditional liposuction most often uses a "super-wet" technique, in which surgeons inject fluid into the site before removing fat. Some surgeons also do ultrasonic liposuction, in which ultrasonic energy is used to liquify fat before it's sucked out.e_SClBVaser

The company advertises its device as "liposelection, not liposuction." But Vaser is actually a form of ultrasonic liposuction, plastic surgeons say.

Cost: Varies; one doctor says $3,500 to $5,000

Risks: As with any surgery, there are risks of infection and poor results.

Features: Proponents say pain is less and recovery time is shorter.e_SClBSmartLipo

A tube is inserted under the skin to treat the fat cells with a laser. Then, some surgeons remove the fat. Others leave it to dispel on its own.

Cost: $1,700 to $5,400 per area treated

Risks: In addition to typical surgical risks, the procedure varies from doctor to doctor.

Features: One surgeon who uses this says it's an excellent technique but best suited for smaller areas, not for large-volume liposuction.e_SClBMesotherapy

Doctors inject medication, herbal supplements or other fluids under the skin, usually with the intention of breaking down fat.

Cost: Can be $1,000 to $1,500 per treatment, with three or more treatments required.

Risks: The technique hasn't been scientifically proven to work; there's no standard formula for which fluids are injected; and none of them are FDA-approved. Risks include serious infections, skin and tissue damage and the fact that scientists aren't sure what happens to the fat or how it might affect other parts of the body.

Features: Proponents say the technique can be helpful for people who want to get rid of smaller areas of fat.e_SClBLipoDissolve

Doctors inject specific chemicals under the skin to melt away fat. The process is similar to mesotherapy.

Cost: Varies, but generally several hundred dollars per treatment; often multiple treatments are required; one patient paid $1,200, another $3,200.

Risks: Like mesotherapy, LipoDissolve isn't approved. "These are unapproved drugs for unapproved uses, and the FDA cannot guarantee consumers' safety," an agency spokeswoman said.

Features: Proponents say it's a way to lose fat, especially for smaller areas, without surgery.