I had the chance to go to an educational event last month put on by Cynosure, manufacturers of the "SmartLipo" platform for body-contouring. Cynosure is a well respected company and has manufactured generally well designed laser platforms. SmartLipo's gimmick is to place a pulsed laser (a 1064nm Nd:YAG for tech geeks in the audience) on a fiber optic cable which is used like a liposuction cannula. The theory is that the laser's energy disrupts and emulsifies fat cells, thereby eliminating or reducing the need for conventional suction assisted lipectomy (SAL). Also promoted is enhanced skin contracture from the thermal energy adjacent to the skin.

I've got to say I was a little unimpressed with the results shown from this device with body contouring procedures. It just didn't produce dramatic results. The presenting doctor in this instance was an ENT surgeon, which I think may have something to do with this. Much like many pictures shown by Dermatologists who do liposuction, there sometimes seem to be an ignorance or indifference to the skin quality and underlying anatomy of patients. (in fairness, many plastic surgeons are guilty of this too.) So picture after picture gets shown of people with undercorrection of significantly fatty areas and lots of residual loose skin in patients who were poor candidates for SAL, SmartLipo, Ultrasonic Liposuction, VASER, etc.... in the first place.

When you read industry publications quoting paid investigators & consultants who are "hanging crepe" about patient selection and expectations, that's usually a code word to me it works best on people who arguably need surgery the least. That's what the expectations had been dumbed down to with the "thread lift" fiasco in 2005-2007 (see here for one of my first blog entries on it).

To get results with SmartLipo, you're still going to have to do traditional liposuction afterwards, begging the question of whether a $100K-120K laser platform that can't be used for other indications makes any sense. It may also be effective for small touch up liposuction cases, but that's an awfully flawed business plan for a doctor assuming that much overhead.

I did see some nice results with SmartLipo when used in the neck/face, and it makes sense that it would work better in those area. If you've got thin fatty layers (like in the neck/face), you may indeed be able to treat that and get skin improvement. Complicating my assessment was the fact that many of those patients had face or neck life surgery simultaneous, which makes it hard to sort the skill of the surgeon's techniques from any effect of the laser. Facial and neck procedures might be the better group for this, but blindly applying high thermal energy to tissue adjacent to nerves and the carotid artery could potentially result in catastrophic complications.

In a nutshell, there may be some applications for this technology but presently I still feel it's more of a marketing tool then revolutionary device.



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