As American waistlines have expanded, the attraction of a quick weight loss fix has increased. Diet and exercise are the key to safe weight loss, but for many of us, the results are discouraging. As a result, liposuction is the third most commonly performed cosmetic procedure in the United States, after breast augmentation and nose reshaping. In 2010, over 203,000 liposuction procedures were performed, a 2% increase over the previous year. Liposuction works by inserting a metal tube, called a cannula, underneath the skin. The surgeon then ruptures the fat to make it easier to suction out of the body.
But is it as safe as it sounds? Although liposuction has been trivialized into a routine outpatient procedure, it is not always as safe as surgeons and popular culture suggest. Most liposuction is not performed in the hospital and as a result, it is removed from medical examiner scrutiny and incident reporting. As a result, the complications are often underreported. The stark truth is that one in 5,000 patients die from the procedure.
In addition, the procedure can result in severe though rare complications including infection, cardiac arrest, blood clots, excessive fluid loss, fluid accumulation, damage to the skin or nerves, seizures, bruising, swelling, and damage to vital organs. Furthermore, the cosmetic results are often disappointing due to loose sagging skin and uneven contours. In response to these problems, many have promoted the new and increasingly popular laser liposuction procedure.
Approved by the FDA in 2006, laser liposuction is advertised as less invasive and more effective than standard liposuction. Lasers have a long history of cosmetic uses, including wrinkle reduction, skin tightening, hair removal, tattoo removal, and acne scar reduction. But does laser liposuction actually result in fat reduction?
How Does Laser Liposuction Work?
According to the American Society of Plastic Surgeons, the new laser liposuction places a tiny laser beneath the skin to liquefy the fat. Once liquefied, the fat is removed with a smaller cannula than is used in traditional liposuction, resulting in a smaller incision site as well as less bruising. Plastic surgeons using the procedure claim that the laser has the additional benefit of tightening the skin through heat, reducing the incidence of loose or bumpy skin associated with traditional liposuction.iv
Because the cannula is smaller, laser liposuction is often used to remove fat from difficult to reach places such as the underarms or neck. The objective isn’t weight loss but rather a change in circumference (the measurement around the neck or upper arm, say). The American Society of Plastic Surgeons claims the surgery is useful to people who are interested in “resculpting troublesome fat” that will not go away with diet and exercise.
What does the research say?
Laser liposuction obtained FDA (Food and Drug Administration) approval through the 510K process in 2006. However, the 510K process is intended for products that are similar to devices that are already on the market. This means the technology was not forced to undergo the extensive premarket approval process, necessitating extensive clinical trials. The FDA allowed 510K approval even though no laser had ever been used for laser liposuction simply because the laser was “substantially equivalent” to another laser used for an entirely different procedure. As a result, the safety and effectiveness of the surgery have not been validated with rigorous clinical trials. Furthermore, while most plastic surgeons believe the technology is effective, some believe it is no better than traditional liposuction.
However, several peer-reviewed journal articles since FDA approval have offered promising results. Two studies, both published in the Journal of Cosmetic and Laser Surgery, provide information on short-term results only. Neither study followed patients for more than six months after their surgery. This means we do not know how long results last or if there are any long-term complications.
In a study published in 2009, doctors performed laser lipolysis on the upper arms of 20 women ages 44-66. After surgery, 80% of patients experienced a decreased upper arm circumference of .83 cm on average. However, this study involved only 20 participants; the 80% success rate means 16 patients saw results and 4 did not.
Ultimately laser lipolysis is a form of surgery with risks and complications, just like traditional liposuction. A number of studies have found that laser liposuction can cause burns, retinal and corneal damaging, hyper and hypo pigmentation (darkening or lightening of the skin), skin infection, skin irregularity, skin ulceration or necrosis, permanent sensory nerve damage, scars, and swelling. Furthermore, because laser liposuction requires sedation, complications of anesthesia might occur. According to a study published in 2008, only five patients out of 537 experienced complications (approximately 1%) These complications consisted primarily of burns and infections. However, 19 touch-up procedures (3.5%) were needed due to ineffective fat reduction.
Burns are so common due to the inherent nature of laser surgery. The heat of the laser makes the skin contract and tighten, one of the most advertised benefits of the laser liposuction procedure. However, if the doctor is not careful and the laser gets too hot or is applied for too long, the skin will burn instead of tightening. Like all surgeries, laser liposuction is heavily dependent on the skill of the surgeon.
Ultimately if you decide to undergo the procedure you should select a skilled plastic surgeon that has a lot of experience with laser liposuction and a good record. If not, complications are more likely and the results will not be optimal.
Does the fat stay off?
Laser liposuction is a relatively new procedure, so we don’t yet know if there are any long-term risks or complications. We also don’t know if fat removed through laser liposuction behaves like fat removed through regular liposuction. With regular liposuction, the fat comes back—but to a new location. A 2011 study by Terri Hernandez and colleagues found that if a liposuction patient gains weight after surgery, the new fat develops in areas not treated in the surgery. This is because liposuction permanently removes fat cells, forcing fat to distribute elsewhere. For example, if fat cells are removed from the abdomen, it may later accumulate in the upper arms or the thighs. The study also showed that most non-obese women who underwent liposuction regained all the weight that was removed within a year of the surgery.
What about the cost?
Laser liposuction is expensive. The procedure costs $5,000 on average, but the cost varies depending on the size of the body area, the extent of excess fat removed, the type of laser used, and the geographic region where the surgery is performed. Since laser liposuction and regular liposuction are used differently, it’s hard to say which is more costly. Because lasers are small and expensive precision tools, it often takes longer to remove fat this way, making laser liposuction potentially more costly. However, laser liposuction is often performed on smaller areas than regular liposuction, which helps keep costs in check. Most people getting traditional liposuction focus on larger areas of their body or want it performed on multiple areas. If you compare the cost of the two methods of liposuction on a small area of the body, laser liposuction will cost more than traditional liposuction.v
The Bottom Line:
Laser liposuction is an expensive way of trimming fat or reducing the circumference of small, hard-to-reach areas of the body. It “works” in the short-term but it also has risks. Because it is a new technology, no one knows the long-term risks, benefits or complications. Do people who get laser liposuction end up gaining back the fat they lost in a new place, the way regular liposuction patients do? Only time and more studies will tell.
American Society of Plastic Surgeons. Laser and Ultrasound Assisted Liposuction. http://www.plasticsurgery.org/cosmetic-procedures/laser-and-ultrasound-assistedliposuction.html?sub=How%20much%20will%20laser%20and%20ultrasound%20assisted%20liposuction%20cost?
Dudelzak, J., Hussain, M., & Goldberg, D. J. (2009). Laser lipolysis of the arm, with and without suction aspiration: Clinical and histologic changes. Journal of Cosmetic & Laser Therapy, 11(2), 70-73.
Terri Hernandez et al. (2011).Fat Redistribution Following Suction Lipectomy: Defense of Body Fat and Patterns of Restoration. Obesity. 19(7), 1388-1395. AND Kolata, Gina. With liposuction, the Belly Finds What the Thighs Lose. The New York Times. (April 30, 2011). Available at: http://www.nytimes.com/2011/05/01/weekinreview/01kolata.html?_r=1&scp=2&sq=liposuction&st=cse
Cosmetic Surgery Prices. How Much Does Laser Liposuction Cost? Available at: http://cosmeticsurgerypricesx.com/laser-liposuction-cost/