Maybe it’s the promises. (A beauty breakthrough in plastic surgery. Lose three to four inches in just two weeks.) Maybe it’s the no’s. (No needles, no surgery, no pain, no downtime.) Or, maybe it’s all the the sparkle and shine that’s generating oh-so-much buzz about the brand new laser fat-loss procedure Zerona.

Zerona is what some doctors consider the Holy Grail of the plastic surgery industry. A sacred object that’s said to possess miraculous powers. Powers that can achieve fat loss from troublesome areas, such as your waist, hips and thighs. Miraculous results without the risks typically linked to more invasive procedures.

Unlike the Holy Grail, Zerona does not have a history that dates back very far. It’s been used in studies since 2008 and first introduced into practices at the start of 2009. So, if you’re weighing your future beauty options, here’s five things to think about – one for each laser that beams down onto your body from the medieval-looking contraption, called Zerona.

Treatment. According to myzerona.com, Zerona is “unlike invasive weight loss surgery.” That’s because it’s applied externally (no knives, nips or tucks), by low-light lasers that reportedly signal your body’s fat cells to shrink. The fatty content from those cells is released to the space between the cells, then absorbed by the lymphatic system. That’s in contrast to liposuction, which removes the entire area of fat cells, using a tube and vacuum.

There are many clients out there who say Zerona works. Numerous testimonials, on plastic surgeon Web sites praise the product.

One client cited Zerona and Dr. Stephanie M. King for her weight loss progress: “I’m now having to buy new clothes and alter ones I just recently bought because I keep losing inches,” said Veronica, whose last name was not provided. “I highly recommend this program to anyone who can’t lose weight.”

Effectiveness. You’ve probably heard of Zerona working wonders from stories in print and aired on various news outlets, as well as TV shows: CBS, FOX News Channel, “Extra,” “The Doctors” and “Rachel Ray,” to name a few.

Despite all the buzz though, Orange County, Ca. Plastic Surgean Dr. John Di Saia is not yet convinced.

“Zerona is looking like a gimmick procedure thus far,” said Dr. Di Saia.

According to Di Saia, certain statistics are stacked against the new procedure. He cited favorable ratings as low as 22 percent.

“I admit that I am a traditionalist in the sense that I do not try new things until there is some objective evidence that they work,” Dr. Di Saia said. “I will be unlikely to try Zerona for that reason.”

Time. Most doctors quote a two-week treatment, which spans over approximately six sessions, every other day. The sessions are expected to last 40 minutes. You’ll probably spend 20 minutes on your back, 20 minutes on your belly. Some patients have reported results immediately.

How long will results last? That’s still a matter of discussion. It’s also dependent upon your lifestyle. During treatment, you’re expected to eat healthy, drink water frequently, and exercise regularly. You’re also supposed to abstain from alcohol and caffeine. Anyone who adheres to this regimen would likely experience weight loss anyway, leading one to wonder if it’s Zerona or the lifestyle that lead to the slimming effects. Zerona fans claim it’s a combination of both.

Cost. It’s estimated to cost $2,000 to $3,000. Some doctors are so confident Zerona will work, they offer credits toward liposuction or other procedures for unsatisfied patients.

Other dorctors though, such as New York Plastic Surgean Dr. Jennifer Walden, said treatment time isn’t all you should expect.

“A diet and exercise regimen must be strictly adhered to during and after treatments for fat loss to occur and persist,” said Dr. Walden. “This is often difficult for the particular patient population who is trying to get rid of fat in a treatment or procedure and had trouble with losing it with diet and exercise in the first place.”

Risks. Myzerona.com promises a revolutionary method that provides results, without the dangers associated with surgery. Doctors tend to agree on this one.

“The low level laser therapy to reduce fat includes no incisions, no downtime, and it’s painless,” said Dr. Walden.

But, you know the saying: no pain, no gain.

“Although this procedure seems low risk, my patients do actually expect treatments I offer to work,” said Dr. Di Saia.

Among all the hype, all the excitement, all the promises, there’s still a plethora of information out there to be considered — and much that still needs to be discovered. It is important to get numerous professional opinions when considering a new treatment, such as Zerona, or speak to a doctor you can trust.

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Jason Pozner, MD

Laser Liposuction is a minimally invasive, cosmetic surgical procedure which combines traditional liposuction techniques with laser treatment. Compared to older or traditional liposuction methods, laser-assisted lipolysis is generally thought to be safer, easier and quicker, providing more precise body contouring along with a skin tightening effect and minimal downtime.

Laser liposuction can be performed on many areas of the face and body, including the abdomen, arms, back, buttocks, chin, flanks, hips, knees, male chest, neck, thighs and waist. The laser enables many more individuals to be treated who previously would have needed surgery along with liposuction, often due to loose skin. Smaller areas and contour deformities not suitable for treatment with traditional liposuction are ideal for treatment with laser liposuction due to the enhanced precision of the laser. Laser liposuction can also treat areas with little or no fat like the submental area, or the area beneath the chin, as well as areas which have previously been treated with liposuction for improvement of contour deformities and skin laxity. Individuals who cannot afford the lengthy recovery associated with other treatments will find laser liposuction to be a particularly appealing treatment due to the rapid recovery and minimal downtime.

Laser liposuction is most often performed on an outpatient basis with local anesthesia, thus eliminating the risks associated with general anesthesia. Each targeted area can typically be treated in less than one hour. During the procedure, a small cannula fitted with a single laser fiber is inserted through small incisions in the treatment area. Because the incisions are small, there are no visible scars. Once the cannula is inserted, the energy from the laser liquefies the fat cells which are then drained away. The laser provides an additional skin tightening effect for improved contour, and the precision of the laser also helps to preserve the surrounding tissue.

There is little downtime or recovery associated with laser liposuction and most patients are able to return to their normal routine and work within one to two days. Patients report less discomfort, bruising and swelling than with traditional liposuction. The results of laser liposuction are long-lasting with sensible diet and exercise.

There are many different types of laser available for use, including the ProLipo Plus™ by Sciton. This minimally invasive, ultra high-powered laser system melts away unwanted fat while also tightening the skin. This technique helps to maintain firmer, smoother, more evenly toned skin with fewer risks and less downtime than traditional liposuction. There are also several new laser liposuction devices which are currently being studied and offering promising results. BodyTite™ from Invasix is a new all-in-one technology which uses radio frequency internally to achieve simultaneous lipolysis and skin tightening. This new technology allows for much shorter procedural times, improved results and fewer side effects. Another company, Zeltiq, is developing a patented technique called Cryolipolysis™. This new approach to fat removal uses precisely controlled cooling of fat cells for removal without harming the surrounding skin or tissue. This technology can be used to safely remove fat cells near nerves, muscle and bone.

Jason Pozner, M.D., F.A.C.S. (www.spsboca.com), can truly claim aesthetic surgery and skin care as his life’s work. The son of a successful health spa and diet center physician in New York, Dr. Pozner is certified by both the American Board of Plastic Surgery and American Board of Surgery, and is a member of the American Society of Plastic Surgeons, the largest and most prestigious organization of board-certified plastic surgeons in the world.

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By, David Shafer, MD

Liposuction is a general term used to describe removal of fat using a suction machine. Tumescent liposuction is the most popular method. In this technique, tumescent solution is injected into the area of fat to be removed. The tumescent solution typically contains lidocaine (to reduce pain) and epinephrine (to minimize bruising). After the solution is injected, liposuction is performed using cannulas (long, thin tubes) to suck out the fat. Fat can be removed from almost anywhere on the body. The most popular areas are the abdomen, waist, back, bra rolls, thighs, buttocks, and chest. Liposuction is usually performed under anesthesia to help minimize any discomfort and to monitor your body during the procedure. Awake liposuction is also possible, but it takes a motivated patient and surgeon since the tumescent solutions must be injected very slowly and the suction performed very meticulously. The volume removed during awake liposuction is also much less than can be removed under general anesthesia in a hospital or surgical center. All types of liposuction are based on variants of the tumescent technique. Liposuction is only for healthy patients.

Recently, laser liposuction (particularly Smartlipo) has received considerable attention and popularity. Smartlipo involves an extra step after the injection of tumescent fluid and before sucking out the fat. During the Smartlipo procedure, a small fiberoptic cable is inserted under the skin and uses a laser to destroy or melt the fat cells. The laser can be set to different modes with different wavelengths to focus more on destroying fat and/or heating up the skin. It is thought that heating the skin leads collagen production and a slight tightening of the skin. After the laser treatment with Smartlipo, the surgeon then performs traditional liposuction with smaller cannulas to remove the melted fat. In most cases, Smartlipo can be performed while you are awake. The advantages are potentially a quicker recovery, slightly smaller incisions, focused treatment and potential for slight skin tightening. Disadvantages, however, are less aggressive treatment since you are awake and can feel the movement of the cannula, smaller volumes of fat removed, inadequate skin tightening and potential for skin burns if you are being treated by an inexperienced surgeon. Also, you should keep in mind that the Smartlipo machine is also sold to doctors who are not plastic surgeons and they perform the procedure with little or no training in liposuction.

In my Manhattan plastic surgery practice, I use both Smartlipo MPX and Power-Assisted Liposuction. I use the Smartlipo MPX, a dual-wavelength laser lipolysis machine, for patients who have small or focused areas requiring liposuction such as love handles, abdomen, arms and neck. I perform these procedures in an accredited, office-based operating room while my patients are awake. In most cases, we perform the procedure on a Friday and patients are ready to go back to work on Monday. For patients requiring larger volume liposuction on multiple areas of their body, I perform Power-Assisted Liposuction in a hospital or surgical center while the patient is under general anesthesia. The Power-Assisted Liposuction (PAL) machine uses a vibrating cannula to quickly breakup the fat and easily such it out. This is a great device for larger volumes of fat to be removed. This can still be performed as an outpatient procedure. However, in the hospital setting, the patient has specialized monitoring. Our priority is patient safety and every precaution is taken to ensure that the procedure is safe and effective.

Whether Traditional or Smartlipo is best for you should be determined in consultation with your plastic surgeon. In either case, liposuction should not be viewed as a weight-loss procedure. Rather, it should be considered a body contouring procedure. Liposuction is not going to prevent you from gaining weight. It will, however, remove fat from specific areas and make drastic changes to your body shape. I like to tell patients that liposuction is a “second chance” to have a nice body. For one reason or another, you let your body get out of control and need fat removed. After liposuction, the patient needs to maintain a healthy lifestyle, eat a balanced diet, and exercise regularly to maintain the results.

Dr. David Shafer completed his plastic surgery residency at the world famous Mayo Clinic. He was then selected to continue his education at the prestigious Manhattan Eye, Ear & Throat Hospital. While most plastic surgeons go directly into practice after residency, Dr. Shafer had the honor to operate with many of the world’s most distinguished plastic surgeons. This unique experience allowed Dr. Shafer to advance his skills to a level that most surgeons take a lifetime to develop. Dr. Shafer continues to operate at MEETH and now teaches the next generation of plastic surgeons from NYU, Columbia and Cornell.

Ask Dr. David Shafer A Question on Makemeheal.com

Visit us at www.ShaferPlasticSurgery.com.

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By Lois W. Stern, Editor-at-Large, Makemeheal.com

A little over a year ago I wrote an article about the tragic death of Donda West, mother of the celebrity rapper, Kanye West, following plastic surgery. In the aftermath of Kanye’s rude mishap with Taylor Swift at the VMA Awards , I thought I would revisit his mom’s tragic story.

Why tragic? After doing some research on her case, I concluded that a significant factor in her death was due to poor medical judgment. Well, here we go again, some more bad news following plastic surgery. But this time, due diligence may avert the supreme tragedy of another life lost.

While investigating the Donda West tragedy, I had called both the ABPS (American Board of Plastic Surgery) and the ABMS (American Board of Medical Specialties) to inquire about the board certification of Donda West’s surgeon, Dr. Jan Adams. I learned two alarming facts. Dr. Jan Adams was not listed as a board certified plastic surgeon. Furthermore the only physician on record with the ABMS bearing the name Dr. Jan Thatcher Adams was board certified in Family Medicine – not plastic surgery.

I concluded that if Donda West had only made those phone calls prior to selecting her surgeon, she might have selected differently. She might even be with us today.

Donda’s autopsy results yielded no physical findings (such as a heart attack or blood clot) to explain why she went into cardiac arrest. According to Barry L. Friedberg M.D., a board certified, globally recognized leader in the field of office-based anesthesia, it was unlikely that either the length or extent of West’s surgeries caused her death. “More likely, it was the manner in which the surgery was performed; i.e. under general anesthesia which does not reliably produce pre-emptive analgesia and, therefore, often necessitates postop narcotics to manage pain. If West had sleep apnea as a pre-existing condition, even average doses of narcotics could easily prove fatal,” claims Dr. Barry Friedberg.

We will never know for sure what killed Donda West. But we do know that sound medical judgment comes only with quality training followed by lots of experience putting that training to practice.

On June 13^th, 2009, the Hartford Courant ran a story about Dr. Efraim Gomez-Zapata, a name currently in the news for allegedly practicing plastic surgery without proper credentials. (According to the Hartford Courant, Dr. Efraim Gomez-Zapata is credentialed as a family practice physician, but because his name is not listed with the Connecticut State Medical Board, I was unable to verify this information.). His medical license has been suspended by this same board based on charges that he violated medical standards by performing plastic surgery without appropriate qualifications or standards to protect patient safety. The allegations of the Connecticut Department of Public Health against Dr. Efraim Gomez-Zapata include administering anesthesia and performing plastic surgery on patients without the proper license or qualifications and failing to keep proper records or have the appropriate staff, equipment, office setup and hospital privileges required in case of complications. In two patient cases cited where complications did occur, one woman had a seizure after Gomez-Zapata administered a combination of painkillers, anti-anxiety medication and a local anesthesia; while a second went into respiratory arrest after Gomez-Zapata gave her a spinal anesthesia.

What simple steps can the rest of us take to avoid fates similar to those of Donda West or the unfortunate patients treated by Dr. Gomez-Zapata? I like to think of the word TEE (short for Training, Experience and Expertise) as a handy acronym to help me remember how to investigate the credentials of any prospective surgeon.

TRAINING: Know that ANY board certified physician in any field of medicine can legally perform plastic surgery and call himself a cosmetic surgeon.
DO YOUR HOMEWORK. Be sure you have selected a surgeon board certified in the area that relates to your surgical needs or desires.

EXPERIENCE: You can check out the history of any prospective surgeon by calling the medical records department of the state where he practices. Visit http://www.floridamalpractice.com/linksotherstatebds.htm for the telephone number of the medical records department of the state where your surgery will take place.

I do not know how many cosmetic surgeries either Dr. Jan Adams or Dr. Efraim Gomez-Zapata has performed. But I do know that their surgical histories send up some immediate red flags. According to medical records from the state of California, in 2001 two malpractice lawsuits were filed against Adams, ending in payouts of close to half a million dollars. Prior to the Donda West tragedy, three new, unsettled medical malpractice lawsuits were pending against this same doctor. As for Dr. Gomez-Zapata’s record, we do know that one of his patients experienced seizures during surgery and a second went into respiratory arrest. These are enough red flags to alert us to quickly do an about face and walk away from either of these offices.

Another way to assess the adequacy of a surgeon’s experience is to inquire about the number of procedures of a particular type he performs each year and how long he has been performing them. Ask to speak with some of his patients and try to meet with them in person to assess the surgeon’s work.

EXPERTISE: Ask your surgeon where he has hospital privileges and place a phone call to that hospital to inquire if he has privileges to perform the exact procedures you are considering. This step is essential, even if your surgery is to take place in an outside surgical facility. Why? The chief of plastic surgery assesses the experience and skill of the surgeon before granting him privileges for any surgical procedure. Surgeons are often granted privileges for some procedures while having privileges for others withheld, based on their experience and expertise. If a surgeon skirts this issue or tells you it isn’t necessary for him to have hospital privileges since surgery will take place in an outside facility, turn around and walk!

It is important to learn how to separate the sound from the noise. Donda West’s surgeon, Dr. Jan Adams had appeared on numerous national TV shows, including Oprah, CNN, Entertainment Tonight, and Discovery Health, to name a few, as a plastic surgery ‘expert’. I congratulate his PR agent for doing a phenomenal job. But great hype does not a great surgeon make. Surgical expertise does not come from making TV appearances.

Statistically, cosmetic surgery procedures have a strong safety record, but you need to heed some cautions. In a study evaluating the safety of accredited office based surgical facilities, only 1 death occurred in 58,810 surgical procedures, but there is one important caveat to that study that should not be overlooked: All of these procedures were performed in office surgery facilities accredited by the AAAASF.

While in the process of writing my first book, I had the privilege of interviewing Dr. Keyes, the lead surgeon of the above study. He explained that each surgical facility accredited by the AAAASF mandates that a) the doctor be board certified in the medical specialty recommended for that procedure and b) that the doctor has been granted privileges to perform those same procedures in the hospitals with which he is affiliated. Again, remember to do your homework.

Here are just a few of the life saving questions you should ask before engaging a surgeon

Do you have hospital privileges to perform the procedures I am considering? If so, where?

What you should do next: Call the hospital(s) to inquire.

What is your board certification?

What you should do next: Contact the American Board of Medical Specialties (Internet: www.abms.org/ Phone:1-847-9091) Consider surgeons with board certification in: plastic surgery, ophthalmology, otolaryngology, dermatology. Here is where Experience and Expertise come into play.

Is the facility where your surgery will take place an accredited facility?

What you should do next: Ask by whom? You are in good hands if accredited by the AAAASF or AAAHC for ambulatory facilities or the JCAHO for hospital facilities.

Who will administer my anesthesia?

What you should do next: Find out if this person is a board certified anesthesiologist? Understand that the training of a board certified anesthesiologist is far more comprehensive than that of a nurse anesthetist. In determining the extent of your anesthesia needs, consider the extent of your surgery, your physical condition and age.

You need to consider the risks and rewards to your surgery. Here are some additional questions to ask your surgeon:

What are the risks to my surgical procedures?

Do you consider me a good candidate for the surgeries I am requesting?

Do I have any medical condition, health habits, etc. that we need to consider?

I am ever mindful of the words of Dr. Rohrich, former president of the ASAPS and a member of their Innovative Procedures Committee: Most women spend more time selecting a pair of shoes than selecting a plastic surgeon. You can take back your shoes, but you can’t take your face or your life back.

Lois is the author of Sex, Lies and Cosmetic Surgery and Tick Tock, Stop the Clock. She also has developed a special Support Tool DVD for Professional office use – a practical communication tool to help surgeons personalize their services while communicating with their patients. Check out Lois’s website at: www.sexliesandcosmeticsurgery.com.

Lois and Patty Kovacs are the co-founders of Coast2Coast - Eye on Beauty Newsletter.

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Many of us try to fight fat on our own. Spending countless hours at the gym, deprived of our favorite foods and treats. Yet stubborn areas still manage to elude us. To help with remaining fat deposits, companies are constantly coming out with new and improved ways to eliminate them, with the most popular weight loss plastic surgery tool being liposuction.

Liposuction continues to be one of the most popular plastic surgeries performed in the United States, helping to slim and reshape the body by removing deposits of fat to help improve the appearance of contours and proportion. Traditional liposuction is suitable for healthy, disease and medical condition-free adults who are within 30% of their ideal weight, but have been unable to lose fat through diet and exercise alone.

While traditional liposuction is an effective fat loss tool, it still comes with many health risks. Some of these include: fat clots, blood clots, bleeding (hematoma), damage to internal body structures such as nerves, blood vessels, muscles, lungs, and abdominal organs, as well as deep vein thrombosis, cardiac and pulmonary complications and complications from anesthesia, among other serious problems. In addition, traditional liposuction plastic surgery procedures may include cosmetic risks, including rippling or loose skin, skin discoloration and swelling as well as other abnormal occurrences that would need to be rectified by a secondary or revision procedure. Into the bargain, because liposuction is an invasive procedure, requiring anesthesia, it also requires significant recovery time.

While liposuction is a very good way to eliminate unwanted fat areas, it is not suitable for all areas of the body where fat deposits may occur. On the other hand, the special technology of LifeSculpt can be just the answer for fat deposits in difficult-to-reach areas such as the fat under the chin, backs, arms, and inner thighs.

The LifeSculpt procedure features the SlimLipo laser body sculpting technology in a minimally invasive way, allowing for much quicker recovery time than traditional liposuction. Not only that but, the minimally invasive laser treatment offers little to no bruising.

While liposuction can leave behind loose skin that requires another procedure to tighten, LifeSculpt not only allows qualified physicians to remove fat, but also to tighten the skin through laser-assisted lipolysis.

What The Experts Say

Doctors and patients both agree that LifeSculpt is an invaluable tool in the fight against fat.

A recent limited study published in US Dermatology, by Robert Weiss, M.D., Director of the Maryland Laser, Skin, and Vein Institute found that all patients who had the LifeSculpt procedure saw an improvement in the area treated. Furthermore, all patients also saw an improvement in skin’s smoothness and tightness within three months after treatment.

“This study proved what I’d been experiencing in my own practice; LifeSculpt offers superior results, better than any other type of fat reduction and fat removal method on the market,” said Dr. Weiss.

“During the recovery period after the LifeSculpt procedure, skin tightening may occur as new collagen is laid down in the layers of the skin. Improvement in skin firmness can continue for up to six months after the procedure; this is particularly gratifying to patients who have experienced significant skin laxity that is often associated with age and weight loss,” noted Brooke Seckel, M.D., plastic surgeon at Boston Plastic Surgery Associates, Concord MA.

“There is an emerging demand for this kind of option among consumers – people want stellar results, but do not want to have to take time out of their busy schedules to achieve those results,” noted Richard Bankowski, Field Clinical Director for Palomar Medical Technologies, Inc..

How It Works

Using a few small incisions in the area to be treated, LifeSculpt “melts” fat for quick and permanent removal from the body. LifeSculpt uses state-of-the-art SlimLipo™ laser lipolysis, which melts fat and sucks it out of the body through a medical suction device. Unlike other liposuction procedures, the fat is removed as a liquid, rather than a clumpy material.

Small areas of fat can be quickly and permanently eradicated, although results vary from patient to patient and are not guaranteed. One treatment is all takes for an area to become fat-free.

Recovery From Lifesculpt

Because LifeSculpt is minimally invasive, downtime for the procedure is also minimal. Some treatments on small areas may take less than an hour, while larger areas will require more time. LifeSculpt can be performed on an outpatient basis, depending on the doctor’s preference. Many patients report little to no pain, only a slight warmth in the treatment area. LifeSculpt allows patients to resume their normal activities almost immediately and patients can return to work the very next day.

Some patients may notice slight bruising which goes away within a few weeks. Depending on the treatment area, compression garments may be necessary and your physician may have special recommendations for your recovery period.

If you’ve already had traditional liposuction and have been left with a lumpy appearance, LifeSculpt may be a good option to help smooth and tighten the appearance of skin. While LifeSculpt is commonly used for patients with stubborn fat deposits, it can also be used on heavier patients, especially after they have lost weight on a program.

The cost of LifeSculpt varies, depending on the area to be treated. Discuss the cost during your consultation with your physician. It is generally less than traditional liposuction, as only a local anesthesia is used and the procedure may or may not take place in an operating room.

LifeSculpt is not a substitute for diet and exercise, but it can help fight against residual fat deposits.

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By Lois W. Stern, Editor-at-Large, Makemeheal.com

With the many innovations of modern day plastic surgery, none seems to be gaining in popularity more rapidly than a variety of emerging technologies for the removal of unwanted body fat. Although diet and exercise remain the first line of defense against weight gain, when it comes to eliminating stubborn pockets of fat, these strategies often have fallen short of expectations. Enter modern day fat removal technologies.

With increasing interest in issues of health and beauty, it is little wonder that a number of plastic surgery technologies have stepped up to the plate to meet popular demand, while addressing America’s fixation with the battle of the bulge. According to statistics gathered by the ASAPS (American Society for Aesthetic Plastic Surgery), last year lipoplasty (liposuction) ranked second in frequency of all surgical procedures performed in the United States with a total of 309,692 lipoplasty procedures. Within this number, 90% were performed on women, a figure consistent with the overall gender ranking for all surgical procedures.

Although tumescent liposuction is still an effective procedure for the removal of large fat deposits, one of the disadvantages of this procedure is its tendency to leave behind unattractive, loose skin. This is where Smartlipo, an innovative laser-assisted device, enters the playing field. It is also one of the reasons it is rapidly becoming the gold standard for the removal of unwanted body fat. In some cases, Smartlipo, also known as lipolysis, is being used as a viable substitute for tumescent liposuction. In other cases, where larger amounts of body fat are involved, Smartlipo is being effectively employed as a complement to traditional liposuction by helping surgeons tighten the loose skin left behind from a tumescent liposuction procedure.

Typically, areas treated effectively through Smart Lipo technology include the chin and neck areas, inner and outer thighs, knees, abdomen, upper arms, hips, “bra fat”, “love handles“, and male breasts.

Before/After Photos Courtesy of Dr. Barry DiBarnardo

How Smartlipo Works

Board certified plastic surgeon, Dr. Alan Kisner, explains how Smart Lipo works:

“Normally the patient is injected with a local anesthesia before the lipolysis procedure. Treatment begins when the surgeon inserts a micro-cannula (tiny tube) about the size of a thick syringe needle into the skin. The tiny incision made for the entrance of the cannula is so small that no stitches are required after the procedure.“

“A three hundred to six hundred micron optical fiber is placed within this micro-

cannula, which is approximately 1.0 mm to 2.0 mm in diameter. This optical fiber extends two mm beyond the cannula. Because the aiming beam is very bright, it is visible through the skin, enabling the surgeon to see exactly where he is working. The laser causes small blood vessels to coagulate immediately, keeping bleeding, swelling and bruising normally associated with traditional fat removal techniques to a minimum.“

“As the surgeon moves this cannula in a slow, fan-like motion through various depths of fat tissue, the optic fiber delivers laser energy in short pulses, which heat the targeted fat cells in the top layers of the patient’s skin. These fat cells rupture and liquefy. The resultant oily liquid substance is then removed with another micro-cannula.“

Of particular significance with any fat melting technique lies a concern for what happens to that fat as it is melted within the body. With Smartlipo, research has shown that little if any fat is reabsorbed into the body.

Further benefits of Smartlipo include both its potential for stimulating the formation of new collagen and for its reduction of cellulite.

During treatment, controlled wounding results in stimulation of new cells under the patient’s skin, which is thought to produce new collagen. Furthermore, the thermal energy within the dermis causes shrinkage of the fat cells residing between the collagen fibers (the bands that keep our skin tight and in place). When fat cells are removed from between these bands, it may result in reduction of cellulite.

Before/After Photos Courtesy of Dr. Jeff Schafer

Before/After Photos Courtesy of Dr. Bruce Katz

Recovery After Smartlipo

The recovery period after a Smartlipo procedure is brief and relatively painless. Patients are typically sent home within one hour after the completion of the procedure with compression bandages to prevent affected tissues from shifting. In some cases, surgeons recommend that the patient wear a compression garment for a short period of time during recovery. Minor bruising and numbness occur after the procedure, but disappear within days after leaving the recovery room. Swelling is normally observable for the first week and gradually tapers off thereafter. Normally one is able to return to work within two to three days and is able to resume exercise and full activities after two weeks. Results become visible within one week, with continued improvement noted over a three to six month period.

Improvements in Smartlipo Technology

The first Smartlipo design was pioneered in Europe and South America beginning in the year 2000. In November, 2006, it became the first laser assisted liposuction technology approved by the FDA. Made by Cynosure, the original Smartlipo machine has already undergone improvement to increase its effectiveness. The newer model, the Smartlipo MPX, employs 2 lasers: the 1064 to treat the deeper fat and 1032 laser to tighten the skin. This model also incorporates some practical innovations in response to plastic surgeon input. Early models worked effectively but slowly, causing considerable surgeon fatigue. As surgeons expressed a need for a model that would work more rapidly, Cynosure searched for a solution, which they amusingly reached while observing the Wii Video Game system in action. Noting how the Wii chip responded to the speed and motion of the user’s arm while swinging a tennis racket or tossing a bowling ball, Cynosure was inspired to develop and insert a similar chip into their latest Smartlipo design, to respond to the speed and motion of the surgeon’s arm during the lipolysis procedure.

Smartlipo Costs

Smartlipo costs will vary depending upon the surgeon performing the procedure, the surgeon’s experience and location as well as the size of the areas to be treated. Although costs for Smartlipo tend to be a slightly higher than those of other modern liposuction techniques, other factors likely to reduce the overall cost need to be considered, including lower anesthesia and recovery charges. Another factor worth considering is the shortened recovery time following Smartlipo due to minimal tissue trauma, which spells less time lost from work.

Look for Dr. Kisner’s chapter, When Diet and Exercise Aren’t Enough, with his amazing before/after photographs in my about-to-be-published book, Tick Tock, Stop the Clock – Getting Pretty on Your Lunch Hour.

Lois W. Stern, Editor-At-Large at Makemeheal.com, is a beauty expert and author of Sex, Lies and Cosmetic Surgery and Tick Tock Stop the Clock. Lois and Patty Kovacs are the co-founders of Coast to Coast - Eye on Beauty Newsletter.

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February 6, 2009 - Los Angeles, CA

Make Me Heal (www.makemeheal.com), the world’s largest website for all things plastic surgery, cosmetic treatments, and anti-aging, has announced that over fifty top plastic surgeons have joined Makemeheal.com to answer questions live that are posted by consumers on the website’s Ask-An-Expert area. Launched in November of 2008, Ask-an-Expert is a free service that allows consumers to ask a question and get key answers from top doctors and experts about any procedure or topic within the fields of plastic surgery, dermatology, and skin care. Moreover, regular people from the Makemeheal.com community can also post responses to questions.

“Ask-an-Expert is rapidly becoming one of Makemeheal.com’s most popular areas of our portal, as it allows consumers to ask important questions and get answers from different leading doctors and experts at a click of a button — and for free,” says Ariel Perets, Founder & CEO of Makemeheal.com.

Aside from asking questions, users can simply use this incredible resource to do research numerous types of procedures, treatments, and products using sophisticated search functions on Ask-an-Expert.

Among the physicians answering questions on the Makemeheal.com site include Dr. Marcel Daniels, Dr. Brent Moelleken, Dr. Shervin Naderi, Dr. Alexander Rivkin, and other top plastic surgeons.

Check out Ask-An-Expert.

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There is truly no body part today that is spared from plastic surgery and the shoulders are the latest area that some women may be looking to enhance.  Celebrities like Madonna and Keira Knightly have apparently set a new beauty standard for slender shoulders that some women are hoping to attain by going under the knife.

Some surgeons in New York are reporting a rise in women getting liposuction in their shoulders to vaccum out fat and achieve more defined shoulders.  The procedure seems to be a standard liposuction, where small incisions are placed in the natural creases and shadows of the shoulder area.  The surgeon then aspirates the fat out with a curved suction cannula (wand).  There are some surgeons who use laser-assisted liposuction like Smartlipo or Vaser to melt the fat and then suck it out.

“Many of my patients are now requesting shoulders like Madonna and Keira Knightley,” said Dr. Douglas Steinbrech to the Daily Mail. The New York-based plastic surgeon said that the procedure costs between $4,000-$10,000, is relatively pain free and patients can return to work within a few days.

“I often perform the operation on a Thursday or Friday and they recover all weekend with anti-inflammatories and painkillers and go back to work on Monday,” he said.

But not everyone believes that shoulder liposuction is going to be a growing trend or that it should be, as the shoulders are not typically an area that has accumulations of fat as other body areas.  If someone really has a lot of fat around the shoulders, they probably need to lose weight instead of thinking about liposuction in the area.

Beverly Hills, CA-based liposuction expert Dr. David Amron, who only performs liposuction at his practice, told Make Me Heal that he has never seen a candidate for shoulder liposuction in the thousands of evaluations.

“I do lipo on almost every area of the body and even many areas most people don’t,” said Dr. Amron.  “But the shoulders themselves are an area I have never seen that needs to be done”.

“I strongly feel that if someone has fat shoulders then it typically is a musculoskeletal issue of larger muscles and bones and maybe that they need to lose weight.  Remember, lipo targets genetic disproportion of fat.”

“I am not saying I wouldn’t, but I have never seen a candidate for this area in thousands and thousands of evaluations.”

“When I do lipo on the arms and upper back, which is quite common, the shoulders have a more defined look.  But I would not be marketing this as shoulder liposuction to have the look of an actress.”

It appears that liposuction on the shoulders should really a last resort solution, as a patient is best advised to lose the weight first before considering a surgical option.  Moreover, if someone is going to get liposuction on the shoulders, one would think that they probably would need it in other areas as well to get a consistent toned look in the entire body.  But if you have the dough, and exercise and diet alone can’t help you rid of that final pesky fat pocket on your shoulder, maybe shoulder liposuction may be right for you.

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By David M. Amron, M.D.

As a physician and surgeon, one of my main responsibilities is to honestly guide, educate, advise and protect my patients. As liposuction surgery is the only major cosmetic surgery I perform and I have done this procedure for 14 years for thousands of patients, I have a lot of opinions and insight into the nuances of consistently achieving a great result and making my patient happy. I have spent years fine tuning my approach and have a particular philosophy on what constitutes a good candidate for liposuction. It is so much more than sucking out or melting as much fat as possible. Despite what a patient may want or the mistaken goal of a surgeon, this approach will commonly lead to a poor result.

One of the most important points I want to emphasize is the importance of choosing the honesty, integrity, artistry, eyes, hands, skills and good judgment of the surgeon over the machine. The machine is only a paint brush in the artist’s hands. Despite interesting technology and aggressive marketing hype, it will not guarantee a great result in a trusting patient. A concerning trend I have seen in the last few years with the introduction of some of this interesting technology is the mistaken tendency of the patient to choose or ask for the machine instead of spending time to find the right surgeon. Unfortunately, companies, the media and sometimes even doctors themselves contribute to this when there is competition for dollars. Like I say on my radio show (and you are doing so by reading this article), please do your homework and spend time educating yourself. Do not be impulsive, continue to learn and hopefully the truth will come to guide you to a great result.

Presently in the United States, liposuction is still the most common cosmetic surgery. It also has one of the highest revision rates approaching 25% in some studies. It is much more difficult than most patients and even many naïve surgeons realize to consistently get a beautiful result. There are many reasons for this as we will start to see. I feel it is extremely important to “get it right” the first time. Every aspect of this procedure from clear honest communication with the patient, to complete evaluation, to meticulous technique should be directed toward this end. If a patient is not a candidate, e.g. they are simply overweight, maybe out of shape but not disproportionate, then I may have no role in their improvement and honestly tell them they are not a candidate for liposuction.

Unfortunately, approximately 30% of my surgeries are revision liposuction where I am using techniques to improve a bad or less than optimum result by another physician or possibly non-physician. In my evaluation of this patient, I can always tell why a bad result has occurred. A bad result occurs for two reasons: either poor evaluation (including poor communication) or poor technique. The surgeon may have been too conservative, been too aggressive (too common), been uneven in his contouring, poorly blended areas, placed his incision points in strategically poor locations or thrown a patient out of balance and proper proportion. And once again, unfortunately no new technologically advanced machine can or ever will prevent any of these problems. Like a perfect haircut or a beautiful sculpture, it goes back to the skills and artistry of the person doing it.

With liposculpture surgery, as with any procedure, a great result begins with a complete honest evaluation as to who is a good candidate. Simply stated, liposuction is all about targeting areas of genetic disproportion and balancing a body. It has virtually nothing to do with being overweight, underweight or normal weight. It is about focusing on stubborn areas that can’t be taken care of with diet or exercise. This is one reason why it is so important to be fully evaluated from your neck to your ankles by someone with a good eye and ability to determine where you are out of balance if at all. It is a mistake to perform liposuction on someone who is simply overweight or out of shape but not disproportionate. Once again, unfortunately this does not uncommonly occur and the result will be a person thrown out of proportion. This is why we hear of cases of people who had lipo and the fat “went” to other area. The surgeon created disproportion. In addition, make sure that the person who is evaluating you for surgery is actually the surgeon and not somebody else. I have heard of patients who met their surgeon for liposuction in the operating room for the first time. Be wary of places that seem like factories and do not truly care about comprehensive individualized care.

With regard to my own approach to liposculpture, I strongly feel that local anesthesia is the gold standard and offers many advantages over general anesthesia for liposuction specifically. This is called “tumescent” liposuction which was developed by a dermatologic surgeon. I like to call this pure tumescent liposuction to differentiate it from other types where they maybe combining it with general anesthesia. Tumescent liposuction has essentially three major benefits. To begin with, studies show it is far safer, especially if compared to liposuction done with other procedures under general anesthesia. The second benefit is easier recovery. The tumescent fluid which is infiltrated into the fat helps hydrodissect (separate with water) and allows much more pure fat removal with decreased bleeding. This results in far less bruising and generally much faster recovery with less post operative discomfort. I only trust myself to do all the local anesthesia as there certainly is an art to infiltration so that the patient feels as little as possible. However, the greatest advantage of local anesthesia is that I have a patient that can always be positioned optimally, so that I can meticulously sculpt without ever jabbing the muscle or poking the skin. This allows me to stay only in the fat layer where I only belong. Jabbing the muscle (which could never be tolerated with a conscious patient) significantly increases bleeding, bruising and postoperative pain. On the other hand, jabbing, poking or tenting the skin with the cannula at the wrong angle is one of the main causes of indentations and irregularities (as we will soon discuss).

With regard to my technique of sculpting, it begins with a good eye for the contour, balance and proper proportions for the male and especially the female body. Each body has its own differences, nuances and limitations. Good surgical technique also encompasses excellent judgment for not only where to target but also how aggressive to be. There must always be respect for skin tone as well as knowing how to deal with looser flabby tissue (flab is the term I use which is loose skin and muscle. Many people confuse flab with fat.)

Where I have learned to place my incisions in each part of the body I approach is extremely important. The goal is not only to place few incisions in places that hide well, but to strategically place them to be able to completely and evenly approach each area without jabbing the muscle or skin. My incisions are small nicks in the skin between two-three millimeters in length. I feel that not suturing the sites allows faster recovery by drainage of fluid postoperatively.

With regard to how I sculpt, this is a little more difficult to convey in words. The fat is embedded in a fairly dense connective tissue framework so it certainly is not just sucking fat out. One must tunnel very precisely in the fat and this is why liposculpture is truly a more accurate name then liposuction. I always start deep in the fat with small round cannulas to debulk the deeper layers of fat. I almost always approach an area from two or more directions and crisscross my tunnels. As I move up in the fat layer, I progressively go to even smaller cannulas and finish in the superficial fat layer with a flat tipped small cannula I had designed for myself many years ago to make sure my surface is smooth. It is how I approach this superficial fat and how aggressive I choose to be with regard to rasping the dermis from underneath that controls how much skin tightening I choose to achieve. Liposculpting is a very tactile procedure and this is one of the main reasons why I do not prefer laser assisted liposuction or ultrasonic liposuction as I lose the “feelings” or vibrations which convey to me exactly where I am and how much I am bringing an area down. Remember, the goal is not to always be aggressive and just suck all the fat out. This is a very amateur approach and bad results will commonly occur. For a more detailed description of how I approach each particular area of the body, please consult my website www.expertliposuction.com in the section entitled “area by area.”

Now, with regard to alternative liposuction procedures, I will group them into internal and external modalities. With regard to the internal modalities, I will begin with mesotherapy (also known as lipozap or lipodissolve) as it will be the quickest to dismiss. One of the deceitful marketing tools is that mesotherapy many times is advertised as being better than liposuction. I find this not only inaccurate but insulting. Mesotherapy is the multiple injections of a nonstandardized solution of phosphatidylcholine into the fat. Now, I am not saying that it won’t ever dissolve fat because it might. But remember when I said that the fat is embedded in a dense connective tissue framework? Well, how do you control the dispersal of the fluid and trust you are going to dissolve everything evenly? Remember how particular I was in how I sculpted each area of the body? There is so much more involved to great liposculpting then just dissolving fat. And, not that this is the most important thing, but mesotherapy is not FDA approved, is not supported by any of the major cosmetic surgery societies and furthermore, no one that I know who specializes in body sculpting has chosen to incorporate it in their practice.

Laser assisted liposuction (eg. Smart lipo, cool lipo) and ultrasonic liposuction (eg. Vaser) are newer quite popular alternatives to more traditional forms of liposuction. The argument here goes that they melt fat and tighten skin, whereas traditional liposuction either does not tighten skin or makes your skin looser. Very alluring, but it’s not that simple or truly accurate. I sometimes call this liposeduction vs. liposuction. There are many surgeons that have embraced these newer machines. Personally, I do not trust simply melting fat and feel I can get as much tightening as I choose by how I deal with the area just under the skin. I prefer this because it gives me more of a feel. With regard to the laser sealing blood vessels, remember that with properly done tumescent anesthesia one gets very little bleeding due to the hydrostatic pressure and epinephrine vasoconstruction. One well done study in a major peer reviewed journal (Plastic and Reconstructive Surgery Sept. 2006) failed to demonstrate any clinical advantages of laser assisted lipoplasty.

However, I feel the bigger danger with many of the newer aggressively marketed machines is that they encourage the potential patient to search for the machine and forget that what is more important is the mind, hands, heart and eyes of the man (or woman) behind it. Since I do a lot of revision work to improve poorly done liposuction, I would have to say that in the past two years I have seen some of the worst disasters result from both laser assisted and ultrasonic liposuction. Once again, I don’t blame the machine but the judgment and skills of the person behind it. I am also aware that the media plays a large role in hyping up whatever is new.

Finally, with regard to many of the newer machines that are targeting either cellulite or tightening of the skin, I feel this is an interesting area as long as it is not too closely compared to well done liposculpture. There are some promising results with regard to this area. Velashape was the first FDA approved machine for cellulite and the temporary reduction of circumference (yes, temporary). There are other machines also used for cellulite. While this is a very intriguing area, I have not yet chosen to incorporate it in my practice as I am not yet sure it really works long term and is worth the cost of the procedures. There are also several skin tightening machines that are used on the body such as Titan, Thermage, which uses radiofrequency, and Affirm. Recently Thermage came out with a deep penetrating tip that penetrates over 4 mm and generates an inflammatory response in the superficial fat layer to generate tissue tightening and shrinkage. I am in the process of forming my opinion as I am starting to use this deep tissue tightening tip to further tighten skin on the body. But I have to admit that it is quite expensive and at least in my hands and eyes, the verdict is still out. But I will keep you posted.

In closing, I hope the insights and opinions I have shared help to guide you in the right direction.

Ask Dr. David Amron Questions & Get Answers

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Dr. Amron has his own message board on Make Me Heal where he answers liposuction questions live from patients.

About Dr. David Amron

Based in Beverly Hills, California, Dr. David Amron (www.expertliposuction.com) is known internationally as an expert in liposuction and revision liposuction. He has meticulously sculpted thousands of patients for over ten years and is well respected for achieving consistently outstanding results with his “pure tumescent liposuction” technique.

Learn more about Dr. David Amron

Visit Dr. David Amron’s Website: www.expertliposuction.com

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There is a new liposuction technique that has just been approved by the Food And Drug Administration that promises to melt fat in a less invasive manner, bring about results within as short as a week, and result in less downtime and less side effects than traditional liposuction. Sounds too good? This new laser-assisted liposuction technique for fat removal is called Laser Body Sculpting and is also being referred to as SmartLipo or “Lunch Time Liposuction” due to the quick 45-60 minute surgery time. Ideal for treating small areas of the face, chin, neck, arms, breasts (gynecomastia), and areas of loose and flabby skin, SmartLipo melts away fat using a high powered laser. A very small cannula (tube) that is approximately 1.0-2.0 millimeters in diameter contains a laser fiber that is inserted into the skin. The cannula is moved back and forth, delivering the laser’s energy to the fat cells, causing them to rupture and easily drain away. As the laser tip comes in contact with the fat cells, the tip literally melts the fat. The laser energy also interacts with the dermis and results in collagen shrinkage – meaning it creates a desirable tightening effect on the area. The SmartLipo laser causes the membranes of the adipose cells (the main storage for fat in the body) to break down, transforming them into an oily substance that is absorbed and eliminated in a natural manner. Because the fat is turned to liquid instead of being suctioned in solid form, using the SmartLipo laser means less blood and trauma, faster recovery, and quicker results with less side effects compared to more aggressive traditional liposuction techniques. Due to the cannula’s small size, Smartlipo can be performed under local anesthesia. After the treatment, the patient will need to wear a compression garment for several days to several weeks, depending on the body area being treated.

SmartLipo’s manufacturer Cynosure claims that results can be seen as soon as a week with continued improvement over several months. “There’s an immediate change right away,” said Coronado, California plastic surgeon Dr. Jeffrey Schafer in a separate interview on 10news.com. Patient Alice Schultz says her hips and stomach seem tighter just hours after her surgery.

SmartLipo claims that this laser- assisted liposuction is safer for the patients because less bleeding and anesthetic drugs are used and because it doesn’t cause destruction of tissues as it could happen with a traditional liposuction. One treatment is usually recommended and results can be seen immediately with continued improvement over several months.

On the Make Me Heal Liposuction Message Board doctors and patients alike have discussed this new technique. Dr Todd K. Malan from Phoenix, Arizona, who was selected to be one of the first surgeons to use SmartLipo in the US, is very happy with the results achieved with his patients, and proudly promotes this device:

“Like traditional Liposuction maximum results can take 3-6 months. However unlike traditional Lipo or Vaser you do see a remarkable immediate effect. We are able to perform Smartlipo in office with a 1mm incision that doesn’t even need to be sutured and the after procedure pain is no worse than you would experience from a workout at the Gym. Best of all in nearly all cases no bruising or swelling so it os great for areas that aren’t hidden by clothing. I still perfom traditional Lipo and Vaser but Smartlipo is a better option for most patients.”

“It’s something that really is going to change liposuction,” added Schafer. Schafer is the first approved physician in the West Coast to use SmartLipo. “This is the first thing I am really excited about. It’s really going to make a significant change in the results,” said Schafer.

But not all doctors share the same enthusiasm. Plastic surgeon Dr. John LoMonaco of Houston Texas sounded caution, referring to a study by Dr. Prado and colleagues from Chile in Plastic and Reconstructive Surgery (118:1032, 2006), where SmartLipo has been in use since 2004.

“They used SmartLipo on one side, standard liposuction on the other side of 25 patients and saw less pain in the laser-treated side, but no differences in recovery, no decrease in swelling and bruising, and no difference in the quality of the result.” Dr. LoMonaco adds “The photos looked the same on both sides at 11 and 15 days, and also at 11 months. They did find that the procedure took longer, and importantly found high levels of free fatty acids in the tissue left over from the ruptured fat cells from the laser treated sides which they call a “major problem.” Dr. Lomanco also says that “Dr. Prado was critical of the “sumptuous marketing” by the company in his country and stated that “The use of any prototype machine in humans should follow the principle of research before commerce.”

It may be too early to judge whether SmartLipo is really as great as its claims say, but it is surely a promising innovation that gives hope for having plastic surgery with great results and minimal side effects. As more and more patients try this new technique, Make Me Heal will offer more of such testimonials.

There are only 15 clinics in the United States offering SmartLipo at this time, although the procedure was developed in Italy and has been performed in numerous clinics throughout Europe, South America, Australia, Japan, Taiwan, and the Philippines.

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