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About smartlipo

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About smartlipo
« on: June 10, 2009, 11:20:05 PM »
I just wanted to know is it as effective as traditional lipo? Would it work for a person who's gynecomastia is primarily fat?

Linkback: https://www.gynecomastia.org/smf/index.php?topic=18009.0

Re: About smartlipo
« Reply #1 on: June 11, 2009, 04:47:51 PM »
Smart Lipo is a laser assisted liposuction system.  It is currently being hyped beyond belief.  Its main claim for superiority over traditional lipo is that it tightens the skin by using a laser underneath the skin to help it contract.  This claim has not yet been scientifically proven!  Traditional lipo also tightens skin.  Both traditional lipo and smart lipo can remove fat.  Neither technique can remove gland.  There is also a possibility that Smart lipo can literally create a burn of the skin from the undersurface -- not common -- but it has been reported.  This can never happen with traditional lipo.

Bottom line:  there are docs out there hyping this as the latest and greatest -- and charging hefty fees for it.  From my perspective, for gyne surgery, it offers no significant benefits over traditional lipo, which has worked extremely well.

Dr Jacobs
Dr. Jacobs 
Certified: American Board of Plastic Surgery
Fellow: American College of Surgeons
Practice sub-specialty in Gynecomastia Surgery
815 Park Avenue
New York, New York 10021
Telephone:  (212) 570-6080
Email:  [email protected]
Website:  http://www.gynecomastiasurgery.com
Website:  http://www.gynecomastianewyork.com/revi

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DrBermant

Re: About smartlipo
« Reply #2 on: June 12, 2009, 07:29:31 AM »
I just wanted to know is it as effective as traditional lipo? Would it work for a person who's gynecomastia is primarily fat?


Liposuction Is Great for Sculpting Fat

Various types of ultrasonic and power assisted liposuction (UAL and PAL) have been around for quite sime time.  Each surgeon uses the tools and techniques he / she prefers.

There are studies claiming that ultrasonic liposuction does not break down gland cells, these were done to justify the safety in female liposuction breast reduction surgery.  Ultrasonic energy cannot be both ways, good for gland breakdown and safe not harming gland unless there is a difference between male and female breast gland tissue which has not been proven to my knowledge. 

Tumescent liposuction is a form of anesthesia where fluid is placed in the tissues to be sculpted.  You can see very graphic pictures of the tumecent technique here.

Liposuction such as ultrasonic, VASER, Laser, power assisted, and sharp cutting cannula preferentially remove fat over gland.  Gland tends to exist under the nipple areola region.  When fingers of fat extend between fingers of gland, breast reduction can come from removing the fat and leaving gland behind.  On animation such as flexing the pectoral muscles or putting the arms over head, gland does not compress or move like fat.

When gynecomastia is from fat, liposuction works very well for contouring the chest.  I have seen many patients from other doctors who tried to use liposuction alone techniques that left gland behind that the patients just did not like for Revision Gynecomastia Chest Sculpture.

Here is an example of Revision Surgery after Liposuction alone.   Here is another revision after liposuction alone.

The problem is picking the right method for what actually is that patient's problem.  That is why I prefer my Dynamic Technique that permits what I find during surgery to guide my sculpture.  The incision at the edge of the areola  opens up my entire spectrum of artist's pallet of tools for my sculpture.  A remote incision robs me of many options and just does not looks as nice.

I have also seen patients with channel problems between remote access sites and the areola / nipple.  Scars, adhesions, and depressions can look terrible.  Check out the lateral (side views) and posterior oblique (side from the back views with and without muscle flexion here to see what I mean.

Ultrasonic liposuction uses energy to help emulsify fat.  Power assisted liposuction uses mechanical vibrating devices to rapidly move the cannula back and forth.  Both PAL and Ultrasonic methods have been around for several years.  Many do not prefer what they do to the tissue.  Others like what they offer.  Both still preferentially remove fat over gland.  Both make the work of the surgeon easier.  Some feel ultrasonic liposuction can cause more swelling, bruising, and the increase the need for drains.

Laser Liposuction ("Smart Liposuction") is just another variation of trying to destroy fat cells while in the body using laser light energy.  There are no reliable studies that it will also destroy gland well.  If it did, it would also destroy connective tissue, fascia, and dermis all closely related to light absorption in the body.  I have seen disasters from patients who had been told that the method would help their gland.  Some had defects I could not help reconstruct.

For a liposuction cannula to remove gland, it can also remove connective tissue and other structures which can lead to more bruising and scars.  I have seen so many patients who were unhappy from doctors that used "special cannula to remove gland," that I just prefer to go directly to the problem itself.  Primary surgery is usually better than needing a revision.  All male breasts have gland.  With access to the gland directly, I can peel it off the areola muscle, minimize bruising and bleeding with direct control of the tiny blood vessels, and then reconstruct the contour.

For me however, they also both remove the feel of the tissue sculpture.  I like the much better control I get with my cannula selection and personally I do not like either ultrasonic nor power assisted techniques.  None of the cases on my website used either PAL, Ultrasonic, nor sharp cutting cannula techniques. 

As any artist, I take my cannula selection very seriously and have evolved what permits me to achieve my results.  I have considered and evaluated many, many technologies.  The many different types of cannula I use have their own advantages and qualities.  I pick a subset of these cannula that varies for the many different types of gynecomastia male chest sculpture that I see.

Gland removal by any technique can still leave a depression when  a major part of the problem is from gland.  For gland removal, I prefer the greater precision of removal under direct visualization and feel.  This also give me access to many more elements for my artistic palette of my Dynamic Technique to sculpt the remaining tissues.

This approach permits me to maximize the removal of the firm gland and sculpt the remaining fat.  How tissues move is important.  The human body is beautiful in animation.  That is why I show pictures of the chest with arms up, down, and with muscles tight / relaxed in addition to the results from multiple views.  Such analysis of the results as well as how tissues evolve, the possible need for drains, comfort level after surgery, are important factors in picking your doctor.  It is like an artist selecting a paint brush.  The results are what matters, not with what tool they sculpt.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Chest Sculpture

Re: About smartlipo
« Reply #3 on: June 12, 2009, 09:38:18 AM »
The very simple, straightforward answer to your original question is yes, Smart Lipo, as well as many other types of lipo, can remove fat.

Dr Jacobs

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DrBermant

Re: About smartlipo
« Reply #4 on: June 12, 2009, 02:52:43 PM »
I just wanted to know is it as effective as traditional lipo? Would it work for a person who's gynecomastia is primarily fat?

When gynecomastia is a component of massive weight as one would see in a Sumo Wrestler's Massive Fat Problems, liposuction of any form will not be of any reasonable value and would not work anywhere as well as weight loss. 

Also you are assuming that the problem is "primarily fat."  Does that mean 99+ percent or 51 percent fat?  Check out what I mean on this page on Pseudogynecomastia. For someone who had a significant amount of gland, liposuction alone can mean failure as I discussed in my prior post. For someone who had a trivial amount of gland and there was no global fat problem, liposuction of any type could help.  However, then you need to deal with the complication rate of that particular technique.  I have seen horrible disasters with the damage done to the skin with "smart liposuction" of other doctors.

"Effective" should mean more that just removing fat.  So higher risk, no particular advantage, higher cost, debris left for the body to remove, higher potential for nerve damage, more bruising and swelling, larger cannula size: no I do not feel it would be "as effective" nor do I plan on offering it unless it proves itself better than what I have seen.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Male Breast Reduction


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