Intelligent Liposuction?


Plastic surgeon Haideh Hirmand surveys the field’s latest innovations: devices that not only vacuum fat, but also claim to tighten and tone the skin

We want a lot out of liposuction. Patients used to come to me just wanting to look thinner. Now they want to leave the operating room looking not just svelte, but with the body they had in their 20s. I’m no magician, but I can tell you that this procedure has entered a new stage.

When liposuction first came along, it was revolutionary. Doctors made small incisions, connected a cannula tube to a suction machine, and manually vacuumed excess fat under the skin. The procedure evolved a bit when surgeons added a magic liquid called tumescent fluid, which not only sucked out the fat more easily but also decreased patients’ pain, bleeding and bruising. The new frontier? Ultrasound-assisted liposuction technology, which is said (though not scientifically proven) to create smoother results. Welcome to a new era in liposuction!

1. Laser-Assisted liposuction (examples include Slim Lipo, Smart Lipo, Cool Lipo, Pro Lipo): There are half a dozen devices, based on laser energy, that claim to remove fat while improving the tone, tightness and firmness of the skin. How is this achieved? Laser light energy, applied using a thin fiber through small incisions, melts the fat before sucking it out with a cannula. Then — and here’s the revolutionary part — the laser energy is applied to the skin’s underlayers through the same incisions. Heating the skin promotes collagen synthesis and remodeling. Over several months, manufacturers claim, the skin will become tighter. The process, done correctly, takes longer than regular liposuction.

Warning: Most of these laser machines are FDA-approved, but the procedure is still controversial. Scientific data suggests that while the technology really does tighten the skin, the results may not be amazing. Laser lipo may tighten the skin better than regular liposuction in some patients, but do your research first. Go to a qualified plastic surgeon, experienced in performing liposuction, who can advise you about the true benefit to you as well as the risks. Also, all laser-lipo machines are not created equal. Doctors are gaining more experience with this technology to see which machines and which wavelengths are most efficient.

The Ideal Patient: Someone who could benefit from a mild to moderate level of skin tightening. If you have super-loose skin, it won’t make the hanging skin or all those ripples disappear.

2. Radio-Frequency Assisted Liposuction: (Example: BodyTite technology) Radio-frequency energy (high-frequency electrical current) has been used in surgeries for decades. It’s also been used for external skin tightening (like Thermage). Doctors zap radio-frequency energy through the cannula to generate heat and melt the fat. Similar to laser liposuction, the energy is using precise settings to heat the skin in the area, so over several months, collagen will process and the skin will tone. It additionally heats all the fibrous tissues that connect the fat and the skin so the tightening is not just at the skin level. This procedure still takes more time than regular liposuction, and its safety and efficacy is under clinical investigation.

Warning: Again! This is NOT FDA-approved at present and only available under the study protocol.

The Ideal Patient: Someone with moderate loss of skin tone. Someone a bit older who has tried working out at the gym and can’t get rid of that annoying excess flub, muffin-top or roll. A younger person with good skin would do fine with regular liposuction.


The Cost: Both procedures start at $2,000 and go up from there, depending on the extent and areas. Expect three days to one week for initial recovery and then three to six months for final results. Surgery is best done in an accredited operating room — either a surgical suite in a doctor’s office, ambulatory facility or hospital. It’s not advisable to have this done in an office examination room or small procedure room. A patient will often need sedation or some kind of mild anesthesia. If you’re having a very small area worked on, local tumescent with a valium may be enough for you. An overnight stay is not required unless large volumes of fat are taken out.

The Bottom Line: For the best results, know that it is not what liposuction machine is used, but who is behind the machine performing the liposuction. Don’t fall for marketing schemes. Seek the advice of a reputable board-certified plastic surgeon and discuss the benefits for your individual situation as well as the risks, which for these latest technologies include skin burns or blisters,  in addition to the usual side effects of liposuction. These new energy-based liposuctions need more expertise. To receive the principal benefit of skin contraction, each step in the process must be done properly and safely – and even then, the benefit may be moderate. Realistic expectations are key and best defined when speaking to your surgeon.

Editor’s Note: Dr. Haideh Hirmand is a plastic surgeon, academic and thought leader in the aesthetic and beauty arenas. She completed her Doctorate in Medicine at Harvard and is Clinical Assistant Professor of surgery at the The New York Hospital/Cornell-Weill Medical Center. She specializes in eyelid and facial rejuvenation, secondary breast surgery, and body contouring, and is recognized nationally as a pioneer in injection techniques.

6 Responses so far.

  1. avatar Lila says:

    Three to six months for final results? Younger patients with good skin? Please. In three to six months of a good fitness program, those younger patients would have MUCH better results than lipo and would reap the internal health benefits as well.

    As for someone older who has tried working out but can’t lose that muffin top, yes, it can be very, very hard, but it is possible. Maybe lipo is more feasible for these folks, but they won’t walk away with toned, tight skin, either… it won’t make them bikini-ready.

    Just look at all the cruel photos of celebrities at the beach for saggy abdominal skin over their fatless frames. It’s not an attractive result. I have yet to see a man drool over those pics. The reaction is usually: “Yecchhh! Look at what’s happened to her! She used to be cute!” And FWIW, men usually prefer a little plumpness over the 12-year-old-boy-stick-figure. If you have a muffin top that’s hard to get rid of, it might not be a “problem” after all.

  2. avatar D C says:

    Here’s an idea for that muffin top you can’t get rid of — WEAR CLOTHES THAT FIT and not the ones you WISH you fit into.  Problem solved. 

    • avatar Briana Baran says:

      Beautifully said. And note, not every style is for every woman. I repeatedly hear admonishments against women of my age wearing lower-waist jeans. Yet, for me, high waist, and even some purportedly “natural-waist” styles make my long torso look even longer, and my extremely short legs look like stumps (and unless I don 8-inch heels, and go through life staggering, nothing helps). I don’t suffer from muffin-top, because I know the companies and styles that work, and I get the correct size. Also, oddly, skinny jeans with decorated pockets look much better on me than straight leg or boot-cut varieties (this from my husband and MIL, both much more conservative than I am, and also extremely honest). It’s all in your own unique build…and never going too loose (which looks sloppy), or please, please, please, too tight.

      I am diligently working on my physician-ordered weight loss. Currently, I have only lost 15 pounds…but 7 inches have disappeared from my waist, 4 from my under-bust, and 2 from my bust. The muscles are showing in my legs, arms, shoulders, back and upper abdomen (I have a dip over my sternum again). I haven’t measured hips or thighs…but I know they’ve lost a lot of size. I have 85 pounds to go, and I am now determined, and delighted, with the prospect of working it off. As a result of changes in cooking and in eating out far less, my husband has lost 20 pounds (no, I’m not jealous, I’m delighted. Men lose weight more quickly, and he’s ten years younger than I am…but the main thing is he is happier and healthier than he’s been for a long time), and my son has trimmed down, and is going to the Y with his dad.

      My only concerns are my breasts and the dreaded “mom-flap”. Despite gaining very little weight with both pregnancies (23 and 20 pounds respectively, with 9 lb. 12 oz. and 7 lb. 11 oz. newborns), I carried all out in front, and enormous, because my pelvis is so oddly shaped and narrow. My skin and muscle took all of the weight and burden. A good bra can alleviate differences caused by weight loss (I am a 36DD now, and wouldn’t mind a bit less. I used to be a 32DD), but, o, the mom-flap. If it is uncomfortable, or truly in the way when I get to my goal, I think I might just get it…tucked. The thought does make me uncomfortable. I’m never going to have a bikini body (stretch marks from hell. My skin can and will develop keloid type scars. The stretchies have faded, but a bikini? In a private pool with R., maybe) and cosmetic surgery makes me feel edgy and weird, I admit it. But I tried to get rid of the flap after the birth of my first son, and although there was barely any extra on my abs (diligent workouts complete with 500 crunches of both upper and lower ab varieties) the flap never disappeared.

      So, what to do? As my body slims, tightens, strengthens and becomes healthy, do I go under the knife, so to speak, if that extra flesh just remains a sort of hanging flap, in the way and perhaps uncomfortable? I’m not ashamed of it…I didn’t bloat up during my pregnancies, and I adore my children who are well worth everything, even the silver hairs. I feel vaguely hypocritical considering this option. I’ll never be skinny…at my ideal weight of about 142, I will be solid curves and muscle, and a jean size of 14, maybe twelve if I stick to Dereon, Apple Bottoms and Baby Phat (made for women with rounder, bigger backsides and smaller waists). But the flap might well be in the way. Do I “suffer” and maintain my integrity, or do I do something that might make a huge difference in my quality of life, but seems hypocritical to me?

      • avatar Lila says:

        Briana, an Army friend of mine had a reduction long ago and she, too, is prone to keloids. She has very thick, ropy scars in the creases under her breasts, and the scars can be sensitive. Of course she would rather not have keloids, but she does not regret her decision – she knew she would get them and saw them as a logical trade-off for a huge amount of relief.

  3. avatar crystalclear says:

    D C, Bingo!   Why women insist on wearing jeans that are too snug and low knowing their middle looks like a spare tire (all the way around) is beyond my understanding!   That would be the LAST look I’d be going for.   

    Liposuction is the lazy way out and it’s expensive.   A good exercise and diet regime is all you need to tighten those loose areas.  

    I do believe in plastic surgery on the face especially if one has gone through life without taking care of their face and neck.   I’ve been using wonderful creams and serums for decades and I’m happy to say I won’t be needing a face lift.   The best bang for the buck is the upper and lower eyelid surgery and leave the rest alone!