Body sculpting: Noninvasive lipolysis tools advance

Key Points

For now, dermatologists mustn't overlook tumescent liposuction, which remains the most popular invasive cosmetic procedure among U.S. patients, says Kimberly Butterwick, M.D., a board-certified dermatologist who practices at La Jolla Spa MD in La Jolla, Calif.

This procedure allows patients to avoid general anesthesia and provides very quick healing times, she says.

Additionally, she says, performing liposuction can provide a welcome respite from the often frenetic pace of examining patients all day.

"If you've thought about offering tumescent liposuction, I would encourage it, because probably my happiest and most loyal patients through the years have been these patients," Dr. Butterwick tells Dermatology Times.

Safe and efficient

One study that reviewed 600,000 cosmetic surgery procedures performed in Florida (where adverse event reporting in outpatient surgical centers is mandatory) showed that liposuction and/or abdominoplasties performed under general anesthesia or IV sedation accounted for more deaths than any other procedures (Coldiron BM. Am JCosmet Surg. 2006 Oct–Dec; 23:179-189).

However, Dr. Butterwick says nearly all the physicians involved in these cases were not dermatologists, but plastic surgeons.

During the five-year study period, she says, "There were no deaths associated with liposuction performed with dilute tumescent anesthesia."

Since the invention of tumescent liposuction, dermatologists and patients have continued to look for helpful innovations. One example is internal ultrasound-assisted liposuction, which Dr. Butterwick pronounces "a bust" because it caused excessive heating and significant tissue necrosis.

Power-assisted liposuction was "too heavy for my hand" and caused more strain than did manual equipment, she adds.

Currently, Dr. Butterwick says laser and light-assisted liposuction devices are capturing significant media attention. As a result, "Patients are demanding these devices before we have them."

To make liposuction faster and easier, Dr. Butterwick says manufacturers have begun offering devices designed to take advantage of wavelengths at which absorption by fat exceeds water, namely 915, 1,210 and 1,720 nm. Examples include the SmartLipo (Cynosure), CoolLipo (CoolTouch) and the Aspire (Palomar).

"The SmartLipo is a 1,064 nm Nd:YAG laser with a very thin fiber that's applied directly to the fat. In theory, the heat is released when the fat is melted, which causes some collagen production and tissue tightening," she says.

However, she says, this method of action creates more potential for burns than the tumescent method does. "The fiber that sticks out from the cannula is very flimsy," Dr. Butterwick says, "and I worry that the tip of it could break off inside a patient." Logistically, she says, the procedure (typically used as an adjunct to tumescent liposuction) adds five to 10 minutes' treatment time per body area.