High Point Plastic Surgery

What makes Smartlipo™ so damn smart?

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The term SmartLipo™ is a registered trademark for a specific laser liposuction device that was developed by the laser company Cynosure.  In terms of marketing, the coining of the phrase SmartLipo was extremely successful in promoting the technology, and it has become an almost universally recognized terminology. But other than being cleverly marketed, is there really something intrinsically better about the SmartLipo technology which makes it a more effective technique for performing liposuction?

To understand where this technology is at today I think it is helpful to know a little of the history of SmartLipo.  The original SmartLipo device was relatively unsophisticated and underpowered, and as result could achieve very little in terms of noticeable body contouring. As a consequence, the technology was largely ignored by Real Plastic Surgeons (those who are certified by the American Board of Plastic Surgery) who were the major providers of body contouring procedures at the time. It did, however, get adopted by many so-called “cosmetic” practitioners such as Dermatologists or Ophthalmologists, who wanted an entry into the aesthetic body contouring market. The majority of “cosmetic” doctors did not have their own certified surgical facilities, and because the device was designed to create less tissue trauma, the procedure could be performed under tumescent (local) anesthesia. While not technically accurate, the concept of having a body contouring procedure under “local anesthesia” was appealing to many patients and also appealing to the “cosmetic” physicians because they didn’t have the capability of providing general anesthesia. During this early generation of SmartLipo, the procedure was heavily marketed as having tiny incisions, no sutures, minimal bruising, no pain, and a very rapid and easy recovery. Not only were all these claims misleading, but also the results were extremely subtle and many patients were dissatisfied with their outcomes.

Cynosure quickly realized that there was a large market for this new body contouring technology that sounded so appealing, but was really not capable of delivering noticeable changes in body contouring. Within a couple of years, a second SmartLipo device called the Duplex was introduced by Cynosure. A second wavelength of laser light was added and the power of the laser was significantly increased. This allowed the generally inexperienced users of the device to achieve more dramatic changes in body contouring, but it also resulted in a big increase in referrals to Real Plastic Surgeons for the complication of skin burns because of the higher energy levels delivered by the laser. Because of this wave of complications being generated by non-plastic surgeons, many Real Plastic Surgeons developed a negative opinion of the technology and began to recommend that patients avoid the procedure.

Again, while there was still a great demand for the procedure, Cynosure recognized the limitations and risks associated with the Duplex model and within a year had introduced the Triplex device. This third generation device had the addition of a couple of safety features; the most important of which was a temperature monitoring device at the end of the laser probe which precisely tracked the temperature of the tissues in real time. Safe temperature parameters could be set on the laser machine with immediate feedback so that if the safe temperatures were exceeded the laser would immediately stop delivering energy. The addition of this safety feature made the Triplex version of SmartLipo extremely safe and at the same time allowed for precise monitoring of tissue temperatures which are critical to achieving greater skin tightening which is one of the major benefits of the SmartLipo technique of laser liposuction.  The Triplex device is the current standard of practice and any patient who is considering having a SmartLipo procedure should make sure that their surgeon is using this version of the device.

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Image depicting laser destroying fat cells

While extra skin tightening is a real benefit of SmartLipo compared to other types of liposuction procedures, it is not a miracle machine. If a patient has significant skin laxity or a noticeable amount of skin excess, SmartLipo is not capable of addressing these deficiencies. Unfortunately, SmartLipo is offered far too often as a solution to these problems, particularly within the high volume, high-pressure liposuction clinics which are only capable of offering a single procedure that is not applicable to all patients. The biggest benefit of the extra skin tightening is that it enhances the results for the average liposuction patient and it allows many patients with diminished skin laxity (such as older patients) to get good results with SmartLipo that cannot be achieved with other types of liposuction procedures.

The other big benefit of SmartLipo has to do with how the laser actually works to contour the subcutaneous fat layer. The SmartLipo probe is small, only 1mm in diameter, but it carries a very high energy laser light. The wavelength of this laser light was specifically chosen because it is selectively absorbed by fat cells. This means that the laser energy functions primarily to destroy the fat cells while minimizing trauma to the surrounding tissues. The laser does, however, heat the fibrous tissues that surround the fat cells, and an effect of that heating is to cause contraction of the collagen in the fibrous tissues that contribute to skin retraction. Since the laser probe has a small diameter, it is not capable of destroying large numbers of fat cells with each pass of the probe.  For this reason, SmartLipo procedures take longer than traditional liposuction procedures which simply rip out large numbers of fat cells with each pass of the liposuction suction cannula. Also due to the small size of the laser probe, SmartLipo allows for more precise and even contouring of the fat layers. All liposuction techniques introduce some irregularities to the fat layers and this will vary from person to person and it also varies according to the area being treated. The problem is that these irregularities can be visibly transmitted through the skin surface particularly in patients with diminished skin elasticity. Compared to standard liposuction techniques SmartLipo allows for a more smooth and even thinning of the fat layer while avoiding creating the kinds of irregularities that are too often seen with other methods of liposuction.

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Puget Sound Plastic Surgery Before and After images of patient treated with Smartlipo to her abdomen and hips.

So why is SmartLipo so damn smart? Not because of tiny incisions, no bruising, no downtime, no pain, which were misleading artifacts of the first generation SmartLipo device. SmartLipo is a surgical procedure and it results in real tissue trauma. Most patients experience some degree of discomfort for a couple of days which is easily managed with moderate amounts of pain medication. There can be bruising which will vary from patient to patient and is largely dependent on whether a tiny blood vessel is injured during the procedure. It takes only a very small amount of blood in the tissues to create some bruising which is not long lasting. There is also a degree of swelling associated with the procedure which is why compression garments are usually worn for about four weeks after the surgery. Most patients feel more comfortable wearing their garments.The reason SmartLipo is smart is because when it is used by well-qualified, experienced plastic surgeons it can consistently deliver better, smoother, and nicely proportioned body contours across a greater range of patients with varying degrees of skin quality. It is not a miracle machine and it will not shrink wrap you, but with experience I have found that the results of SmartLipo are consistently better than traditional techniques and that the device is particularly useful for patients with diminished skin elasticity and for difficult conditions such as Gynecomastia where the tissues are more fibrous and improved skin retraction is necessary to achieve optimal results.

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Puget Sound Plastic Surgery Before and After images of patient treated for Gynecomastia (male breast reduction) with Smartlipo.


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Puget Sound Plastic Surgery
Braden C. Stridde, M.D.
(Temporarily Located in Lake Washington Dermatology)
Kirkland, WA 98033
Click here for driving directions (425) 202-4709(425) 202-4709

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5400 Carillon Point
Building 5000, Suite 409
Kirkland, WA 98033
Monday–Friday: 9a.m.–5p.m.
(425) 202-4709(425) 202-4709

 Braden Stridde, M.D.