Lipodissolve and SmartLipo: Alternatives to Liposuction

LipoDissolve and SmartLipo have been proposed as alternatives to traditional liposuction. How well they work is still open to question.

Ever since the development of liposuction there has been a search for easier and less traumatic ways to get rid of fat. Traditional liposuction is a physically demanding procedure for the surgeon, even with the advent of smaller cannulas. Some time ago, ultrasonic liposuction devices were developed. They turned out to have unacceptably high rates of complications, and were never approved by the FDA. The newest device being advertised for liposuction is the SmartLipo laser assisted liposuction. This device uses a 1064 nanometer NdYag laser cannula which is inserted through the skin and melts the fat before suctioning it out. This device is slower than traditional liposuction and is only practical for small areas. It is claimed that this laser is less invasive than traditional liposuction, but that is really playing with words. Melting fat is not exactly non-traumatic. An additional benefit claimed for SmartLipo is tightening of the skin, due to thermal injury to the skin. SmartLipo has received FDA approval, but the jury is still out on the long term utility and safety of this device.
LipoDissolve involves the injection of a chemical, phosphatidyl choline (PC), that is injected into the fat and causes the fat to shrink, in some people. Originally developed in Brazil, this procedure has been widely adopted because it seems easy and can be performed by relatively untrained practitioners. It is not clear whether it is the PC, or the vehicle in which it is dissolved, that is the active ingredient. Other ingredients are sometimes added, but there is little evidence that any are effective. There appears to be a consensus that in some people PC injections do produce some localized fat reduction. There is considerable variability in results between individuals, and a series of injections are necessary. PC injections are not practical for large fat deposits and, in their current form, they will not replace liposuction for the vast majority body areas.
The safety of PC is a big question mark. PC is not approved by the FDA for any medical or cosmetic use. Studies of the safety of PC are small and limited in number. With many procedures and products, the problems become available only after widespread use (think Vioxx). Currently anyone receiving PC injections is receiving an experimental treatment, almost certainly without proper safeguards. As in many areas of cosmetic surgery, it's buyer beware.

Gerald N. Bock MD
Stockton, CA
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