Liposuction Gets Powered Up – Studies show LAL adds oomph to results

Cosmetic doctors agree: Of all the body contouring options available, tumescent liposuction provides the most dramatic and effective results—for the right patients and in the right doctor’s hands. However, it is possible to enhance those results by adding laser devices to liposuction procedures. That’s according to Kimberly Butterwick, MD, a dermatologist based in La Jolla, Calif., who was interviewed for a recent story in Dermatology Times (DT).

Standard tumescent liposuction has been established as safe and effective in literature. One study in particular looked at 700,000+ patients who underwent tumescent liposuction and found zero associated deaths.1 In recent years, laser-, water-, and power-assisted liposuction have emerged as add-on options in an attempt to improve or enhance results and shorten procedure time.

“The goal has always been to make the procedure faster, with quicker healing and tighter, smoother skin. But the truth is that with tumescent liposuction, if you do it properly, patients heal very quickly anyway,” Dr. Butterwick told DT.

How successful are these add-on high-tech options? The jury may still be out.

One study that compared them all against one another, Dr. Butterwick tells DT, “Researchers showed that compared to internal ultrasound or water-assisted liposuction, laser-assisted liposuction and power-assisted liposuction preserved the highest numbers of septal fibers — those are what we need to achieve skin tightening.”2

And skin tightening, she said, is a primary benefit. The notion of melting fat also has appeal, as it is a gentler way to loosen and remove fat.

Laser Specs
Depending on wavelength, laser energy can target fat and tighten skin:

  • 915 nm, 1,210 nm and 1,720 nm devices target fat absorption
  • 1,064 nm and 1,320 nm devices target water, and thus, tighten skin

“If we target the water,” Dr. Butterwick told DT, “we probably get slightly better skin tightening.”

She also pointed out that for safety’s sake, it’s important to know that the tumescent fluid used in liposuction can also absorb heat.

“Although you think you’re not overheating the tissue, the fluid stores the heat, and the tissue continues to heat up after you stop applying the laser. Most studies advocate keeping the external skin temperature at 40 C to 42 C. But we usually stop at 36 C or 38 C, especially if we’ve used a lot of tumescent fluid, because that will slowly keep heating the area while avoiding burns,” she’s quoted as saying.

Water Target
The lasers used to target water that Dr. Butterwick discusses in the article include:

  • 1,064 nm Smartlipo (Cynosure), which she said is not strong enough.
  • 1,064 nm LipoLite (Syneron), which she suggested may generate more heat for better results.
  • 1,064/1,320 nm Smartlipo Multiplex (Cynosure), is powerful, she said, but requires careful observation to avoid burning.
  • 1,064/1,320 nm/1,440 nm Smartlipo Triplex (Cynosure) may be better at fat cell destruction, she said.
  • 1,320 nm Nd:YAG CoolLipo (CoolTouch)

According to Dr. Butterwick, it’s the CoolLipo device that she has the most experience with. “When the laser is hitting the tip of the fiber, and the fiber is touching the fat cell with a very short (100 microsecond) pulse duration, like a white-hot jackhammer, this provides a lot of power at the tip of the cannula. It essentially melts the fat that it’s touching,” she is quoted as telling DT.

Fat Target
The lasers used to target fat that Dr. Butterwick discusses in the article include:

  • 980 nm Lipotherme (Osyris)
  • 924/975 nm SlimLipo device (Palomar)

While these may effectively melt fat, they don’t necessarily reduce the amount of time needed to perform the procedure, Dr. Butterwick said.

As she told DT, “The technology is evolving — manufacturers are trying different wavelengths and wavelength combinations to find the optimal wavelengths that will provide skin tightening and hopefully speed up the procedure…To me, the CoolLipo is the only device that doesn’t take extra time because the fiber can be inserted in your liposuction cannula, and you can aspirate at the same time. I like it because it doesn’t slow me down. Liposuction is already a very time-consuming procedure.”


  1. Coldiron BM, Healy C, Bene NI. Dermatol Surg. 2008 Mar;34:285-291.
  2. Fatemi A. Am J Cosmetic Surg. 2011 Sept. 28:163-168.