Deciphering differences between Smartlipo and Vaser

I am often asked by patients, “Which form of liposuction should I have, Smartlipo or Vaser?” I start by telling my patients that it is easier to understand the difference between Smartlipo and Vaser if you think about them not as two different procedures, but as two different tools used during the same procedure. 

The procedure is tumescent liposuction. Smartlipo and Vaser are two different tools that can be used to aid a surgeon during a tumescent liposuction procedure. Both tools aid in fat removal and both have advantages and disadvantages outlined below.

The procedure: Tumescent liposuction using only local anesthetic

Tumescent liposuction done using only local anesthetic was first performed in 1985 by a dermatologist, Dr. Jeffery Klein. Dr. Klein’s tumescent solution (numbing solution) consisted of normal saline with lidocaine, bicarbonate as a buffer, and epinephrine. This solution was injected into the fat layer until the area became tumescent, which means swollen. He demonstrated the fat could then be removed with very small cannulas. His method caused less bruising and postop swelling than the forms of liposuction that had previously been used. His “tumescent” liposuction is this author’s preferred method of liposuction. Dr. Klein still offers a training course for those interested in learning his technique.

The tools: SmartLipo & Vaser

Smartlipo, also known as laser-assisted liposuction, is a tool that is used during tumescent liposuction. Smartlipo (Cynosure) was first cleared by the Food and Drug Administration in 2006. The Smartlipo laser is used to melt the fat prior to the suctioning process. The laser fiber is introduced through the skin in a 1 mm cannula. The laser energy also has been shown to increase collagen formation in the dermis, which can lead to skin tightening. The laser does not melt all the fat in the area and must be accompanied by thorough liposuction of the target area to obtain optimal results.

Vaser (Solta Medical) is another tool that can be used during tumescent liposuction. Vaser is also known as ultrasound-assisted liposuction. This instrument was first FDA-cleared in 2001. Vaser uses ultrasonic energy to separate fat cells and soften the fat layer.

The ultrasound wand must be introduced through a plastic port placed in the skin. This skin port prevents burns as the ultrasound wand becomes very hot during the procedure. Because a skin port must be used, larger incisions must be made in the skin compared to Smartlipo. Also, the ultrasound usually does not soften or liquefy all the fat in the target area, so Vaser must be followed by thorough liposuction to obtain optimal results.

Liposuction Comparison: SmartLipo vs. Vaser

In my own practice I use Smartlipo on every case for the added benefit of skin tightening and use Vaser only when I come across extremely dense or fibrous tissue. I do not feel that either instrument helps me to increase the total volume of fat removed during a procedure. The results of liposuction and overall patient satisfaction are based on many factors including the amount of fat removed and the smoothness/naturalness of the results. Fat removal and smooth results can be optimized by proper tumescent technique and willingness/patience to use only small liposuction cannulas.

Many traditionally trained plastic surgeons say that they can’t be “aggressive enough” during liposuction using only local anesthetic. I argue that they are not trained in proper tumescent technique. Most surgeons that are inexperienced in performing tumescent liposuction using only local anesthetic do not use enough solution or do not give the tumescent solution enough time to fully vasoconstrict. Dr. Klein now waits over and hour after administering the tumescent solution before beginning liposuction. In my opinion, the use of small cannulas (I use only 2-3 mm cannulas on most cases) makes for smoother results and an easier recovery for the patient compared to large cannula liposuction.

In conclusion, I feel both Smartlipo and Vaser can be of some value as “tools” for liposuction surgeons. However, the overall results and satisfaction of the patient with liposuction surgery are mostly determined by the experience and skill of the surgeon.

Disclosures: Dr. Bergeron is a highly experienced liposuction specialist and one of the most experienced doctors performing Smartlipo. He received his medical degree from the University of Texas Health Science Center, Houston, and is one of the most-requested liposuction experts in the Houston area.