The Smart Solution

Created on 05th March 2009

Dr Ayoubi of the London Medical & Aesthetic Clinic speaks to Cosmetic Surgery & Aesthetics Magazine about SmartLipo, the groundbreaking treatment he introduced to the UK

The most important thing to understand is that we have two different types of fat in the body: deep fat and the superficial fat which sits just beneath the skin. This superficial fat is extremely vascular and the fat cells are positioned very closely together.

Prior to launching SmartLipo into the UK I was using traditional liposuction to achieve fat reduction. When you do traditional liposuction you make an incision in the skin to suction out the fat and you can very safely suck out the deep fat but it is not possible to suck out the superficial fat because of the high risk of bleeding and the damage that you can do to the skin from the inside when you remove that fat. With some patients - in about 20 per cent of cases - it can result in a 'collapsed banana skin' effect as the skin isn't supported.

As a surgeon, another problem I found with traditional liposuction is that you are restricted in the areas that you can do the procedure. The under the arms procedure could result in numbness in the hands if you damage the nerves and under the chin it is extremely vascular so can cause bleeding during the surgery.

I had read an article in 2002 from a plastic surgeon in Brazil, Alberto Goldman, about SmartLipo which fascinated me as a Laser Surgeon but at first I did think it sounded too good to be true. The principle is that instead of only sucking the fat out, the laser targets the fat cell membrane and punctures it. Like a balloon filled with water, you pierce the fat cell and the fat drains out through the lymphatic system. The structure of the fat cell is then disturbed so it won't continue working in the same way.

I tried to get SmartLipo into the UK from 2003 but there weren't enough clinical studies available for it to be approved in the country at that stage. Approval was finally given in 2006 in the UK. I started doing procedures with the first generation SmartLipo machine which had great results in small areas, particularly in terms of skin tightening. The skin tightening effect is because the heat of the laser goes up to 38-40° and it produces an inflammation which tightens the skin.

The difficulty we found was that patients were coming to us who had much larger areas of fat to remove. They were not keen to have traditional liposuction because it is often shown being performed on TV and patients think it looks a very aggressive procedure. Also, patients often don't want to have a general anaesthetic or are not able to because of medical reasons. So we knew from a clinical point of view that we needed a stronger laser.

The first machine I was working with had a power of 6 watts then later 10 watts. Cynosure then produced the next generation machine, SmartLipo MPX. This was much more powerful - the laser produces 32 watts.

This meant we could destroy more fat cells in a shorter period of time so not only is the patient having a much faster treatment but you can do much bigger areas and also do multiple areas within the same treatment. More importantly it has two lasers. One which targets the fat cells with a laser power of 20 watts and one which targets the water and the blood vessels which is 12 watts. The two lasers work both at the same time but the other great thing with this machine is that you can change the settings which gives you a greater degree of flexibility in what you can offer patients. I then took this further and developed my own technique for patients with much larger areas of fat.

This combined SmartLipo and gentle suction at the same time. We laser the deep fat first and then the superficial fat and then suction out the fat. This is producing great results and is relatively painless. I always remind patients that it is not possible to have any procedure without some discomfort but this is very good and safe.

The skin tightening is immediate - patients often like to see results straightaway, they don't like to be told that it can take a few months. It is also done under local anaesthetic so there is no need for a general anaesthetic or to stay overnight which also means that it can be done on patients who aren't suitable for a general. There are no stitches, just a very small incision that heals very well. By three or so months the patients can see the final result. What is important to remember is that this procedure is not designed to lose weight. We can take out a litre or more of fat but this is about body reshaping and sculpting. Any technique, whether it be surgery, traditional liposuction, or SmartLipo, will only have the optimum outcome if the patient is committed to being fit and healthy to maintain the results.

As a surgeon who specialises in laser surgery, I find that I am increasingly doing less aggressive procedures and I am getting fantastic results by combining SmartLipo with gentle suction. That is the wonderful thing with the continuing advances in technology; we can get the results without aggressive invasive surgery.