Chewing the Fat

By: Katharine Griffiths
Created on 18th June 2010

We all want the perfect body but we also find it difficult to stick to a rigid exercise and diet regime and, even if we do manage to achieve our perfect weight, we're often plagued by stubborn pockets of fat that just won't go. Dr Ayoubi of the London Medical & Aesthetic Clinic, one of the UK's leading laser surgeons, talks us through the history of fat reduction, from surgical procedures through to Smartlipo

The surgical option, from late 19th century
The surgical technique to remove fat has been performed for many years - the most common example being the tummy tuck - and it works in a very simple way. You cut the skin, remove the fat and then re-drape the skin.

There are some advantages: you can remove a lot of fat, it is good for the surgeon because they can see what they are doing and you can achieve skin tightening at the same time by removing any loose skin.

The downsides though often outweigh the advantages: it is performed under general anaesthetic, entails a lengthy period of downtime and you are left with a very obvious scar.

Traditional liposuction, early 1980s
Traditional liposuction was introduced in the early 1980s and became the standard technique for the next twenty years.

It works by making a small incision in the skin and sucking out the fat with the liposuction device, but the problem lies in the fact that we have two different types of fat: deep, loose fat and superficial fat.

Liposuction tackles the deep fat but can't remove the superficial fat because it is very vascular. If you attempt to remove it with liposuction you risk too much bleeding and damage to the skin. It was obvious; we needed to find a solution to the superficial fat.

Other alternatives, the 1990s
All research at the time was dedicated to finding ways to tackle the superficial fat. The first approach was applying heat to the surface of the skin in an attempt to emulsify the superficial fat underneath - not through an incision - and lots of different forms of energy were experimented with, including laser, radiofrequency and ultrasound.

These techniques were often combined with traditional liposuction, but they didn't have the desired result because the more energy you apply through the dermis, the more you risk damaging or burning the skin before you even have an impact on the fat underneath.

Smartlipo, 2000
Finally, we had a breakthrough; Smartlipo works by making a tiny incision, under local anaesthetic, and then emulsifying the fat by rupturing the membrane of the fat cell using the light, not the heat, of the laser. The contents of the fat cell leak out and the cell itself no longer has a function so is removed by the body.

The first machine had six watt energy and was fantastic in small areas such as under the chin, and for small amounts of tummy or thigh fat but I had many patients wanting much larger areas dealt with. The machine wasn't producing the results I wanted and the length of the procedures meant discomfort for the patients.

Smartlipo MPX, 2008
The company was introducing more and more powerful machines which were producing better results and more comfortable patient experiences, then their sister company in the US, Cynosure, developed Smartlipo MPX. MPX stands for multiple lasers and the machine employs two lasers. One targets fat membrane and the other targets blood vessels.

The current Smartlipo MPX is also so much more powerful than the original machine - from six watts to 46 watts and that increase in power means you go through tissue easier and tackle larger areas in less time. It also means increased skin tightening which is crucial when you're tackling larger areas of fat.

Other alternatives:
Bodytite. Introduced into the UK last year, this uses radiofrequency and, at 75 watts, is very powerful. It is suitable for large areas but doesn't produce the same skin tightening as MPX, nor does it have the flexibility when dealing with rounded areas such as the inner thigh.

It doesn't have the same range of safety features as MPX, which is invaluable even for an experienced surgeon.

Vaser. Reliant on ultrasound, this is good for small areas but doesn't give the skin tightening of Smartlipo. It works by vibrating the fat cells and damaging them but it can also damage the tissue around it causing pain and bruising. It can also cause irregularities. It has its place but has pros and cons as all systems do.

Other lasers. Targeting the fat cells not the membrane, they can produce unwanted dead tissue under the skin.

The Future
Currently, Smartlipo MPX provides an alternative to liposuction and non-surgical techniques to remove fat but I feel that in the next five to ten years it will become a viable alternative to many surgical procedures.

I have started to use the machine for several lifting procedures, for the neck, knees, buttocks, even as an alternative to the breast lift by applying it to the area above the breast and utilising its skin tightening effect.

Every week I train visiting plastic surgeons from all over the world; they are very experienced in all that liposuction and surgery have to offer, but they realise that this is the future.