Opinion about technologies like VASER, smart lipo etc

[rokulikahurican]

Dear all,
                                 Recently I have been reading a lot about Vasser and smart lipo.

To the kind Doctors doing great service here, Could you tell us how you see these technologies helpful in achieving better results ? and how different are they from the existing UAL liposuction techniques.

Thanks,
Roger

[rokulikahurican]

ALSO could you tell us more about the impact of these technologies on recovery for surgeries needing both lipo and tissue excision

[skyhawk]

Topshelf is right. Its the skill of the surgeon. Different surgeons use different tools and methods. Try not to get wrapped up in the marketing of things like Vaser and smart lipo. Focus on the surgeon and his track record of happy patients. Study the before and afters. Talk to past patients. If he can do a super job with an ice pick and a vacuum cleaner, well......   

[belfastmale]

had smartlipo done a year ago, complete waste of money. Did notice a slight difference in my chest but think this was more down to the strict diet and exercise than the lipo

[DrBermant]

Dear all,
                                 Recently I have been reading a lot about Vasser and smart lipo.

To the kind Doctors doing great service here, Could you tell us how you see these technologies helpful in achieving better results ? and how different are they from the existing UAL liposuction techniques.

Thanks,
Roger

Liposuction Is Great for Sculpting Fat

Various types of ultrasonic and power assisted liposuction (UAL and PAL) have been around for quite sime time.  Each surgeon uses the tools and techniques he / she prefers.

There are studies claiming that ultrasonic liposuction does not break down gland cells, these were done to justify the safety in female liposuction breast reduction surgery.  Ultrasonic energy cannot be both ways, good for gland breakdown and safe not harming gland unless there is a difference between male and female breast gland tissue which has not been proven to my knowledge.

Tumescent liposuction is a form of anesthesia where fluid is placed in the tissues to be sculpted.  You can see very graphic pictures of the tumecent technique here.

Liposuction such as ultrasonic, VASER, power assisted, and sharp cutting cannula preferentially remove fat over gland.  Gland tends to exist under the nipple areola region.  When fingers of fat extend between fingers of gland, breast reduction can come from removing the fat and leaving gland behind.  On animation such as flexing the pectoral muscles or putting the arms over head, gland does not compress or move like fat.

When gynecomastia is from fat, liposuction works very well for contouring the chest.  I have seen many patients from other doctors who tried to use liposuction alone techniques that left gland behind that the patients just did not like for Revision Gynecomastia Chest Sculpture.

Here is an example of Revision Surgery after Liposuction alone.   Here is another revision after liposuction alone.   I have even done revisions on some patients of doctors who wrote articles in plastic surgery journals claiming how great these new devices were for treating gynecomastia!

The problem is picking the right method for what actually is that patient's problem.  That is why I prefer my Dynamic Technique that permits what I find during surgery to guide my sculpture.  The incision at the edge of the areola  opens up my entire spectrum of artist's pallet of tools for my sculpture.  A remote incision robs me of many options and just does not looks as nice.

I have also seen patients with channel problems between remote access sites and the areola / nipple.  Scars, adhesions, and depressions can look terrible.  Check out the lateral (side views) and posterior oblique (side from the back views with and without muscle flexion here to see what I mean.

Ultrasonic liposuction uses energy to help emulsify fat.  Power assisted liposuction uses mechanical vibrating devices to rapidly move the cannula back and forth.  Both PAL and Ultrasonic methods have been around for several years.  Many do not prefer what they do to the tissue.  Others like what they offer.  Both still preferentially remove fat over gland.  Both make the work of the surgeon easier.  Some feel ultrasonic liposuction can cause more swelling, bruising, and the increase the need for drains.

For me however, they also both remove the feel of the tissue sculpture.  I like the much better control I get with my cannula selection and personally I do not like either ultrasonic nor power assisted techniques.  None of the cases on my website used either PAL or Ultrasonic techniques. 

As any artist, I take my cannula selection very seriously and have evolved what permits me to achieve my results.  I have considered and evaluated many, many technologies.  The many different types of cannula I use have their own advantages and qualities.  I pick a subset of these cannula that varies for the many different types of gynecomastia male chest sculpture that I see.

Gland removal by any technique can still leave a depression when  a major part of the problem is from gland.  For gland removal, I prefer the greater precision of removal under direct visualization and feel.  This also give me access to many more elements for my artistic palette of my Dynamic Technique to sculpt the remaining tissues.

This approach permits me to maximize the removal of the firm gland and sculpt the remaining fat.  How tissues move is important.  The human body is beautiful in animation.  That is why I show pictures of the chest with arms up, down, and with muscles tight / relaxed in addition to the results from multiple views.  Such analysis of the results as well as how tissues evolve, the possible need for drains, comfort level after surgery, are important factors in picking your doctor.  It is like an artist selecting a paint brush.  The results are what matters, not with what tool they sculpt.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Chest Sculpture

[patientx1]

belfastmale - I'm guessing you had laser lipo / smart lipo / smartlipo in N Ireland? Why was it a waste - aren't you awake while they do it - didn't you say - "hey! do it properly!"
Who was your surgeon and how much did it cost?
Sorry for the questions but there doesn't seem to be many people on here that have had smartlipo done or writing about it, but it does seem to have had good reviews elsewhere on the net such as on realself.com, where it gets an unbiased 81% of users recommendation.
If anyone has had smartlipo, I'd be interested to hear about it - I've now had 3 traditional lipos, with 3 different surgeons and I still dont feel a reasonable amount has been taken out!!! I read somewhere that the male chest is very fibrous and that the laser's melting characteristics could help - I'm pretty keen to move on with my life but do what I can first!!!!!!!!

[Tedaltman]

VASER is proving to be a wonderful tool for the treatment of gynecomastia. For the physician above, the ultra sound is tuned to emulsify the material, a different setting than is used for fat when it's used in liposuction. Take a look at this video and interview. This seems to be a godsend solution. Not many physicians are doing this with VASER yet, but this physician is the top VASER physician in the country. He's in Denver.
http://www.youtube.com/watch?v=8TRu9h565_I

[strato]

my opinion is that laser, vaser, smart or other kinds of lipo techniques are concerns of the surgeon not the patient. some surgeons prefer the traditional lipo and some prefer other. they choose which they work better and feel comfortable with. what is important for you is there is fat in there and it needs to be taken out.

[Dr. Elliot Jacobs]

There are lots of different methods of doing liposuction, such as PAL (Power Assisted Lipo), UAL (Ultrasonic Assisted Lipo), Vaser (pulsed ultrasonic lipo), Laser assisted lipo (such as SmartLipo and others).  Truly, none of them offer significant advantages over standard, well-performed lipo. NONE of them can remove fibrous tissue or gland tissue!!!

Ultrasonic liposuction (UAL) was introduced with great fanfare, claiming to make standard liposuction better and easier. It utilized an ultrasonic probe which turned the fat into liquid and then standard liposuction had to be used to remove the liquid. Unfortunately, in some cases, the ultrasound probe produced burns and extensive post-operative pain. It has lost following but in the hands of an experienced surgeon, it can still be useful. It will not remove gland, however.

PAL is short for Power Assisted Liposuction. In essence, it is a lipo cannula attached to a motor which creates very short back and forth strokes. Although originally touted as a finesse tool, it is now used simply to make the work of liposuction less strenuous for the surgeon. It is useful but not essential and does not offer any benefits as regards the final results of surgery. It too does not remove gland.

Vaser is a pulsed ultrasonic liposuction machine. It has reduced some of the problems of the original ultrasonic liposuction and is touted to help skin to tighten -- it is still being used. It is not substantially better than traditional liposuction. It does not remove gland.

SmartLipo (and others) are the latest additions on the liposuction scene. It offers a laser which travels under the skin to destroy fat cells. The body then scavenges and removes the dead fat cells and released fat. Some surgeons use the laser and then traditional liposuction to remove the released fat. Its main claim is that it tightens skin at the same time. However, this has not as yet been scientifically proven. There have been some reports of skin being burned by the laser. SmartLipo has yet to prove itself amongst many plastic surgeons but it is being heavily hyped to the general public. It does not remove gland.

Bottom line:  these newer devices and methods can be useful in dealing with the fat component of gyne -- but are not able to remove excess fibrous tissue or gland.

Dr Jacobs

[DrBermant]

VASER is proving to be a wonderful tool for the treatment of gynecomastia. For the physician above, the ultra sound is tuned to emulsify the material, a different setting than is used for fat when it's used in liposuction. Take a look at this video and interview. This seems to be a godsend solution. Not many physicians are doing this with VASER yet, but this physician is the top VASER physician in the country. He's in Denver.

Sorry, this sounds like hype that salespeople have been pushing their expensive toys. I have yet to see any early after surgery pictures or movies after VASER fat cell technology.  Better yet try to find any other technique that can show After Gynecomastia Bruising and Swelling anything close to what I have evolved over the years. Less swelling, less bruising, and better technique lead to more rapid Healing and Recovery after Gynecomastia Surgery. If that surgeon is so good, where are the before and after surgery pictures and better yet, how the tissues move.  Unfortunately, I have seen too many unhappy patients after surgery by such doctors claiming that the gland can be removed by the VASER.  I do not adopt a technique that is hyped without proof that it is better in some way for the patient.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Male Breast Reduction