SmartLipo Versus Traditional Liposuction

One of the most frequently asked questions I receive is how do SmartLipo and regular liposuction differ and which is better.

Traditional liposuction involves infiltrating a wetting solution, typically a combination of saline with lidocaine and epinephrine).  In most cases, this is done in the operating room under general anesthesia. Most patients will need to take about 4-6 days off of work to recover. Since it is done under general anesthesia, you have to pay for the operating room and the anesthesiologist. You also need to fast beforehand and have someone with you to drive you home. Most patients are quite sore for several  days. It does work – and until SmartLipo and ultrasonic liposuction came along, it was the only game in town.

SmartLipo on the other hand is done in my office under local anesthesia. I prefer to give an oral sedation (Ativan), which means you do need to have a driver with you. Unlike traditional liposuction, there are no IVs involved and I do insist you eat and drink before your procedure. You can return to work the next day and to your regular workouts within 5 days. First, I will numb up the areas to be treated. What makes this procedure unique is the second step. I pass a fiberoptic laser back and forth in the subcutaneous fat, which melts the fat. The heat damages and destroys much more fat (similar principle as with the SculpSure laser that we also own) than what will come out in the liposuction. The laser helps stimulate collagen and elastic fiber production in the skin, leading to some skin tightening. The last step involves liposuction’ing out the fat. There is less pain after the procedure compared to regular liposuction because smaller, more delicate instruments are used. Also, there is less risk of unevenness. There is usually less bruising as well because the laser coagulates small blood vessels. And you will continue to see improvements for 6 months!

SmartLipo offers all of the benefits of traditional liposuction, but also has several important additional benefits. Where traditional liposuction always comes into play, however, is if you are already in the operating room for another procedure with me. This is for two reasons – 1) SmartLipo equipment is not portable and 2) SmartLipo takes longer than traditional liposuction. If you are under general anesthesia, it is better to get it done as quickly as possible. But if SmartLipo is the only procedure you need, I’d recommend getting that done in my office – no general anesthesia needed, saving you recovery time and the cost of anesthesia and facility fees. 


SmartLipo versus SculpSure – Which is Better?

This is an interesting question, especially since they are both designed to be spot treatments for areas of unwanted fat.

First, let’s look how these two treatments work to eliminate fat. Fat has a poor blood supply compared to muscle or organs. This means that when fat is heated to 47 degrees Celsius, it will die. Both Smartlipo and SculpSure work on this principle.

SculpSure requires no anesthetic. Essentially 4 cell phone size attachments are secured to the area where you want to decrease the fat. (a belt holds them in place against your body). These attachments allow a laser to send wavelengths through your skin to heat the underlying fat. These attachments also cool the skin. The skin is not damaged but the underlying fat is heated to the necessary 47 degrees. It definitely gets warm and is somewhat uncomfortable. However, I had no problems treating my flanks. The entire treatment only takes 25 minutes. I was able to go to the gym immediately afterward with no problem. The company’s research revealed that 24% of the fat will be removed (the body just breaks down the killed fat cells with no problems). Most people should do a second treatment 6 weeks later. A person with more fat may want to do additional sessions and can expect further improvement (though not likely 24% each time). They will continue to improve for 3 months after the treatment.

Smartlipo is done in the office with local anesthetic and usually some oral sedation (if you take oral sedation you need to have a driver). I make small incisions (only 2-3 mm) which allow me to infiltrate the local anesthetic. I then insert a fiber-optic laser fiber directly into the fatty layer and significantly heat the fat (there is a temperature probe in the fiber so that the area is not over-heated). It also heats the underside of the skin which causes the skin to tighten. I then liposuction out the melted fat. You can return to work the next day and resume exercising after 5 days. You will continue to improve for 6 months.

So which is better, Dr. Berman?


Clearly, SculpSure is the easiest. You can do this on your lunch break or on your way to the gym. You do need to repeat this at least twice. There is no bruising and little to no swelling. There may be some minor tenderness but you should not require any painkillers afterward. This is the clear winner for ease of treatment.

Smartlipo is definitely more involved. You can expect to lose a day from work. You should expect some discomfort the next day and many people require painkillers, at least at for a few nights. Many people will get some bruising. The improvement will continue for 6 months. However, if you think about it: The laser fiber is in direct contact with the fat, gets very hot, and the fiber is  continuously moved to contact multiple fat cells. Liposuction is then carried out after the laser is removed. Except in very thin people, you can expect more fat to be removed with Smartlipo and more skin tightening to take place. This should be considered a more aggressive treatment.

Ultimately they are both great tools to help get you closer to the body you want. It depends on what you want to achieve, and how easy you want the treatment to be.

It is best when going for a consult, to see a board certified plastic surgeon, who offers both of these treatments, to help you decide which is best for you.

What does SmartLipo Cost?

What is the Cost of SmartLipo Compared with Traditional Liposuction?

It is very normal for people to wonder, what is the cost of Smartlipo and how does that compare to the cost of regular liposuction.

First of all, it is important to be clear about the difference in procedures. Regular liposuction involves infiltrating the area (usually associated with the word, “tumescent” which just means a lot of fluid is infiltrated into the area) which contains some local anesthetic (lidocaine) with some epinephrine to minimize bleeding. After this, the fat is liposuctioned out. This is usually done under general anesthesia in an operating room.

Smartlipo (or laser-lipo) is a major advance in this technique and involves a middle step of inserting a fiber-optic laser fiber into the fatty layer (uses the same very small incision which was used to infiltrate the subcutaneous tissue with the local anesthetic). The laser fiber heats up and kills the fat cells. It also heats up the skin so that it causes the skin to tighten. There is a built-in temperature sensing device in the laser fiber, so the fat and skin are heated but not burned.  Smartlipo is almost always done in the surgeon’s office under local anesthesia with oral sedation. Some surgeons will use IV sedation.

As one might expect, costs are going to vary across the United States. Invariably, large urban centers, with a higher cost of living, are probably going to cost somewhat more. I would strongly caution against using a Groupon or accepting a very out of proportion low fee. This is safe surgery but it is surgery and the person should know what they are doing and know anatomy. I would strongly recommend a board certified surgeon, especially a plastic surgeon. No decent surgeon will use Groupon.

Regular liposuction, since it is being done under general anesthesia in an operating room, is generally going to be more expensive.  You are paying, not only for the surgeons time but also for the anesthesiologist (or nurse anesthesiologist) and the operating room (even if the surgeon happens to have one in his office).  

In general, if you treat multiple body areas (eg a common combination is upper and lower abdomen and love handles/flanks) at one time, you will pay less than if you came in for 3 separate treatments.

A rough idea of costs would be about $3,600 for one area, $5,600 for two areas and $6,500 for 3 areas – though we are currently running a 30% special discount at the moment.

Common Smartlipo Areas

Common Smartlipo Areas

The best areas to get Smartlipo are the areas that you find hardest to trim down. For most people, the love handles (flanks) are a notoriously difficult area to trim down. I have done both marathons and full Ironmans and it is rare to see someone who does not have some extra bulge there especially if they are older than 18 years old! Some women have saddlebags (lateral thighs) that even when they get thin refuse to reduce in prominence. This can be a real problem since it forces them to wear a larger pants size which is out of proportion to the rest of their body. It is noticeable in most types of clothes.

So what would I say, are the top 5 areas for Smartlipo?


For men, really there are only 3 top areas: lower abdomen, love handles (flanks) and sometimes upper abdomen. Occasionally a very trim man, may only need the periumbilical area which is more like doing just the middle abdomen.


For women, the 5 commonest areas would be: lower and upper abdomen, flanks and inner/outer thighs. This is followed closely by neck, medial knees and bra line and upper arms. Much less common but still doable are the lateral breast area and calves.

Breast Augmentation and Smartlipo – Can They Work together?

Breast Augmentation and Smartlipo – Can They Work together?

The answer is yes and no.

I do my breast augmentations in a surgicenter, outside of my office, because I use general anesthesia (GA). I do my Smartlipo cases in my office. I will do regular liposuction when the patient is under GA.

What does this mean in practical terms?

I am a huge fan of Smartlipo. I have had many patients, who have had Smartlipo with me in the week or weeks before having their breast augmentation. This works great. Many patients prefer that since they are already asleep, for both cost and convenience reasons, to have their breast augmentation done and at the same time, have their liposuction done.

There is no absolute right or wrong answer to this question. In general, for those wanting the absolute best result from their liposuction, it is generally preferable to do the Smartlipo in my office, in advance of the breast augmentation. You can return to work the day following Smartlipo. This approach does require more time from you and me, and since the Smartipo is much more time consuming procedure, and requires additional equipment, this will cost more. However, you will be saving some time under general anesthesia, which will raise your OR costs and your anesthesia costs.

I will discuss both these options with you, when you come in for your consult since the decision, will be an individual one.


What are the best areas for Smart Lipo?

What are the best areas for Smart Lipo?

Patients want to know, which areas respond best to Smartlipo?

The true answer is every area will respond well to Smartlipo provided that the skin tone is good and there is not a ton of fat there. You will get an especially good result, if you work out more after the procedure and lose some weight by improving your diet.

One area that is almost always excellent is the flanks/love handles. This is because the skin tone here is almost always good. Next I would say, the lateral thighs do very well. 

The upper and lower abdomen, and inner knee area, will depend on your skin tone and this does not depend on your age. Upper arms and neck can do nicely but in women in their late 50’s or older, usually do not have good skin tone, at this point in their lives.

The inner thigh area, even in younger women, may not have very good skin tone. This means there can be some improvement but it will not be close to perfect, unless you have excellent skin tone.

If your skin tone is not ideal, rather than have you just wear a support garment, like a Spandex, for just 5 days,  I may ask you to where it most of the time for 6-12 weeks. This does not mean every minute. You can still go to the pool etc and not wear the support garment. Remember you will continue to improve for 6 months in most cases.

Will people know that I had Smart Lipo?

I often get asked, “will people know that I had Smartlipo?”

The answer depends on who are those people? If you are referring to your partner, then the answer is “yes” unless they are very unobservant or they are away for a week or two.

The incisions for Smartlipo are very small, only about 3 mm. I usually cover them with small steristrips that will stay on for a week. Also, I recommend that you wear spanx or a compression garment for at least 5 days and sometimes for several weeks.

Will my partner know that I had smart lipo?

Your partner may wonder why you are wearing a compression garment to bed, if that is not your normal attire for bed. You may have to explain to your partner that the steristrips are a fashion statement and of course, have nothing to do with incisions or surgery. Also sometimes the incisions may leak the first night of surgery. This will stop by the time you go to work the next day, but your partner may wonder, if you have continence problems. It also may be difficult to explain why the bed is wet after you have slept in it the first night after Smartlipo. Or they may wonder why you are putting a towel under you when you go to sleep. Other than these very personal times, there won’t be any glaring differences.

Most patients do not bruise very much or at all, after Smartlipo, but it definitely does occasionally happen. It may be challenging to explain to your partner, why you have bruises on your love handles or your hips. Perhaps you can fib and tell them that you have a very aggressive trainer at the gym, who insists on hitting you with a stick, if you don’t do your exercises with perfect form. Or maybe it was that cardio-combat class at the gym that is unbelievably tough.

If you are used to jogging with your partner, your partner may wonder why you are taking 5 days off from working out. However it is only 5 days off from exercising, so perhaps you can convince them, that you are working on your meditation skills for 5 days. This will convince your partner that you are doing way too much yoga.

Will everyone else know that I’ve had smart lipo?

If you are talking about anyone except your partner knowing – the answer is that it is fairly easy to hide the Smartlipo event. If you do get some bruising, you may have to wear garments that hide these areas. However you will be back at work the next day. Spanx or compression garments, can easily be worn under your clothing. You are showering and dressing normally and moving normally the very next day. It can be very easy to keep the procedure a secret if you have Smartlipo with me.

Of course, I hope you will be so thrilled with the results that you will want to tell all of your friends and write reviews all over the internet about how much it has helped you.

How to Minimize Smart Lipo Recovery Time

Minimize Smart Lipo Recovery Time

One of the best things about Smartlipo, is the fact that virtually everyone goes back to work the next day (nothing is 100% but almost 95% of my patients do). You may drain some fluid overnight but this almost always stops the next morning. You can shower the next morning, put on your compression garment and then drive to work.

How will you feel? This will vary from person to person. The most frequent things I hear are: “sore”, “not too bad”, “I feel a bit beaten up” or “I feel like I had a crazy hard workout at the gym yesterday.” These are all quite normal responses and as you can expect the comments will vary from person to person.

I think you will bounce back much quicker from this procedure (and almost every procedure that I do) if you get up moving immediately. It is also good to do gentle stretches from the beginning. There is no reason why you should not have a full range of motion. Everything in life is a balance. I want you up moving and walking and going up and downstairs and walking the dog etc. But I also want you to take a bit of extra time to rest up. Any procedure will wear you out somewhat and it is important to give your body a bit of extra rest time. I don’t want you working out for 5 days. However, after 5 days, you can go at it hard, if you feel up to it. Some of my patients will and others will take it somewhat easier for 10 days or so.

I am a great believer in vitamin and supplements. I particularly like the DFH products which you can find as a link on my web site. It is probably a good idea to stop any weird supplements and herbs and megadose vitamins a week before surgery. I think you can resume them a day or two after Smartlipo.

You will generally feel better if you wear any type of  compression garment for 5 full days (except, of course, in the shower) and most people will want to wear it much longer when you exercise.

I am always available for questions in the post op period. I give all of my patients my cell phone number after surgery and they are encouraged to text me if they have any concerns.

Fine Tuning the Athletic Body

Fine Tuning the Athletic Body

The Extra Help of Smart Lipo

You have worked your butt off for your athletic body. You get to the gym 5-6 days per week. You have really modified and been strict with your diet. You have lost weight and all your friends think you look great. You have come a long way from where you started. However, as your body has gotten better, your expectations for yourself have gone up. You have had to buy all new clothes because your former ones are all too large for your frame.

But where are those defined abdominal muscles? Why are there still love handles? How could those saddle bags possible still persist?

Smart lipo almost certainly can be a helpful tool to get you closer to your goal. Let me preface my comments by saying that I do not believe any liposuction technique can “liposculpture” you to a 6-pack or make you into the cover a Fitness magazine. If it was as easy as that, we would be seeing them all the time in the gym! I have serious ethical issues, with those advertisements that suggest they can. Smart lipo works in conjunction with your diet and exercise program. You don’t want to put on weight after your Smart lipo and in many cases, you want to lose a few pounds.

Smart lipo is minimally invasive (to get a real result, I believe you need a small incision so that the fat can be accessed and melted – in comparison to CoolSculpt which is much less effective) and only requires incisions that are a miniscule, 3 mm or so (⅛ of an inch). It is done in the office with local anesthetic, plus often an oral sedation pill. Since you are not put to sleep, you are at no increased risk of blood clots and pulmonary emboli. There is no anesthesiologist to pay. You go home immediately afterwards and can return to work the very next day. It is important to note, that you will continue to improve for 6 months and you are very unlikely to be perfect.

Smart lipo with the fiberoptic laser  making direct contact with the fat, is a great way to be very precise with the fat removal. It is then liposuctioned away. This can be an excellent tool to get you much closer to the body that you have always wanted. 

My cosmetic consults are free and I look forward to discussing the options with you.

Unhappy with Your Love Handles and Lower Abdomen?

Unhappy with Your Love Handles and Lower Abdomen?

Have you tried dieting and exercising but still feel that your love handles and lower abdomen are too full? Or are you at a road block where you know you should be dieting and exercising but can’t get the willpower to put yourself through the cycle of dieting and exercising again.  Do dieting and exercise not seem to work for you?

I am a board certified plastic surgeon, who has done over 600 Smartlipo cases (as of March 2016, so could be much higher by the time you read this) and many tummy tucks, so I have some thoughts on this issue.

I feel there are 3 major options for you and which option is best can vary from person to person. Some patients will benefit from Smartlipo, some from a Tummy Tuck and some patients need to just diet and exercise before they proceed to either of these two options. These are some of the items you should consider. Let me preface my comments by saying that there is no magic (despite Hollywood and TV shows and some unscrupulous advertisements, suggesting otherwise) If you want to look your best, you will still need to lose weight. However, sometime doing either a tummy tuck or Smartlipo, can help motivate you to start dieting and exercising. I have many, many patients, who after doing one of these procedures, get highly motivated and does a great job losing weight and transforms themselves.

  1. The first consideration is how much fullness do you have in your lower abdomen and love handles. What is your skin tone like in your lower abdomen? The love handles almost always have good skin tone and will respond well to liposuction or better yet ,Smartlipo. If you have a lot of loose skin in your lower abdomen, you will almost certainly need a tummy tuck.
  2. Do you have a lot of bowing to your lower abdomen? Is the fullness due to muscle laxity or fat? If it is due to muscle weakness or fascial weakness (eg from having children) you may need a tummy tuck to tighten these up.
  3. Can you take time off from work? If you do Smartlipo, you can return to your job the very next day. If you do a tummy tuck, you should generally plan 10-14 days off from work (though you can get some work done at home)
  4. Are you willing to accept a scar?  A tummy tuck scar fades nicely with time but it is long. Usually it is well worth it, in order to get a better shape for your body. Remember, only a select few see your scars, whereas your better shape will be seen by everyone in all of your clothes. The scars from Smartlipo are usually almost invisible.
  5. Have you considered supplementing your diet with both vitamins, minerals and maybe a detox program or weight management program. I am impressed with the Designs for Health products which can be found through a link on my web site. They deliver their products to your house, so you don’t need to come by the office to get them.

Nothing is a substitute for a free cosmetic consult so that I can see you person. However, if you live out of the area, you can email me and send me pictures and I can usually do a consult this way.