Forty-six-year-old Leslie Pearson was skeptical of cosmetic surgery at first.

“It just didn't look like something I wanted to go through,” she said. “I have a very active life and it was a little too much down time, a little too much bruising.  It just looked a little scary to me.”

What changed her mind was something new called laser liposuction, a different kind of fat removal recently approved by the Food and Drug Administration. 

Traditional liposuction uses a wider cannula, or metal rod, to tunnel through and suction out pockets of fat that don't seem to respond to diet and exercise.  This newer smart lipo, or laser lipo, uses a tiny one millimeter-wide cannula to liquefy the fat.  Some is then suctioned out, some leaks out of the tiny punctures and some is left in the body, then metabolized away.

“The biggest thing is that it's minimally invasive,” said cardiologist Dr. Paul Nathan. “it's all local anesthesia and also you have the effects of skin tightening, which none of the others can perform.”

Skin tightening is why Cynosure, the makers of the first laser lipo, say it's different.  The company also claims there is less trauma and bruising during fat removal, so the recovery time is fast.  Both traditional and smart laser lipo can be done in an outpatient setting with only local anesthesia.

When Dr. Nathan began using laser lipo last year on the north shore, aesthetic surgeons such as Dr. Kamran Khoobehi were skeptical, saying it was too new and more studies were needed.

Khoobehi’s concerns included weak power and whether the melted fat could hurt a patient's health.  But Dr. Nathan pointed to studies showing no significant adverse affects on cholesterol levels.  Now a year later, Khoobehi not only likes laser lipo, but he is using it on patients.

“The company worked on it and they increased the energy on the  machine from eight to 18 watts and so when I heard about that, I decided to look into it,” Khoobehi said.

Local dermatologic surgeon Dr. William Coleman III has been performing liposuction for  25 years and is not convinced.

“Smart liposuction is not smart and it's not liposuction,” he said. “It is a laser that burns fat, but after that you have to perform liposuction.  The problem with that approach is there have been side effects  from doing that, and yet no more benefit than if you do liposuction alone.”

Coleman believes the laser could burn the skin and he's seen no scientific evidence of skin tightening. So the question remains: should patients choose regular traditional liposuction or the new smart lipo?

“In my opinion, and right now the opinion of the American Society of Plastic Surgery is still to recommend standard tumescent liposuction,” said cosmetic and reconstructive surgeon David Jansen. “That’s because it gives the best results.  It’s been around, it's been giving great results for 35 years.” 

Jansen thinks smart laser lipo might be good for small areas like under the chin and hard-to-respond areas like male breasts or love handles or even for  touch ups after traditional lipo, but he wants more evidence.  Dr. Khoobehi is now convinced it's best to give patients the option.

“It is not to replace normal liposuction because you can not do a lot of large volume,” Khoobehi said. “But one advantage is you can stay very close to the skin so you can provide more skin shrinkage and that's the main difference between them.”