Smart Lipo

Dear Doctor,
I have had two consults regarding my sagging underarms.  Both doctors have stellar reputations and busy practices.
The first said that I would not like the underarm scar. Period.  He did not offer any other alternatives.
The second said that Smart Lipo is the way to go, and he thought that I still had enough elasticity in the skin to get a good result.
He said that if I was not satisfied with the resolution of the sagginess and crepiness, that we could then do Thermage to improve it even more.
My questions are:  what do you think about Smart Lipo and Thermage?
Why would a knowledgable reputable plastic surgeon not even offer these procedures as an alternative to brachioplasty?
Thank you.

[Howard Rosenberg, MD]

It is apparent to me, based on your consultations, that liposuction alone will probably not meet your needs.  There is no question that brachioplasty (using a combination of direct skin excision as well as some traditional liposuction) will be the definite solution for your problem.  There is a linear scar that runs along the inside of your arm, but this usually heals very well.  If you are willing to accept this scar, then this form of surgery is for you and is very predictable.  I have treated a sizable number of patients who have uniformly been pleased with the results.

The use of Smartlipo (use of a laser based system to destroy fat cells) is relatively new and advocated for localized fat cell deposits.  Thermage can be very unpredictable for skin tightening.  If you want to be a trial case for these techniques, then go into them with your eyes opened!  The second doctor offering these techniques spent a lot of money purchasing these systems.  It remains to be seen if they will be effective for your problem.

[aviationgal]

A related discussion, Tummy Tuck or Smart Lipo was started.