Chewing the FatWe all want the perfect body but we also find it difficult tostick to a rigid exercise and diet regime and, even if we domanage to achieve our perfect weight, we're often plagued bystubborn pockets of fat that just won't go. Dr Ayoubi of theLondon Medical & Aesthetic Clinic, one of the UK's leading lasersurgeons, talks us through the history of fat reduction, fromsurgical procedures through to Smartlipo

The surgical option,from late 19th centuryThe surgical techniqueto remove fat has beenperformed for many years -the most common examplebeing the tummy tuck - andit works in a very simple way.You cut the skin, remove thefat and then re-drape the skin.

There are some advantages:you can remove a lot of fat,it is good for the surgeonbecause they can see whatthey are doing and you canachieve skin tightening at thesame time by removing anyloose skin.

The downsides though oftenoutweigh the advantages: itis performed under generalanaesthetic, entails a lengthyperiod of downtime and youare left with a very obviousscar.

Traditional liposuction,early 1980sTraditional liposuction wasintroduced in the early 1980sand became the standardtechnique for the next twentyyears.

It works by making a smallincision in the skin andsucking out the fat with theliposuction device, but theproblem lies in the fact thatwe have two different typesof fat: deep, loose fat andsuperficial fat.

Liposuction tackles thedeep fat but can't remove thesuperficial fat because it isvery vascular. If you attempt toremove it with liposuction yourisk too much bleeding anddamage to the skin.

It was obvious; we neededto find a solution to thesuperficial fat.

Other alternatives, the1990sAll research at the time wasdedicated to finding waysto tackle the superficialfat. The first approach wasapplying heat to the surfaceof the skin in an attempt toemulsify the superficial fatunderneath - not throughan incision - and lots ofdifferent forms of energy wereexperimented with, includinglaser, radiofrequency andultrasound.

These techniques wereoften combined with traditionalliposuction, but they didn'thave the desired resultbecause the more energy youapply through the dermis, themore you risk damaging orburning the skin before youeven have an impact on thefat underneath.

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The FutureCurrently, Smartlipo MPXprovides an alternative toiposuction and non-surgical

techniques to remove fat but Ifeel that in the next five to tenyears it will become a viablealternative to many surgicalprocedures.

I have started to use themachine for several lifting

procedures, for the neck, knees,buttocks, even as an alternativeto the breast lift by applying it tothe area above the breast andutilising its skin tightening effect.

Every week I train visitingplastic surgeons from all over theworld; they are very experiencedin all that liposuction and surgeryhave to offer, but they realisethat this is the future.

Available from: For moreinformation on Cynosureand their lasers visit www. 3cynosureuk.com or call 01628 o"522252. For a full list of allthe procedures that Dr Ayoubiperforms and to book aconsultation with the LondonMedical & Aesthetic Clinic visitwww.lmaclinic.com or call 0208342 1100

Smartlipo, 2000Finally, we had abreakthrough; Smartlipo worksby making a tiny incision,under local anaesthetic, andthen emulsifying the fat byrupturing the membrane ofthe fat cell using the light,not the heat, of the laser.The contents of the fat cellleak out and the cell itself nolonger has a function so isremoved by the body.

The first machine hadsix watt energy and wasfantastic in small areas suchas under the chin, and forsmall amounts of tummyor thigh fat but i had manypatients wanting much largerareas dealt with. The machinewasn't producing the results Iwanted and the length of theprocedures meant discomfortfor the patients.

Smartlipo MPX, 2008The company was introducingmore and more powerfulmachines which wereproducing better results andmore comfortable patientexperiences, then their sistercompany in the US, Cynosure,developed Smartlipo MPX.

MPX stands for multiplelasers and the machineemploys two lasers. Onetargets fat membrane and theother targets blood vessels.

The current Smartlipo MPXis also so much more powerfulthan the original machine -from six watts to 46 watts andthat increase in power meansyou go through tissue easierand tackle larger areas in lesstime. It also means increasedskin tightening which is crucialwhen you're tackling largerareas of fat.

Other alternatives:Bodytite. Introduced intothe UK last year, this usesradiofrequency and, at 75watts, is very powerful. It issuitable for large areas butdoesn't produce the sameskin tightening as MPX, nordoes it have the flexibilitywhen dealing with roundedareas such as the inner thigh.It doesn't have the samerange of safety features asMPX, which is invaluable evenfor an experienced surgeon.Vaser. Reliant on ultrasound,this is good for small areasbut doesn't give the skintightening of Smartlipo. Itworks by vibrating the fat cellsand damaging them but itcan also damage the tissuearound it causing pain andbruising. It can also causeirregularities. It has its placebut has pros and cons as allsystems do.Other lasers. Targeting thefat cells not the membrane,they can produce unwanteddead tissue under the skin. D

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