(1) Background: The demand for body-contouring procedures has surged, with lipolysis emerging as a common technique for excess fat removal. Laser-assisted lipolysis (LAL) has gained attention as a potential alternative to surgical fat removal (SFR), offering perceived advantages in safety and efficacy. However, the comparative benefits of LAL and SFR remain uncertain. (2) Objective: To conduct a review of the existing literature comparing the efficacy, safety, and patient satisfaction of LAL and SFR. (3) Methods: A comprehensive search of major electronic databases was conducted to identify studies comparing LAL and SFR for body-contouring procedures. Studies were included if they were published in English, involved human subjects, and reported outcomes for LAL and SFR. All studies were classified according to the Oxford Center for Evidence-Based Medicine evidence hierarchy (4) Results: LAL may not be a safer and more effective option than SFR. However, the evidence for these differences was limited by the quality of the studies and the heterogeneity of the results. (5) Conclusions: This review suggests that LAL may not be a safer and more effective option than SFR for body-contouring procedures because LAL is associated with higher risks of complications such as burns and scarring, whereas SFR offers a more established safety profile and consistent efficacy.