Histologic evaluation of the pulsed Nd:YAG laser for laser lipolysis

Evaluating the effect of glycerol on increasing the safety and efficiency of hyperthermic laser lipolysis

This study aimed to investigate the effect of glycerol as an Optical Clearing Agent on the temperature profile of the skin during HyperThermic Laser Lipolysis using computer simulation. In this study, a three-layer model of the skin was used to simulate HyperThermic Laser Lipolysis. The Monte Carlo MCML code was used to investigate the propagation of laser photons inside skin tissue. The energy absorbed from photons is used as a heat source to determine the increase in temperature and assess thermal damage in the layers of the skin. The finite element method in COMSOL software was used for calculation. The simulation of single-pulse radiation exposure with and without applying glycerol to the skin model was investigated to assess the impact of glycerol. Glycerol decreases the temperature and thermal damage to the epidermis layer while increasing the temperature of the fat layer. Moreover, the presence of glycerol increases the depth of fat cell destruction. Glycerol, as a supplement, significantly improves the efficacy of HyperThermic Laser Lipolysis.

Histopathological evaluation of the R134a multipulsed spray cooling assisted 1210 nm laser lipolysis by the murine model in vivo

BACKGROUND AND OBJECTIVE

Owing to the greater absorption affinity for lipo-rich tissue than water, the 1210 nm laser is a promising candidate for transcutaneous lipolysis in the near-infrared band. However, fat reduction is limited because laser therapy may yield thermal injury of normal tissue. A new protocol to incorporate multipulsed cryogen spray cooling is beneficial to improve the lipolysis effect, and the parameters of laser and cooling can be optimized via skin histopathological analysis.

MATERIALS AND METHODS

A murine in vivo model of inguinal tissue of SD rats was established to test the effectivity of transcutaneous lipolysis protocol by R134a multipulsed spray cooling assisted 1210 nm laser irradiation. Tissue response of lipolysis with/without cooling 10 days post the treatment was evaluated by histopathological analysis of skin samples stained with hematoxylin-eosin (HE), through which safe and effective parameters for lipolysis were determined.

RESULTS

From histopathological analysis of the inguinal tissue of SD rats irradiated by the 1210 nm laser alone, the optimal durations are respectively 7 and 3 s (seconds) for low-dosage (6 W) and high-dosage (9 W) therapy, with pronounced lipolysis effect and minimum injury of skin tissue. The multipulsed spray cooling by R134a with a pulse duration of 10 ms (milliseconds), a pulse delay of 2000 ms, and a pulse number of 5 can be introduced to assist the 1210 nm laser therapy with a power of 9 W and a duration of 7 s to achieve desirable fat liquefaction while keeping the complete structure of skin tissue as well as esthetic-related beneficial effects of hair removal and skin rejuvenation.

CONCLUSION

Excellent lipolysis effect can be achieved via R134a multipulsed spray cooling assisted high-dosage 1210 nm laser irradiation with reasonably matched laser and cooling parameters. The protocol is as follows: Start MP-CSC for one cycle, and then fire the laser with specific power and duration, while keeping MP-CSC accordingly. This new protocol may promote the safe and effective clinical implement of transcutaneous laser lipolysis in body contouring.

Skin and subcutaneous fat morphology alterations under the LED or laser treatment in rats in vivo

The main objective of this work is to quantify the impact of photodynamic/photothermal treatment by using visible LED and NIR laser irradiation through the skin of subcutaneous fat in vivo followed up by tissue sampling and histology. The optical method may provide reduction of regional or site-specific accumulations of abdominal or subcutaneous adipose tissue precisely and least-invasively by inducing cell apoptosis and controlled necrosis of fat tissue. As photodynamic/photothermal adipose tissue sensitizers Brilliant Green (BG) or Indocyanine Green (ICG) dyes were injected subcutaneously in rats. The CW LED device (625 nm) or CW diode laser (808 nm) were used as light sources, respectively. Biopsies of skin together with subcutaneous tissues were taken for histology. The combined action BG-staining and LED-irradiation (BG + LED) or ICG-staining and NIR-laser irradiation (ICG + NIR) causes pronounced signs of damage of adipose tissue characterized by a strong stretching, thinning, folding and undulating of cell membranes and appearance of necrotic areas. As a posttreatment after 14 days only connective tissue was observed at the site of necrotic areas. The data obtained are important for safe light treatment of site-specific fat accumulations, including cellulite. This work provides a basis for the development of fat lipolysis technologies and to move them to clinical applications. Schematics of animal experiment.

Clinical Study to Assess the 1,060 nm Diode Laser for the Treatment of Post-Liposuction Deformities

BACKGROUND AND OBJECTIVES

Liposuction has become increasingly popular in the past decade due to advances in technique and technology. Despite the demand, there exists a significant population of patients who have contour deformities post-liposuction. The 1,060 nm diode laser has been Food and Drug Administration cleared for the removal of unwanted fat, so it was theorized that this noninvasive laser system could be efficacious to smooth these areas of post-liposuction contour deformities. This study was designed to retrospectively study the clinical changes induced by a 1,060 nm diode laser system to treat contour deformities in tissue post-liposuction.

STUDY DESIGN/MATERIALS AND METHODS

Fifteen patients with contour deformities post-liposuction (minimally six months post-surgery) were treated in the area of the deformity with the noninvasive hyperthermic 1,060 nm diode laser system. Each patient received two treatments at a 6-week interval in the anatomical area of their contour deformity.

RESULTS

Fifteen subjects had completed two treatments and the necessary follow-up needs to be included in these results. Two blinded evaluators could correctly identify the pre-treatment image compared to the post-treatment image in an average of 85% of subjects. So, 100% of the patients were graded to be at least "Improved" with an average of 40% of subjects being "Very Much Improved". Patient satisfaction was "High" in all subjects who have completed the treatment protocol. The physician satisfaction was rated as "Much Improved" in 33% of the patient results and "Improved" in 66% of the patient results.

CONCLUSIONS

The noninvasive hyperthermic 1,060 nm diode system is highly effective and safe for the treatment of contour deformities post-liposuction. Lasers Surg. Med. © 2019 The Authors. Lasers in Surgery and Medicine Published by Wiley Periodicals, Inc.

A Single-Blind Study Evaluating the Efficacy of Gold Nanoparticle Photothermal-Assisted Liposuction in an Ex Vivo Human Tissue Model

BACKGROUND

Liposuction is one of the most performed cosmetic surgery procedures. In a previously reported study, gold-nanoparticle (GNP) laser-assisted liposuction (NanoLipo) was shown to improve procedure parameters and outcomes in a porcine model.

OBJECTIVES

An ex vivo human liposuction model was developed to assess the ease, efficacy, and outcomes of NanoLipo, and to further explore its mechanism of action in facilitating liposuction.

METHODS

NanoLipo was compared to a control without GNPs in sets of fresh, nonperfused, anatomically symmetric, matched tissue specimens from 12 patients. A subset of three experiments was performed under single-blinded conditions. Intraoperative assessments included lipoaspirate volume, percentage of free oil, ease of removal, and temperature rise. Specimens were palpated, visualized for evenness, and graded with and without skin. Postoperative assessment included viability staining of the lipoaspirate and remaining tissues. Microcomputed tomography was used to assess the distribution of infused GNPs within the tissues.

RESULTS

NanoLipo consistently removed more adipose tissue with more liberated triglycerides compared to control. NanoLipo specimens were smoother, thinner, and had fewer and smaller irregularities. Infused solutions preferentially distributed between fibrous membranes and fat pearls. After NanoLipo, selective structural-tissue disruptions, indicated by loss of metabolic activity, were observed. Thus, NanoLipo likely creates a bimodal mechanism of action whereby fat lobules are dislodged from surrounding fibro-connective tissue, while lipolysis is simultaneously induced.

CONCLUSIONS

NanoLipo showed many advantages compared to control under blinded and nonblinded conditions. This technology may be promising in facilitating fat removal.

LEVEL OF EVIDENCE 5

Treatment of xanthelasma palpebrarum with a 1064-nm, Q-switched Nd:YAG laser

BACKGROUND

Xanthelasma palpebrarum is the most common cutaneous xanthoma characterized by soft, yellow papules or plaques that arise on the periorbital skin. As these lesions can be cosmetically disfiguring, many patients seek medical help to remove these lesions.

OBJECTIVE

To determine the effectiveness and minimum number of treatment sessions with a 1064-nm, Q-switched neodymium-doped yttrium aluminum garnet (Nd:YAG) laser for the treatment of xanthelasma.

METHODS

A retrospective review of patients with xanthelasma consecutively treated with Q-switched Nd:YAG laser was conducted. Forty-six patients with 103 lesions were identified from January 2012 through August 2015. Photographs taken of patients immediately before treatment and 4-8 weeks after treatment were independently evaluated by 2 dermatologists.

RESULTS

After a single treatment session, 93.2% of lesions had some degree of clearance. All lesions had excellent-to-complete clearance after at least 4 treatment sessions. Patients usually required 4 treatment sessions for optimal results.

LIMITATIONS

This was a retrospective study. Treatment parameters varied, follow-up periods were not uniform, and response was not assessed with a validated scale.

CONCLUSION

The Q-switched Nd:YAG laser is effective and well tolerated in the treatment of xanthelasma in our study population.

Evaluation of lower blepharoplasty treated with the SmartLipo 1064-nm system and its clinical implications: A retrospective review

INTRODUCTION

This study used the SmartLipo 1064-nm system to remove herniated orbital fat tissue to improve lower eyelid appearance. A retrospective review of 128 patients was performed to evaluate the size of prominent fat pads and complications.

MATERIALS AND METHODS

Altogether, 128 patients underwent a procedure using the SmartLipo 1064-nm system via postseptal access, which helped locate fat tissue more precisely. Digital photographs were taken preoperatively and at one week and six months postoperatively. Eyebag sizes were determined preoperatively and six months postoperatively using the Non-Contact 3D Digitizer.

RESULTS

Altogether, 118 primary and 10 revision patients (average age 31 years) were placed in one of two groups: mildly protruding fat pads (group 1, 86 patients) and moderately protruding fat pads (group 2, 42 patients). After injection of about 1 ml of anesthetic and 1 ml of 0.9% iced saline on each side, the patients received an average 450 joules of energy delivered at 20 Hz and 3 W. Postoperatively, the eyebag's height, depth, and area were significantly reduced in both groups (р = 0.000). The main symptoms (swelling, chemosis, engorgement, and pain) subsided within 5-7 days.

CONCLUSION

The SmartLipo 1064-nm system with postseptal access, a minimally invasive procedure, can be used to correct mildly and moderately prominent fat pads.

The post-adipocytic phase of the adipose cell cycle

Subcutaneous white adipose tissue harvested by liposuction has been studied with the aim to understand how the adipocytes modify their morphology when subjected to the passage in a needle for liposuction and to cryopreservation. The work try to clarify the ultrastructural aspects of adipose tissue, in the conditions described before, examining samples of body fat employed in fat graft procedures, and samples after cryopreservation. Scanning and transmission electron microscopy show that the first event that occur in the adipocytes is a lesion of mild degree detectable early in the samples fixed immediately after liposuction. The sequence of events following the adipocyte stress appeared composed by different phases: plasmatic membrane interruption, loss of lipid charge, formation of cup-like adipocytes and formation of post-adipocytes (i.e. cells that survive to traumatic events and restart to internalize lipid droplets). In conclusion, the study suggests that the loss of lipid charge in adipose cell is an active process that can be due to a small hole in the cytoplasmic membrane with the preservation of a large part of the cytoplasmatic content and that at the end of the process of lipid extrusion the cell can maintain viability.

Combining facelift with SmartLipo 1064-nm system, technique overview and retrospective analysis of 56 patients

OBJECTIVE

This study reviews novel approach using SmartLipo 1064-nm system with short-flap facelift treatments focusing on 3 specific facial areas and specific target treatment endpoints. A retrospective review of 56 patients undergoing combined treatment is performed.

METHODS

Fifty-six consecutive patients undergoing SmartLipo with facelift were reviewed using pre-operative photographs as a baseline. The reviewed post-operative photographs were taken at 6 weeks and 6 months. Photographic review was performed by an independent board of physicians on the following scales: Wrinkle Severity Rating Scale, the Global Aesthetic Improvement Scale Assessment, and the Cervicomental Scale.

RESULTS

The 53 primary and 3 revision facelift patients included in this study had a mean body mass index of 24.7, and a mean age of 65 years. These patients received an average of 5,050 joules of energy between three treatment areas which was delivered at 12 Watts and 40 Hz. No major complications were reported, including hematoma and dyspigmentation, even in combined cases with surface lasers. The 6 week and 6 month post-operative photographs showed marked improvements in outcomes in each of the reviewed scales according to the independent board of physicians.

CONCLUSIONS

The SmartLipo 1064 nm is a safe and effective platform to combine with facelifts.

Laser lipolysis without suction: reality or myth?

BACKGROUND AND OBJECTIVE

Liposuction is one of the most frequently performed aesthetic surgical procedures. Laser- and ultrasound-based systems have become especially popular in recent years, including laser lipolysis, which has a number of advantages over classic liposuction. Some researchers contend that the aspiration step is not necessary. Herein, we report a case that highlights the negative consequences when the basic surgical rule of not leaving any necrotic tissue is not followed.

MATERIALS AND METHODS

We report the case of a 50-year-old man who presented with a 15 cm mass in the right lower quadrant, located immediately subcutaneously, passing the midline infraumbilically, tender to touch, and with beginnings of abscess formation, who underwent laser lipolysis. The subcutaneous necrotic fat was removed with a skin island en bloc. No postoperative complications occurred and the patient was problem free 6 months post-surgery.

RESULTS

In the surgical literature, most studies on fat necrosis have focused on fat necrosis in the breast. Fat necrosis is usually a gradual process that is noticed by the patient or physician as a mass. Radiologically, it can imitate cancer, especially in breast tissue. Complications from fat necrosis are primarily linked to the amount of necrosis. Any amount of necrosis above the body's resorption capacity will lead the body into attempting self-limitation, with consequences to both the physical and psychological health of the patient.

CONCLUSIONS

We believe that claiming that no aspiration is required after laser lipolysis, without the necessary studies, has no scientific basis.

Short-flap facelift with 924 nm/975 nm laser lipolysis: a retrospective study of 78 patients

OBJECTIVES

This study reviews the overall outcome of 78 patients undergoing a short-flap facelift with laser-assisted lipolysis using a continuous-wave 924/975-nm diode laser.

METHODS

Seventy-eight patients undergo treatment of lipolysis and facelift using the traditional platysmaplasty technique along with continuous-wave 924/975-nm diode laser-assisted lipolysis. A combination of 3D and 2D photographs is used from before, 6 weeks after, and 6 months after the procedure to judge the overall improvement in the cervicomental angle and the patient's general appearance. The Cervicomental Scale and the Global Aesthetic Improvement Scale Assessments, respectively, are used among a professional panel of three judges to determine improvement.

RESULTS

Elevated flap, continuous-wave lipolysis showed remarkable improvement in patients base on the CAS and GAIS judging system. Ninety-five percent of patients showed improvement on CAS and 100% of patients showed improvement on GAIS when 6 months had passed after time of procedure.

CONCLUSION

The use of a continuous-wave 924/975-nm diode laser shows remarkable effectiveness in lipolysis of the sensitive jowl and neck area. Flap elevation serves as an important technique in assuring safety during procedure. This dual-wavelength laser presents a revolutionary advance in performing facelifts and lipolysis in higher BMI patients.

Lasers as an approach for promoting drug delivery via skin

INTRODUCTION

Using lasers can be an effective drug permeation-enhancement approach for facilitating drug delivery into or across the skin. The controlled disruption and ablation of the stratum corneum (SC), the predominant barrier for drug delivery, is achieved by the use of lasers. The possible mechanisms of laser-assisted drug permeation are the direct ablation of the skin barrier, optical breakdown by a photomechanical wave and a photothermal effect. It has been demonstrated that ablative approaches for enhancing drug transport provide some advantages, including increased bioavailability, fast treatment time, quick recovery of SC integrity and the fact that skin surface contact is not needed. In recent years, the concept of using laser techniques to treat the skin has attracted increasing attention.

AREAS COVERED

This review describes recent developments in using nonablative and ablative lasers for drug absorption enhancement. This review systematically introduces the concepts and enhancement mechanisms of lasers, highlighting the potential of this technique for greatly increasing drug absorption via the skin. Lasers with different wavelengths and types are employed to increase drug permeation. These include the ruby laser, the erbium:yttrium-gallium-garnet laser, the neodymium-doped yttrium-aluminum-garnet laser and the CO2 laser. Fractional modality is a novel concept for promoting topical/transdermal drug delivery. The laser is useful in enhancing the permeation of a wide variety of permeants, such as small-molecule drugs, macromolecules and nanoparticles.

EXPERT OPINION

This potential use of the laser affords a new treatment for topical/transdermal application with significant efficacy. Further studies using a large group of humans or patients are needed to confirm and clarify the findings in animal studies. Although the laser fluence or output energy used for enhancing drug absorption is much lower than for treatment of skin disorders and rejuvenation, the safety of using lasers is still an issue. Caution should be used in optimizing the feasible conditions of the lasers in balancing the effectiveness of permeation enhancement and skin damage.

Nonexcisional tissue tightening: creating skin surface area reduction during abdominal liposuction by adding radiofrequency heating

BACKGROUND

Recent publications show that heat-mediated tissue tightening is a promising treatment for the lax abdomen and may provide better long-term outcomes than traditional suction-assisted liposuction (SAL).

OBJECTIVES

The author evaluates the degree and duration of skin surface area contraction, as well as the influence of anatomic location of the treatment region on the degree of tissue tightening, in a study comparing SAL alone vs SAL plus radiofrequency-assisted liposuction (RFAL).

METHODS

In this prospective, randomized, split abdominal study, 12 consecutive patients were treated with SAL alone on 1 side and with SAL plus RFAL on the other side. Each patient had 4 (3 × 3-cm) squares-2 per treatment type-tattooed in the lower abdominal region (2 on the right and 2 on the left). The surface area of these squares was measured with the Vectra computerized measurement system (Canfield, Inc, Fairfield, New Jersey) at pretreatment, at 6 weeks posttreatment, and at 1 year posttreatment. All measurements were subjected to statistical analysis using predictive analytic software and were evaluated for statistical significance.

RESULTS

In regions treated with SAL alone, there was a 10.4% mean skin surface area contraction at 6 weeks and 8.3% at 1 year posttreatment. The mean skin surface area reduction was 25.8% in regions treated with radiofrequency plus SAL at 6 weeks and at 1 year. The anatomic location of each square (medial vs lateral) did not statistically correlate with more or less tissue tightening.

CONCLUSIONS

Radiofrequency-assisted tissue tightening, when applied in conjunction with SAL, is effective in achieving greater skin surface area reduction.

Combined laser treatment of actinic sun damage and acne scarring

Since its approval for use in 2007, many surgeons have been using the laser for subcutaneous use, primarily for lipolysis, facial neck and body contouring, and skin tightening. Techniques have recently evolved to enable use of the subcutaneous laser with concurrent skin resurfacing techniques for improvement of photoaging and acne or facial scarring. The technique shows great promise in patients with facial aging and photodamage who are not deemed candidates for rhytidectomy surgery. With strict patient-selection criteria of mild to moderate facial laxity and mild to moderate photoaging, the procedure can be gratifying for the surgeon and patient alike.

Effect of laser and tumenescent liposuction on skin retraction and turgor

The authors describe clinical results of the laser liposuction procedure using the MultiPlex technology. They give a comparative quantitative assessment of the effect of laser and tumenescent liposuction on skin retraction and turgor by the example of three patients. Processing local fat deposits by laser emission resulted in the increased skin turgor and elasticity in the liposuction area in all subjects, and skin retraction and higher skin elasticity were more evident than with the use of the traditional liposuction method.

Evaluation of Tissue Tightening by the Subdermal Nd: YAG Laser-Assisted Liposuction Versus Liposuction Alone

BACKGROUND

Skin tightening is a desirable outcome for skin flaccidity.

OBJECTIVE

We evaluated the applicability, safety, capacity and intensity of skin tightening with the subdermal 1,064 nm Nd: YAG laser application to the upper arms, and compared the results with liposuction.

MATERIALS AND METHODS

Patients with lipodystrophy and mild-to-severe skin laxity of the arms were included (n=28). In half of patients, a single treatment with a subcutaneous laser and liposuction was performed, while the other 14 had a regular liposuction. Treatment parameters, adverse effects and photographic documentation were recorded.

RESULTS

Aesthetic improvement and skin retraction was superior by laser lipolysis. The procedure was well tolerated without significant complications.

CONCLUSIONS

The subdermal laser-assisted liposuction using a 1,064 nm Nd: YAG laser achieves improved skin tightening.

New clinical outcomes utilizing a 1064-nm Nd:YAG laser for lipolysis of the torso oblique region

OBJECTIVES

The safety and efficacy of a 1064-nm Nd:YAG laser (Cynosure, Westford, USA) utilizing a 300-microm optical fiber and a 1-mm diameter micro-cannula were evaluated as a treatment for reduction in the appearance or elimination of unwanted fat in the lower back/flanks ('love handles'). In addition, the use of the laser for tightening the skin and collagen regeneration in the area of lipolysis was assessed through biopsies.

METHODS

Ten subjects with unwanted flaccidity and fat deposits in the oblique region of the torso were enrolled in the study. Subjects underwent a single laser lipolysis treatment followed by aspiration of the treatment area. The total tumescence used, laser energy delivered, and tissue removed was recorded for each subject. All subjects had baseline photographs taken and their weight recorded prior to treatment. Pregnancy tests (if applicable) were performed prior to treatment as well. Three subjects had 4-mm biopsies taken at baseline and 6 months to evaluate collagen regeneration. Collagen and elastic tissue fibers were evaluated using special routine stains and histochemical stains designed to highlight these dermal components. Follow-up visits were conducted at 1 week, 1 month, 3 months and 6 months following treatment to evaluate side effects, weight loss and laxity. Additionally, patients kept an evaluation log for each of the first 7 days following treatment. At the 6-month conclusion, patient satisfaction was recorded.

RESULTS

Laser lipolysis procedures with subsequent aspiration were performed bilaterally on the flanks of 10 subjects. At 1-week post-treatment, 80% of the subjects demonstrated reduction in laxity. Similarly, 100% of patients showed visible skin improvement at 1 month, with 70% recording a score of 2 (good improvement). Three-month evaluations yielded one patient (10%) with a score of 3 (excellent improvement) and seven patients (70%) with a score of 2. Histology reports confirmed the visual clinical outcomes, describing thicker collagen bundles at 6 months, as well as coagulation of blood vessels and adipocytes. Side effects were mild and transient in nature, and the majority of discomfort, redness, bruising, swelling, and tingling experienced was resolved within 1 week post-procedure. The treatment was well tolerated and efficacious, with 90% of patients rating their results as good or excellent and 100% of patients reporting that they would recommend the procedure.

CONCLUSION

The use of the 1064-nm Nd:YAG laser with a 300-microm fiber demonstrated the ability to treat adipose tissue in the highly vascular flank area with favorable efficacy and safety. Patients exhibited a quick recovery time and excellent tolerance, as well as visually improved skin.

Laser lipolysis with pulsed 1064 nm Nd:YAG laser for the treatment of gynecomastia

BACKGROUND

Lipolysis using laser is currently widely used for reducing localized fat. A 1064 nm neodynium-doped yttrium aluminum garnet (Nd:YAG) laser lipolysis was investigated in this study to evaluate its efficacy and safety in the treatment of gynecomastia.

METHODS

Five male patients diagnosed with gynecomastia were enrolled in this study, which was designed as a controlled split-breast trial. One breast of each patient was subjected to laser lipolysis and was then compared with a contralateral breast. Photographs and clinical assessments were obtained before the lipolysis, and at the fourth and eighth weeks thereafter. Computed tomography (CT) scan and ultrasound (US) imaging were used to evaluate the changes in the breasts' thicknesses.

RESULTS

The mean chest circumference was found to have been significantly reduced 8 weeks after the laser lipolysis. The clinical outcomes of the laser lipolysis were considered favorable by both the patients and clinicians. The CT and US scans showed that the thicknesses of the treated right breasts reduced more than those of the left breasts were 8 weeks after the laser lipolysis. The side effects (pain, edema, and ecchymosis) were minimal and disappeared shortly after they first manifested. Limitations The limitations of this study are that it employed small treatment groups and short-term follow-up.

CONCLUSION

This study demonstrated that gynecomastia can be treated effectively and safely through 1064 nm Nd:YAG laser lipolysis.

Randomized, blinded split abdomen study evaluating skin shrinkage and skin tightening in laser-assisted liposuction versus liposuction control

BACKGROUND

Laser-assisted liposuction has shown great potential in facilitating fat removal, improving patient recovery time, and decreasing postoperative side effects. Clinical experience has indicated superior skin tightening after laser-assisted liposuction than with liposuction alone.

OBJECTIVES

The aim of the present study was to obtain quantitative, objective data for comparing tissue shrinkage and skin tightening achieved by laser-assisted liposuction versus liposuction alone.

METHODS

Ten female subjects from the author's private practice with unwanted abdominal adiposity and mild to moderate skin laxity were enrolled. On the abdominal skin of each patient, the corners of four rectangular regions (approximately 5 × 5 cm each) were tattooed with India ink and randomly assigned to treatment with laser-assisted liposuction (Smartly MPX laser, Cynosure, Inc., Westford, Massachusetts) or with liposuction alone. The laser system permits individual as well as sequential emission of 1064-nm and 1320-nm wavelengths. Skin shrinkage was quantified by calculating the changes in surface area of the regions. Skin tightening was quantified by changes in the skin stiffness index measured in the treated regions.

RESULTS

One month and three months after treatment, the mean skin shrinkage ratios were significantly higher on the laser-treated side than on the suction side. One month after treatment with or without laser, the mean skin stiffness and skin tightening showed no statistically significant difference from baseline. Three months after treatment, the mean skin stiffness and skin tightening were significantly higher on the laser-treated side.

CONCLUSIONS

Laser-assisted liposuction has a statistically significant effect on skin shrinkage and tightening of the skin in the abdominal area when compared to liposuction alone.

The role of laser tunnels in laser-assisted lipolysis

BACKGROUND AND OBJECTIVES

Laser-assisted lipolysis (LAL) devices are used as adjuncts to liposuction that create laser tunnels to heat the adipose and connective tissue. Available systems vary significantly across choice of wavelengths, power delivery, and tip design. Rationale are developed for optimum laser parameters evaluated with physical principles and in controlled ex vivo tests.

STUDY DESIGN/MATERIALS AND METHODS

A computer model for radiation propagation, thermal conduction and coagulation was developed to study laser tunnels formed in human adipose tissue. An ex vivo study with porcine tissue compared laser tunnels created by a device that operates in short-pulse mode with a 0.6 mm diameter fiber emitting lipid non-selective laser wavelengths to a device that operates in continuous-wave (CW) mode with a 1.5 mm diameter fiber emitting lipid- and water-selective laser wavelengths.

RESULTS

Photothermolytic heating is the optimum mechanism to control delivery of heat to the tissue. Fiber tip surface power density can be optimized for ease of penetration and good volumetric heating while avoiding extremely high peak temperatures. CW rather than pulsed laser emission also minimizes peak temperature rise that can interfere with tunnel formation. Lipid- or water-selective laser wavelengths with low absorption yield lower peak temperatures and more uniform volume heating, while lipid-selective wavelengths offer greater safety near the dermis. Ex vivo histology demonstrated greater volumetric heating with the CW, lipid-selective device at similar power settings.

CONCLUSION

Wavelength, power delivery, and tip design are based on physical principles and together with treatment technique laser tunnel dimensions can be optimized as confirmed in ex vivo histology. The resulting thermal zones provide ease of penetration through adipose tissue and enable treatment uniformity. Based upon principles of fractional skin treatment the thermal zones induce healing responses in adipose tissue with potential to enhance clinical efficacy.

Discussion of laser-assisted liposuction

There has been a significant advancement in the use of lasers for body contouring over the past several years. This article will review the recent past and discuss the future of this trend.

INTRODUCTION

There is much confusion over the definition of procedures using lasers for lipolysis and liposuction. This review article discusses the definitions of suction-assisted liposuction, laser lipolysis, and laser-assisted liposuction in detail. The development of these procedures is then discussed and pertinent articles are reviewed.

MATERIALS AND METHODS

Pubmed and FDA.gov web sites were searched for published articles and FDA approved devices employing lasers for targeting fat for body contouring. This information along with the authors' personal experience was used to review and discuss this topic.

DISCUSSION

There is a specific difference between suction-assisted liposuction, laser-assisted liposuction, and laser lipolysis. This review article clarifies these definitions and highlights the recent articles employing lasers for minimally invasive fat reduction.

Quantification of human abdominal tissue tightening and contraction after component treatments with 1064-nm/1320-nm laser-assisted lipolysis: clinical implications

Internal lipoplasty (iLAL) represents an evolving procedure that depends on delivery of sufficient and controlled thermal energy for lipolysis and collagen denaturation. Of the two outcomes, the particular advantage of iLAL may exist in its capability to selectively denature, remodel, and contract collagen and elastin fibers for eventual skin contraction. Despite the practice of sound laser principles and clinical outcomes, laser lipolysis has not been readily accepted because of its yet unproven advantages over other liposuction devices. This limited clinical research study on the lower abdomen of three female subjects provides objective data by Vectra 3D analysis (Canfield Scientific, Fairfield, New Jersey) of significant skin contraction (average, 9.1% at three months; average, 7.6% at six months) as a consequence of the application of sequential wavelengths of 8 W 1064 nm/8 W 1320 nm within the shallow but not the deep subdermal layers. The application of sustained and confluent thermal injury within the targeted 4 x 10-cm rectangular panel (zone 5) was continually monitored by an internal temperature-sensing cannula (45-47 degrees C) and by an external surface temperature-sensing infrared camera, recording surface skin temperatures to 40-42 degrees C threshold levels. Minimal skin contraction was measured at three months in panels that were treated by tumescence (1.1%, zone 1) and cannulation (1.5%, zone 2). Of interest, the slight increase in skin contraction in zones treated by volume reduction after liposuction (3.6%, zone 3) or deep lasing plus liposuction (3.6%, zone 4) may be due more to skin accommodation than active skin contraction. The second highest amount of skin contraction was observed in zone 6 (4.2%), which was treated by shallow lasing, liposuction, and deep lasing. Further quantitative clinical studies will be needed to validate these findings.

Laser lipolysis versus traditional liposuction for fat removal

Liposuction is second only to breast augmentation as the most commonly performed cosmetic procedure in the USA. Liposuction removes fat through very small skin incisions, with atraumatic, blunt-tipped cannulas. Simplicity, quality of results and relatively rare complications are but a few benefits that explain its success. Its main limitation is the minimal skin retraction achieved after the procedure. Laser lipolysis is based on a thermal effect. The laser can vaporize, melt tissues and coagulate blood vessels. More importantly, the laser stimulates the formation of collagen in the region, enhancing skin elasticity and promoting skin contraction in the treated areas. This review aims to describe traditional liposuction and laser lipolysis, and discusses the difference between the two techniques.

Laser lipolysis used to treat localized adiposis: a preliminary report on experience with Asian patients

BACKGROUND

Localized deposits of fat (adiposis) located in the face, chin, neck, and arms usually are more compact and difficult to treat using conventional liposuction. It is necessary to find an effective approach for this type of localized adiposis. This study aimed to investigate the clinical application of laser lipolysis for the treatment of localized adiposis in Asian patients.

METHODS

In this study, 35 patients with localized adiposis were treated by laser lipolysis. Neodymium:yttrium-aluminum-garnet (Nd:YAG) laser energy was transferred through an optic fiber into the adipose tissue. The optimal energy and frequency of the laser were controlled precisely to melt and destroy the adipose tissue without damage to the skin and deeper tissues. The histologic study of treated adiposis tissues, the postoperation reaction, and the clinical results were observed and studied.

RESULTS

After laser lipolysis, the localized adipose tissues were liquefied effectively, and the compact fibrous tissues were broken down into a looser structure. Bleeding was noted to be less than with conventional liposuction due to the coagulation of capillary vessels and the thermal effect of the laser. Laser lipolysis caused less edema, petechiae, and other postoperative complications, producing rapid recovery and satisfactory results.

CONCLUSION

The Nd:YAG laser has a definite lipolysis effect on compact adipose tissue and is a more effective approach for the treatment of localized adiposis than conventional liposuction.

A new approach for adipose tissue treatment and body contouring using radiofrequency-assisted liposuction

A new liposuction technology for adipocyte lipolysis and uniform three-dimensional tissue heating and contraction is presented. The technology is based on bipolar radiofrequency energy applied to the subcutaneous adipose tissue and subdermal skin surface. Preliminary clinical results, thermal monitoring, and histologic biopsies of the treated tissue demonstrate rapid preaspiration liquefaction of adipose tissue, coagulation of subcutaneous blood vessels, and uniform sustained heating of tissue.