Laser‐assisted lipolysis: A report on complications

Using multiple wavelengths in order to improve the facial contouring procedure by the lipolysis and sculpting

BACKGROUND

The process of fat redistribution during aging is well-known to fat accumulation toward inferior and medial areas of the face. Utilizing laser devices with simultaneous multiple wavelengths has been employed for fat lipolysis and body and facial sculpting.

MATERIALS AND METHODS

The study is case series that had been taken over 10 women (24-45 years old) participated in this study to address fatty tissue redistribution with aging, which was treated using a triple-wavelength laser (755, 810, and 1064 nanometers) device (Soprano Titanium, Alma, Israel). Each participant underwent up to three treatments at three-week periods and was followed up for 6 months after the last treatment. Clinical photographs were taken before and after the treatments to evaluate the efficacy.

RESULTS

The 10 participants scored a satisfaction result with the GAIS and the VAS scores, measuring pain perception during the procedure. Only two patients experienced minor pain during treatment, and no participants reported significant side effects.

CONCLUSION

Employing a laser device with multiple wavelengths would represent an innovative approach, offering the advantage of no downtime and a painless procedure for facial contouring treatments.

Strategic Approaches to Intraflap Anastomosis: Navigating Conjoined DIEP Flap Reconstruction-A Comprehensive Roadmap

Background

For patients desiring autologous breast reconstruction without adequate abdominal tissue volume, the deep inferior epigastric perforator (DIEP) flap may be stacked or combined with other flaps for bilateral reconstruction. Various combinations of anastomoses have been described in the literature. We sought to describe a framework for intraflap anastomoses.

Methods

A retrospective review of 17 patients who underwent conjoined DIEP flaps with intraflap anastomoses with a single surgeon was performed. Patient demographics, comorbidities, operative details, and complications were reviewed. A framework scheme was developed for the type of intraflap anastomosis performed.

Results

Between 2016 and 2020, 17 patients underwent conjoined DIEP flaps for unilateral breast reconstruction. Fourteen patients had delayed reconstruction. Eleven patients underwent an intraflap anastomosis in which a medial perforator on the left hemiabdomen flap was anastomosed with a distal lateral row perforator in the right hemiabdomen flap (type A). Four patients underwent an intraflap anastomosis in which a left lateral perforator was anastomosed to a right distal lateral row perforator (type B). Two patients underwent an intraflap anastomosis in which the left superficial inferior epigastric vessel was anastomosed to a right lateral row perforator (type C). Complications included reoperation (11.8%), partial flap loss (5.9%), seroma (23.5%), and hematoma (11.8%).

Conclusions

We report a detailed framework for intraflap anastomoses of conjoined DIEP flap reconstruction including superficial inferior epigastric artery/superficial inferior epigastric vessel options. Knowledge of this comprehensive framework will allow surgeons to identify the type of intraflap anastomoses required for the anatomy they encounter and will standardize reporting of surgical technique in the literature.

Complications of Aesthetic Liposuction Performed in Isolation: A Systematic Literature Review and Meta-Analysis

Introduction: Aesthetic liposuction represents one of the most commonly performed cosmetic procedures worldwide. The purpose of this article is to examine and synthesize reported complication rates and explore the analytical prospect of possible patient or procedure-related predictive factors associated with specific complications. Methods: A systematic review was performed using the Pubmed, Cochrane, and Embase databases in line with specific criteria set to ensure an accurate assessment of complication rates; extracted data was synthesized through a random-effects model and meta-analysis of proportions. Results: A total of 60 studies were included in the meta-analysis, representing 21,776 patients undergoing aesthetic liposuction. Most studies followed an observational design. The overall complication rate was 12% (95% confidence interval [CI] 8%, 16%). When stratifying according to specific complications, the incidence of contour irregularities was determined to be 2% (95% CI 1%, 2%), seroma 2% (95% CI 1%; 2%), hematoma 1% (95% CI 0%, 1%), surgical site infection 1% (95% CI 1%, 2%), fibrosis or induration 1% (95% CI 1%, 2%), and pigmentary changes 1% (95% CI 1%, 1%), among others. A meta-regression to identify patient- or procedure-related factors associated with greater complication rates proved infeasible given the nature of the available data. Conclusion: Overall, liposuction demonstrated a relatively low complication rate profile, however, a considerable degree of heterogeneity exists within the examined literature preventing the recognition of predictive risk factors. While this calls for efforts to establish consensus on unified methods of outcomes reporting, the present meta-analysis can serve to provide practitioners with an evidence-based reference to improve informed consent and inform clinical guidelines, specifically pertaining to the incidence of commonly encountered complications in aesthetic liposuction, of which presently available survey studies and database queries remain devoid.

Efficacy and Safety of the Micro-insulated Needle Radiofrequency Device for Reduction of Submental Fat

BACKGROUND

Recently, it has been reported that a micro-insulated needle radiofrequency (RF) system is effective at achieving subcutaneous fat reduction; however, no study has yet applied this technique to reduce submental fat.

OBJECTIVE

To evaluate the efficacy and safety of a fractional RF device with a micro-insulated needle to reduce submental fat.

MATERIALS AND METHODS

In this prospective, single-blinded, pre-post comparative study, 24 adults with excess submental fat were treated once using a micro-insulated needle RF device. Outcomes included efficacy (submental fat rating by an independent investigator, fat volume quantified with a 3-dimensional camera, and patient satisfaction), assessed 1 and 2 months after the procedure, and safety (adverse events), assessed throughout the study.

RESULTS

The patients' Physician-Assisted Submental Fat Rating Scale score significantly decreased after 1 month and further decreased after 2 months. The average volume of submental fat was significantly decreased after 2 months (20.44 ± 5.53 cc to 16.41 ± 4.58 cc, p < .001). Patient satisfaction was high. Transient and mild local skin reactions without long-term sequelae were observed in 4 patients.

CONCLUSION

The micro-insulated needle RF device is beneficial for the reduction of submental fat and has tolerable safety profiles.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT05517824.

Effectiveness of HIFU Therapy for Nonsurgical Facial and Body Contouring: A Systematic Review of Prospective and Experimental Studies

BACKGROUND

Liposuction, the most common body sculpting surgical procedure known today is associated with the risk of numerous complications. A safer and more noninvasive approach involves the use of high-intensity focused ultrasonography (HIFU) lasers, which work by selectively damaging fat tissue through apoptosis or necrosis induction of fat cells. The authors' systematic review was designed to identify the effectiveness of HIFU for nonsurgical facial and body contouring.

METHODS

An exhaustive literature search was conducted of the PubMed/MEDLINE, Cochrane Central, Scopus, and EBSCO electronic databases for the period from November of 2005 to July of 2020. The full text of selected articles was reviewed for possible study inclusion, and articles fulfilling the inclusion criteria were recruited. Characteristics of the included studies were noted, and outcomes were assessed. Assessment of quality and risk of bias was performed for all the studies using the RevMan tool and the methodological index for nonrandomized studies.

RESULTS

The initial search revealed a total of 4584 citations, of which only 11 were included in the present review: nine used HIFU for recontouring of the abdomen and only two used HIFU over the face and neck. Studies evaluated either the efficacy of HIFU or the safety of its use. The average total energy ranged from 140 to 248 J/cm 2 for the abdominal region and 0.3 to 1.2 J/cm 2 for the face and neck. The focal depth ranged from 1.1 to 1.8 cm. All the studies showed promising results with the use of HIFU.

CONCLUSION

HIFU therapy is safe, effective, and minimally invasive, with predictable results when used for body and facial recontouring.

High-Quality Lipoaspirate Following 1470-nm Radial Emitting Laser-Assisted Liposuction

BACKGROUND

Laser-assisted liposuction (LAL) has been used to maximize viable adipocyte yields in lipoaspirates, although optimizing tissue processing methods is still a challenge. A high-quality lipoaspirate has been a key factor for extended graft longevity.

OBJECTIVE

To assess the viability and potency of stromal vascular fraction (SVF) cells and adipose-derived stem cells (ASCs) in fat samples from lipoaspirates harvested with a novel 1470-nm diode, radial emitting LAL platform. Two processing methods, enzymatic and nonenzymatic, were compared.

METHODS

Laser-assisted liposuction lipoaspirates harvested from 10 subjects were examined for cell viability after processing by enzymatic or nonenzymatic methods. Isolated SVF cells were cultured with an ASC-permissive medium to assess their viability and proliferation capacity by cell proliferation assay. Flow cytometric analysis with ASC-specific markers, gene expression levels, and immunofluorescence for ASC transcription factors were also conducted.

RESULTS

Lipoaspirates showed high SVF cell viability of 97% ± 0.02% and 98% ± 0.01%, averaged SVF cell count of 8.7 × 10 6 ± 3.9 × 10 6 and 9.4 × 10 6 ± 4.2 × 10 6 cells per mL, and averaged ASC count of 1 × 10 6 ± 2.2 × 10 5 and 1.2 × 10 6 ± 5 × 10 5 cells per mL in nonenzymatic and enzymatic methods, respectively. The ASC-specific markers, gene expression levels, and immunofluorescence for ASC transcription factors confirmed the adipose origin of the cells.

CONCLUSIONS

The laser lipoaspirates provide a high yield of viable and potent SVF cells and ASCs through both nonenzymatic and enzymatic processes. Improved purity of the harvested lipoaspirate and high ASC content are expected to result in extended graft longevity. Furthermore, eliminating enzymatic digestion may provide advantages, such as reducing process time, cost, and regulatory constraints.

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.

Safe and effective subcutaneous adipolysis in minipigs by a collagenase derivative

Adipocytes attached to the extracellular matrix (ECM) mainly consist of collagen in adipose tissues, while the degradation of ECM by collagenase induces the apoptosis of adipocytes, leading to a decrease in local subcutaneous adipose. To achieve this goal, we are developing a mutant collagenase H (ColH) to remove local subcutaneous fat such as submental fat (SMF). Three vectors were constructed for expressing rColH(FM, mutant for fat melting, with 6xHis tag), rColH(WT, wild-type, with 6xHis tag), and rColH(E451D, E451D mutant, without 6xHis tag) in Escherichia coli. rColH(FM) & rColH(WT) were purified by Ni Sepharose on a laboratory scale, while rColH(E451D) was purified by five chromatography purification steps on a large scale. Then, the stability of rColH(FM) and rColH(WT) was tested by SDS-PAGE to investigate the influence of the E451D mutation on stability. Afterwards, the enzyme kinetics of ColH (mutant or wild-type, with or without His tag) were investigated and compared. Finally, the adipolysis of rColH(E451D) at various doses was tested in vitro and in vivo. The ultrasound results in minipigs suggested that effective adipolysis was induced by rColH(E451D) compared with the negative control, and the histological results suggest dose-dependent fibrosis, necrosis, inflammation and cholesterol cleft formation. These findings indicate the possibility of rColH(E451D) becoming a new injectable drug to safely remove subcutaneous adipose.

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.

Laser-assisted Lipolysis Burn Safety: Proposed Detailed Parameters with Assessment of Their Efficacy and Safety

Supplemental Digital Content is available in the text.

Background:

Many recent studies have evaluated the clinical safety and efficacy of therapeutic lasers in laser lipolysis, but without detailed description of the safe and effective parameters.

Purpose:

To propose a method for adjusting safe and effective parameters for laser lipolysis.

Methods:

Detailed calculations of the safe and effective laser parameters for fat melting are proposed in the study. Amount of energy delivered in joules was calculated based on data from Havenith research. External skin and internal tissues temperatures during the procedure were kept in a recommended range and monitored for safety and efficacy. Prospective statistical study was designed on a series of 300 patients who underwent laser-assisted lipolysis and /or liposuction using 2 different machine manufacturers, delivering 1,064/1,320 nm.

Results:

All areas submitted to laser-assisted liposuction in this series have resulted in no clinical thermal burns injury to the skin. There was improvement in the bulk of fats, skin tightening, skin textures, and cellulites.

Conclusion:

This study is proposing a simple method for calculations of safe and effective laser lipolysis. Skin burn injury could be highly prevented by following up the proposed detailed basic parameters for laser lipolysis treatment.

1000 Consecutive Cases of Laser-Assisted Liposuction Utilizing the 1440 nm Wavelength Nd:YAG Laser: Assessing the Safety and Efficacy

BACKGROUND

Liposuction remains one of the most popular aesthetic surgery procedures performed today, and it has undergone continuous refinements over the past four decades. Advancements in anesthesia, improvements in instrumentation, better understanding of fluid dynamics and the addition of energy to liposuction have led to better outcomes with improved safety and efficacy.

OBJECTIVES

The purpose of this study is to review 1000 consecutive laser-assisted liposuction (LAL) cases utilizing the 1440 nm wavelength. Emphasis was placed on complication rates and the need for revision procedures.

METHODS

The charts of 611 patients who underwent 1000 consecutive LAL operations were reviewed. All cases were performed either under general anesthesia or under local with sedation, and the cases were performed alone or in conjunction with other procedures. All patients went to presurgical testing and had preoperative laboratory and additional clearance by a specialist when indicated. Before and after medical photographs were obtained of all patients. All operations were done in an accredited office-based operating room. Demographic information, tumescent volume, aspirate volume, surgical time, complications and other data were reviewed.

RESULTS

There were one minor complication and no major complications such as burns, hospitalizations or mortalities. One patient developed a small hematoma, which was likely caused by the patient self-aspirating edema fluid during the immediate post-op period. The hematoma resolved with non-surgical management. The average laser energy applied was 15,756 J with an average total aspirate volume of 1256 cc. Fourteen anatomic areas were treated with LAL, and 59 operations were combination cases.

CONCLUSION

Energy-assisted liposuction using the 1440 nm wavelength has been shown in this series to have a very low complication rate when performed alone or in combination with other aesthetic operations under local and general anesthesia.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Assessment of equivalence of adipose tissue treatment with a noncontact field RF system delivering 200 W for 30 min and 300 W for 20 min: An in vivo porcine study

BACKGROUND AND AIMS

Abdominal circumferential reduction with noncontact high frequency apoptosis-inducing field RF (AiRF) is becoming very popular. The present study compared the treatment results from two different sets of parameters giving the same dose from the same system in an in vivo porcine model.

MATERIALS AND METHODS

Two 10 cm × 10 cm areas were symmetrically marked on both sides of the midline (total of 4 areas) over the rectus abdominis muscle of two anesthetized female micropigs. In Animal A (G1), 27.12 MHz AiRF treatment was given at 200 W for 30 min, and 300 W for 20 min in Animal B (G2). Four sessions were performed at weekly intervals. Gross observation by a veterinary specialist was performed on a daily basis. Temperature measurements (fat and skin), clinical photography and ultrasound imaging were carried out at each session. In addition, blood chemistry was performed before each session to check lipid levels, any adverse changes in markers for liver damage in addition to an enzyme-linked immunosorbent assay (ELISA) for raised levels of TNF-α and IL-1β. Biopsies were taken and routinely processed for hematoxylin and eosin, Toluidine blue and oil red O stains to examine for tissue damage at baseline and after each treatment. TUNEL assays were performed to check of apoptotic-related DNA damage. Follow-up assessments included photography, ultrasound, ELISA tests and biopsies which were taken regularly up to 90 days after the final treatment.

RESULTS

The maximum adipose tissue temperatures at and over the apoptotic threshold of 43°C were reached and maintained in both G1 and G2. The skin surface temperature was slightly higher in G2 after 20 min than in G1 after 30 min, but was still below 43°C. Gross and magnified observation revealed no appreciable differences or thermally-mediated damage between the skin of either of the two groups after the treatments or during the 90-day follow-up period. No lasting erythema or any other adverse event was seen in either group. The liver enzyme markers showed very similar patterns over the 4 weeks of treatment compared with baseline with no levels outside of the normal range. Triglycerides were all within normal rage with no significant differences between the groups. Remarkably similar patterns were noted for the ELISAs in both groups performed over the 4 weeks of treatment and at periods during the 90-day follow-up with no notable abnormal changes in levels. Staining patterns for both G1 and G2 specimens were similar for all stain types during treatment and the 90-day follow-up, showing decreased numbers of adipocytes by the 90-day point. The ultrasound findings revealed a 44.8% and 55.6% decrease in the adipose layer for G1 and G2, respectively, at the 90-day assessment.

CONCLUSIONS

The 200 W AiRF treatment for 30 min (G1) and the 300 W AiRF treatment for 20 min (G2) produced very similar results in the porcine model for all assessments and at all assessment points during and up to 90 days after treatment, with slightly better findings suggested for G2. Based on the above findings, the two different settings, delivering the same dose, produced good results with no skin damage and no adverse events. This has implications in busy clinics for AiRF treatment, where the shorter treatment time could represent time saving for the clinic and the patient without compromising safety and giving equal if not better efficacy.

Abdominal Subcutaneous Mass After Laser-Assisted Lipolysis and Immediate Multiple Treatments with a Dual-Wavelength Laser, Vacuum and Massage Device

Body contouring by means of minimally invasive procedures is a growing trend. Current approaches to body contouring often involve a combination of surgical techniques (eg, laser-assisted liposuction) and a series of noninvasive device-based treatments aimed at accelerating recovery and improving aesthetic outcomes. In this case study, we describe a 38-year-old woman who presented with an abdominal-wall mass that resembled a tumor when assessed with magnetic resonance imaging. Twenty-six months before presenting to our office, the patient had undergone laser lipolysis and a series of treatments with a device that delivered dual-wavelength laser energy and vacuum-assisted massage. To address the patient's concerns, we removed the mass and performed abdominal dermolipectomy. No postoperative complications occurred, and the patient was highly satisfied with the aesthetic outcome. The results of histologic studies indicated that the mass was pseudocystic and fluid-filled, surrounded by a fibrous capsule, and characterized as a foreign-body granuloma. Further analysis is warranted regarding the safety of laser lipolysis without aspiration combined with a device delivering dual-wavelength laser energy and vacuum-assisted massage.

LEVEL OF EVIDENCE

5 Risk.

Laser cellulite treatment and laser-assisted lipoplasty of the thighs and buttocks: Combined modalities for single stage contouring of the lower body

BACKGROUND AND OBJECTIVES

Cellulite and lipodystrophy are often found together, especially in areas of the buttocks and thighs, causing skin surface irregularities. Each of these conditions is currently treated independently as two separate surgical procedures. In our practice, we developed a novel combined approach for the simultaneous treatment of cellulite and lipodystrophy, as a single stage procedure in the same anatomic area. For the treatment of cellulite, we used the Nd:YAG laser at a wavelength of 1,440-nm, along with an innovative 1,000-micron directional side-firing fiber optic laser system. For the treatment of lipodystrophy, the Nd:YAG laser with a 1,440 nm wavelength, along with a fiber optic laser system was used. The objective of this study is to determine the efficacy and safety of a combined approach for the simultaneous treatment of cellulite and lipodystrophy.

STUDY DESIGN, PATIENTS AND METHODS

In 2012, 16 subjects with noticeable cellulite, Grade II and Grade III, accompanied by mild-to-moderate lipodystrophy of the lower body received single treatments of the Nd:YAG laser at a wavelength of 1,440-nm along with the 1,000-micron side-firing fiber optic laser system for simultaneous treatments of both cellulite and lipodystrophy. Patients were assessed at baseline and 3-6 months post-treatment by a modified Nurnberger-Muller scale utilized to quantify the cellulite severity. Additionally, patient satisfaction and a global aesthetic improvement scale were used to measure the improvement in lipodystrophy.

RESULTS

Blinded reviewers identified the correct baseline photographs 97% of the time when presented with a set of photographs. The median modified Nurnberger-Muller scale score at baseline was 4.75 ± 1.2 and the average improvement was 2.0 ± 1.2. Global aesthetic improvement scores ranged from 1 to 3 with an average of 1.58 indicating a much-improved overall appearance. Satisfaction was high for both physicians and patients with scores corresponding to extremely satisfied/satisfied.

CONCLUSION

Precise, effective delivery of laser energy to the dermal-adipose tissue, as well as the deep adipose lipodystrophy is feasible as a safe modality for the simultaneous treatment of cellulite and lipodystrophy in the buttocks and thighs, as a single stage procedure.

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.

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.

The effectiveness and safety of combining laser-assisted liposuction and abdominoplasty

BACKGROUND

Lipoabdominoplasty is nearly a daily aesthetic procedure. Despite the emergence of laser-assisted liposuction, to date, it has not been clearly evaluated combined with abdominoplasty. This prospective study aimed to evaluate the effectiveness and safety of laser-assisted liposuction relative to traditional liposuction combined with high-lateral-tension abdominoplasty.

METHODS

This study investigated 36 consecutive female patients who underwent high-lateral-tension abdominoplasty combined with liposuction of the upper central abdomen and both flanks. The patients were divided into three equal groups based on the technique used for liposuction. Group 1 underwent conventional liposuction with abdominoplasty. Group 2 underwent a mixture of conventional and laser-assisted liposuction with abdominoplasty. Group 3 underwent laser-assisted liposuction with abdominoplasty.

RESULTS

The patients in groups 2 and 3 had a better aesthetic outcome than those in group 1 with regard to abdominal contour and skin tightness. No major complications were observed in groups 1 and 2. The patients in group 3 had a higher incidence of complications (3 seromas, 3 central necroses and dehiscence), and one patient underwent secondary sutures.

CONCLUSION

Laser-assisted liposuction combined with abdominoplasty in the lateral abdomen seems to be a safe technique with good aesthetic outcomes. Although the combined use of laser-assisted liposuction in the lateral and central abdomen can achieve relatively better aesthetic results, it is associated with significant complications, and its use cannot be supported. Proper laser parameters in the central abdominal area still need further study.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Complications from laser-assisted liposuction performed by noncore practitioners

Liposuction is one of the most commonly performed aesthetic surgery procedures in the United States, and most plastic surgeons perform suction-assisted, ultrasound-assisted, or power-assisted liposuction. The past decade has seen a growing interest in laser-assisted liposuction (LAL) and the proposed advantages of traditional liposuction methods. However, it is performed by a minority of plastic surgeons. In fact, many LAL providers are not trained in aesthetic practice, and many offer LAL as their only body-contouring procedure. When only one method of body contouring is available to a provider, it may lead to inappropriate patient selection with associated poor outcomes. This report discusses the use of laser liposuction in body contouring and the demographics of those performing liposuction, including LAL. Complications from laser-assisted liposuction performed by noncore practitioners are illustrated.

Comparison of laser-induced damage with forward-firing and diffusing optical fiber during laser-assisted lipoplasty

BACKGROUND AND OBJECTIVES

Laser-assisted lipoplasty is made possible by using an optical fiber that delivers light endoscopically to subcutaneous fat tissue. Most optical fibers for laser-assisted lipoplasty are designed to be irradiated in a forward direction. In this study, we compared forward-firing fiber and diffusing fiber for use in laser-assisted lipoplasty. The effective parameters of the ablation pattern which resulted from the laser-induced damage are discussed for both systems. In particular, we note the effect resulting from the different beam emission patterns and the contours of laser fluence.

METHODS

We used two different laser delivery systems (a forward-firing fiber and a diffusing fiber) to examine how the beam emission pattern affects the laser-assisted coagulation and damage pattern of in vitro fat tissues. A porcine liver tissue (water-rich tissue) was used as a secondary laser target to investigate how the laser-assisted coagulation pattern depends on both the type of tissue (water-rich and lipid-rich tissue) as well as the delivery system. An evaluation using a digital camera and a thermal camera was conducted for the tissue ablation processes in order to observe the generated heat transfer in fat and liver.

RESULTS

The overall shape of the laser-assisted coagulation zone was different from the beam emission pattern in the case where a forward-firing fiber was used within fat tissue. The center of the laser-affected zone is characterized by the formation of a reservoir of melted fat. In the thermal image analysis, there existed a discrepancy between the temperature distribution of the fat tissue and the liver tissue during the forward-firing fiber irradiation. In the liver tissue ablation process, the temperature distribution during the laser ablation also demonstrated an elongated ellipse that matches well with the laser-induced damage zone. The temperature distribution in fat tissue adhered to a more discoid pattern that corresponded to the laser-induced damage zone.

CONCLUSIONS

Based on our findings, we have proposed mechanisms that can explain the laser-induced damage in both tissues when a forward firing fiber is employed as the delivery system. In the case of fat tissue, the ablation mechanism can be characterized by the reservoir formation of melted lipids while the ablation is characterized as the well-known drilling effect for liver tissue.

Low-level laser therapy for fat layer reduction: a comprehensive review

BACKGROUND AND OBJECTIVE

Low-level laser (light) therapy (LLLT) is a noninvasive, nonthermal approach to disorders requiring reduction of pain and inflammation and stimulation of healing and tissue regeneration. Within the last decade, LLLT started being investigated as an adjuvant to liposuction, for noninvasive body contouring, reduction of cellulite, and improvement of blood lipid profile. LLLT may also aid autologous fat transfer procedures by enhancing the viability of adipocytes. However the underlying mechanism of actions for such effects still seems to be unclear. It is important, therefore, to understand the potential efficacy and proposed mechanism of actions of this new procedure for fat reduction.

MATERIALS AND METHODS

A review of the literature associated with applications of LLLT related to fat layer reduction was performed to evaluate the findings from pre-clinical and clinical studies with respect to the mechanism of action, efficacy, and safety.

RESULTS

The studies as of today suggest that LLLT has a potential to be used in fat and cellulite reduction as well as in improvement of blood lipid profile without any significant side effects. One of the main proposed mechanism of actions is based upon production of transient pores in adipocytes, allowing lipids to leak out. Another is through activation of the complement cascade which could cause induction of adipocyte apoptosis and subsequent release of lipids.

CONCLUSION

Although the present studies have demonstrated safety and efficacy of LLLT in fat layer reduction, studies demonstrating the efficacy of LLLT as a stand-alone procedure are still inadequate. Moreover, further studies are necessary to identify the mechanism of action.

Laser, light, and energy devices for cellulite and lipodystrophy

Cellulite affects all races, and it is estimated that 85% of women older than 20 years have some degree of cellulite. Many currently accepted cellulite therapies target deficiencies in lymphatic drainage and microvascular circulation. Devices using radiofrequency, laser, and light-based energies, alone or in combination and coupled frequently with tissue manipulation, are available for improving cellulite. Laser assisted liposuction may improve cellulite appearance. Although improvement using these devices is temporary, it may last several months. Patients who want smoother skin with less visible cellulite can undergo a series of treatments and then return for additional treatments as necessary.

The American Society for Aesthetic Plastic Surgery (ASAPS) survey: current trends in liposuction

BACKGROUND

The emergence of new technologies necessitates a study of current trends in liposuction and other methods for fat removal.

OBJECTIVE

The American Society for Aesthetic Plastic Surgery (ASAPS) conducted a survey of its members to gain valuable information from Board-certified plastic surgeons about their experience with new technologies for fat removal and managing complications after liposuction.

METHODS

The ASAPS Current Trends in Liposuction Survey was emailed to 1713 ASAPS members. Data were tabulated and examined to determine current trends in liposuction and other fat removal techniques performed by ASAPS members.

RESULTS

The response rate for the survey was 28.7% (n = 492). Most ASAPS respondents reported performing between 50 and 100 liposuction procedures annually. Most plastic surgeons currently employ or have previous experience with suction-assisted lipectomy/liposuction (SAL), ultrasound-assisted liposuction (UAL), and power-assisted liposuction, but fewer reported experience with laser-assisted liposuction (LAL), mesotherapy, or external, noninvasive devices. SAL was the preferred method of fat removal for 51.4%. UAL, LAL, and SAL were most commonly associated with complications. Only 10.5% of ASAPS members employ LAL; 38% have treated a patient with complications secondary to LAL.

CONCLUSIONS

Valuable information about current trends in liposuction and other fat removal techniques has been gained from this survey. Although many studies have been published that review issues related to safety, morbidity, aesthetics, and recovery after different methods of fat removal, more prospective studies with standardized objective outcome measures comparing these techniques, particularly newer modalities, are needed to continue improving safety-related standards of care.

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.

High-intensity focused ultrasound effectively reduces waist circumference by ablating adipose tissue from the abdomen and flanks: a retrospective case series

BACKGROUND

Currently available technologies for performing aesthetic body sculpting are either noninvasive but require multiple treatments to achieve relatively superficial effects or very effective but also invasive and sometimes associated with serious complications. A new, noninvasive alternative is to ablate adipose tissue using high-intensity focused ultrasound (HIFU). When focused within subcutaneous adipose tissue, HIFU quickly raises the local temperature, resulting in instantaneous cell death via coagulative necrosis within the targeted area but no damage to the surrounding tissue.

METHODS

A new HIFU device, the LipoSonix system (Medicis Technologies Corporation, Bothell, WA, USA), was used by our clinic staff to reduce waist circumference via removal of excess adipose tissue from the anterior abdomen and flank areas. This report describes the results of a retrospective chart review of patients at one clinic who underwent HIFU treatment of the anterior abdomen and flank areas.

RESULTS

A total of 85 men and women with a mean age of 43.8 years underwent a single HIFU treatment session. The time required to complete treatment was approximately 1 to 1.5 h. Using a mean energy level of 134.8 J/cm(2) and a focal depth of 1.1 to 1.6 cm, the waist circumference was decreased by an average of 4.6 cm after 3 months. Of the 85 patients, 10 (11.8%) reported adverse events including prolonged tenderness (n = 3), ecchymosis (n = 3), hard lumps (n = 2), edema (n = 1), and pain (n = 1), which resolved spontaneously.

CONCLUSIONS

The authors conclude from their experience that HIFU represents a safe and effective means for performing noninvasive body sculpting.

A pilot study of the efficacy of a 1,064 and 1,320 nm sequentially firing Nd:YAG laser device for lipolysis and skin tightening

BACKGROUND

Laser-assisted lipolysis with a medium pulsed 1,064 nm Neodymium:Yttrium-Aluminum-Garnet (Nd:YAG) system has been used since FDA approval in October 2006 [1]. Since then, this technology has been advanced to include an additional wavelength (1,320 nm) and an accelerometer designed to improve efficacy and safety.

OBJECTIVE

(1) Evaluate the efficacy and safety of a sequentially firing 1,064 and 1,320 nm Nd:YAG laser device for lipolysis. (2) Evaluate the skin tightening effect by photographic documentation and skin measurements. (3) Assess new collagen formation by histologic and scanning electron microscopic studies.

METHODS

Twenty subjects with unwanted local adiposities and skin laxity were enrolled. An Nd:YAG laser with sequentially firing wavelengths of 1,064/1,320 nm was used to treat localized areas of body adiposities. Digital photographs were taken before and after treatment, blinded independent observers graded improvement utilizing a percentile evaluation scale and subjects performed self-assessments. Five of the 20 subjects had the following tests performed: (1) Placement of 4 cmx4 cm square India Ink tattoos for measurement of skin tightening, (2) histology and electron microscopy, (3) biopsies prior to the procedure, 3 days and 1 month after the procedure to determine the presence of new collagen markers.

RESULTS

Results showed reduction in localized adiposities with no adverse events from use of this device. Independent observers found 76-100% improvement in adiposities in 85% of subjects and 51-75% improvement in 15% of subjects. Of the subset of five patients, India Ink tattoo maps demonstrated an 18% decrease in surface area indicating a significant skin tightening effect. Histology by H&E, Methylene blue stains, and electron microscopy indicated new collagen formation compared to baseline.

CONCLUSION

The 1,064 nm Nd:YAG and 1,320 nm Nd:YAG sequentially firing device with an accelerometer appears to be an effective and safe treatment for localized adiposities with the additional benefit of skin tightening.

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.

[Lipolysis lasers]

We use lipolysis lasers for around five years. The principle of those lasers is that, for some wavelengths, the fat, located in the adipocytes reacts as a chromophor. In order to allow the direct exposure of the adipocytes to the optical fiber (around 1mm diameter), this has to be inserted in the hypodermis, then move back and forth inside the treated areas. The theorical benefits, compared to the liposuction procedures are related to the fact that the thermal effect of the laser emission allows to avoid laxity, sometimes observed after a liposuction. If we consider the first publications related to this emerging procedure, the profile of tolerance seems good, and even possibly better than the liposuctions. Nevertheless, this procedure with lasers is still a surgical procedure, exposing theorically to the side effects related in and after each surgery: infections, ecchymosis... Recently, some cases of severe side effects (infection of the skin, and necrosis) have been reported. They seem to be related to a homogeneous distribution of the energy inducing an excessive thermal injury. Some new improvements, with the last generation lasers, could allow us to avoid, or at least to dramatically reduce those side effects. The efficacy of those lasers is visibly satisfying; the key question is to precise the optimal modalities of use : in a surgery room, after an optimal training, with the last generation lasers?