Biomedical Engineering Reference
In-Depth Information
14
Laser lipolysis
Melanie D. Palm, Ane B.M. Niwa Massaki,
Sabrina G. Fabi, and Mitchel P. Goldman
background
Liposuction is one of the most popular cosmetic procedures.
During the past several decades, liposculpting has evolved dra-
matically with many changes that have substantially improved
effi cacy and safety (1). The advent of tumescent anesthesia by
Klein has greatly improved the safety of liposuction by elimi-
nating the need for general anesthesia and hospital stays and
decreasing the risks of bleeding complications (2,3).
Several adjunctive techniques to routine liposuction have
been developed such as ultrasound-assisted liposuction (inter-
nal and external), power-assisted liposuction, and laser-
assisted liposuction (1,4).
Laser lipolysis (LAL), also known as laser lipoplasty, was
piloted fi rst in Europe and Latin America before gaining
acceptance (and FDA approval) in the USA as well as in Japan
(5). The earliest description of laser-assisted liposuction was
by Dressel in 1990 (6). Shortly thereafter, Apfelberg with col-
leagues reported on the use of a 1064-nm light source in 51
liposuction patients. The lack of statistically signifi cant
improvements or minimization of adverse effects on the laser-
treated areas compared with traditional liposuction halted the
application for FDA approval of this device (6,7).
Blugerman, Schavelzon, and Goldman used a 1064-nm
neodymium:yttrium-aluminum-garnet (Nd:YAG) system for
LAL and were the fi rst group to demonstrate the effect of this
laser energy on fat, surrounding dermis, vasculature, apocrine,
and eccrine glands (8-11). In 2002, Badin and colleagues
reported histologic changes after thermal damage by the laser,
including rupture of fat cell membranes, coagulation of small
vessels, and collagen remodeling (12). The authors found that
LAL was less traumatic than conventional liposuction meth-
ods due to smaller cannula diameter (1 mm) and the effects of
the laser-tissue interaction.
After FDA approval of a 1064-nm Nd:YAG laser (manufac-
tured by DEKA and distributed by Cynosure Inc., Westford,
Massachusetts, USA) in 2006, additional systems employing a
variety of wavelengths were introduced to the market and LAL
found its place as a potential adjunct and an alternative to tra-
ditional tumescent liposuction (13).
making LAL ideal for some traditionally challenging cases in lipo-
sculpture: (
i
) fi brous areas such as the male breasts, abdomen,
and fl anks (15); (
ii
) revisional surgery where tissue is diffi cult to
penetrate or suffers from irregularities (12,17); (
iii
) small areas of
adiposity that may be inadequately removed (e.g., periumbilical
fat) (12,18); and (
iv
) large volume liposuction in highly vascular-
ized areas such as the scapula, waist, and fl anks (12).
In addition to its ability to melt fat, the neocollagenesis
afforded by LAL lends itself to areas that require skin tighten-
ing. The neck, arm, and abdomen are areas well suited for this
indication (12,14-16,19).
Stebbins and colleagues reported that LAL alone or in con-
junction with suction can be a highly effective and a mini-
mally invasive method for removing large lipomas (>10 cm),
particularly fi brous lesions, resulting in excellent cosmetic
outcome (20).
advantages
The most commonly mentioned advantages of LAL relate to
the ease of recovery (14,15,21,22). Compared with traditional
liposuction, LAL may diminish postoperative pain and
decrease the extent of edema and bruising after the procedure
(12,14,15,22-24). Laser-induced thrombosis of blood vessels
and closure of lymphatic channels may explain the reduction
in the severity of bruising and swelling following LAL (21).
Laser-operated liposculpture allows for reduced trauma to the
tissue during fat removal, allowing improved wound healing
(25). As a result, patients have a more rapid return to daily
activities (14,25). All in all, the safety of body contouring
using LAL may be increased when compared with traditional
liposuction (22).
Operator as well as patient safety is increased with the pro-
cedure. The process of fat emulsifi cation allows for effi cient
fat extraction and less operator fatigue (7,17,21). The fre-
quency of touch-up procedures may be decreased compared
with traditional tumescent liposuction performed by experi-
enced surgeons (16).
Two specifi c clinical goals make LAL a superior choice to
liposuction. When the primary goal of a surgical intervention
is to treat skin laxity rather than body contouring, LAL is the
appropriate choice for inducing collagen production and sub-
sequent skin contraction (14,18,21,22,26). In larger-volume
cases of body contouring, LAL may facilitate volume debulk-
ing by liquefying the fat prior to aspiration as well as decreas-
ing blood loss during the procedure (7,12,21).
indications for laser lipolysis
Like liposculpture, the main indication for LAL is body contour-
ing (14). Beyond this function, the addition of laser energy creates
other biological effects that result in additional indications for
this procedure. Photothermal energy from LAL melts fat (15,16),
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