Precision Liposculpture and definition of muscles has become the new trend in body contouring surgery. This method is geared to the healthy non-obese patients who request an athletic look. To achieve this, a meticulous liposuction and Laser Liposculpture with Lipolysis and skin tightening are required. A sound knowledge of the muscular and adipose layer anatomy is essential. The basic principle of Laser Lipolysis lies on the tissue tightening and coagulation that result from delivering a controlled thermal energy to the adipose and the subcutaneous tissue. This energy causes collagen denaturation and collagenesis remodeling and the ultimate outcome is measurable shrinkage of the tissue area with definition of the underlying muscles.
The aim is to demonstrate the 1444 Laser Assisted Liposculpture technique and the results of using a combined precision Classic Liposculpture with Laser Lipolysis.
Methods/Technique:
Thirty two (32) male and female subjects were treated with Laser Assisted Liposculpture. The Laser used was the 1444 Nd: YAG. Compared to the other lasers, its tissue absorption indicates a more absorption by the adipose cells. Tumescent Anesthesia was used for all patients. An attempt to define the anatomic landmarks of the underlying musculature was performed by conducting the procedure in two planes. The deep fatty layer where lipolysis was performed delivering almost 1000 joules per10 x10 cm area (palm size). And a superficial subcutaneous scoring for tightening and line contour definition purposes delivering between 35 – 50 joules per square cm. The Laser probe was introduced into the tissue through puncture incision and depth is assessed by palpation, skin tenting, and laser light transillumination.Lipolysis lasing performed in the deep layer by homogenous continuous back and forth gliding motion. Laser skin tightening is performed by tenting the skin with the laser probe and transilluminating the skin while lasing the subcutaneous layer in a retrograde scoring motion. All the patients were advised to wear compression garments for 6 weeks to 3 months.
Results/Complications:
There were 5 male and 27 female patients. The main indications for LAL were:
- Size Reduction
- Skin Irregularities
- Skin Tightening
Total areas treated were 53. Areas included face, neck, torso, buttocks, and thighs. The energy delivered and amount of fats aspirated were recorded.
Areas Treated |
Mean Energy Used |
Mean Fat aspirated |
Chin |
500 joules |
30 cc |
Face |
300 joules |
25 cc |
Neck |
793 joules |
455 cc |
Arms |
1925 joules |
1696 cc |
Abdomen |
5650 joules |
2052 cc |
Thighs |
4125 joules |
2653 cc |
Buttocks |
500 joules |
250 cc |
Back |
1000 joules |
300 cc |
Flanks |
700 joules |
1116 cc |
Upper Knees |
1000 joules |
50 cc |
Chest |
11000 joules |
700 cc |
The end point in lasing was either achieving the suggested guidelines of the manufacturer or when the surface skin temperature reached 45.
LAL is performed in 3 steps:
1. Laser Lipolysis
2. Fat aspiration
3. Laser tightening
Initial lasing performed for lipolysis. Technically the laser probe glided easily as it thermolysed and penetrated through the adipose layer. The probe can be either used as a bare fiber (600 microns) in the facial region or thread through a cannula of various sizes and lengths.
Fat aspiration is performed in the routine classic liposuction way.
Laser tightening is is performed by scoring the subcutaneous layer. This is technically time consuming and tricky as over doing it may cause over heating and possible skin burns.
The side effects and complications noted in the above cases were the same as traditional liposuction but in addition the following had been noted:
Two (2) cases sustained minor skin burns in the early cases which were attributed to steep learning curve required to control the heat.
Two (2) cases of seromas which could have happened with classic liposuction since the volume was too large (5 liters aspirate).
One (1) case with symptoms mimicking pulmonary embolism but was not proven by CT or other standard tests but could have been explained by micro embolism and further evidence is required.
The operating time is usually longer as the additional lasing step extended the time by an extra hour.
The patients were followed for minimum of 6 months. The results overall were very satisfactory in terms of size correction and smooth contour. Examples of before and after photos will be presented.
Conclusion:
The use of Laser Lipolysis has made a significant impact on the patients on the pre-operative consultation and it was a good marketing tool.
For the aim of volume and size reduction the clinical advantage appears to be marginal compared to the Classic Liposuction. The length of operation was significantly longer with the use of the Laser.
For the purpose of high definition and skin shrinkage it had a marked effect. The laser added more shrinkage to the skin and also defined the muscles of the abdomen (the athletic 6 pack).