Suction-Versus Laser-Assisted Lipectomy: A Prospective, Randomized, Blinded Clinical Trial
Goals/Purpose: Liposuction is the most commonly performed aesthetic procedure in the United States. Traditional suction-assisted lipectomy (SAL), when performed by competent providers, has low rates of complications and high levels of patient satisfaction. Its potential risks, however, include post-operative pain and bruising, as well as skin redundancy and irregularity. Laser-assisted lipectomy (LAL) utilizes the Nd:YAG laser to achieve lipolysis. It has been suggested that the laser yields improved skin tightening and decreased bruising, by way of collagen remodeling and thermocoagulation of subcutaneous vasculature, respectively. However, no studies have demonstrated that LAL achieves these benefits when compared to traditional SAL. This prospective clinical trial randomized nineteen women to undergo either LAL or SAL of the upper arms, and compared outcomes with respect to changes in arm circumference, patient-rated pain, bruising, and appearance.
Methods/Technique: Institutional Review Board approval was granted for this study. Nineteen consecutive female patients with localized adiposity of the bilateral upper arms were identified for inclusion, and each gave written informed consent. Each patient was randomized to undergo SAL in one arm, and LAL in the contralateral arm. Patients were blinded to this assignment. All procedures were performed by the senior author (SDV) in an outpatient plastic surgery facility. Equal amounts of tumescent solution were infiltrated and equal amounts of fat were suctioned. Arm circumference was measured pre-operatively, and post-operatively at 1 week, 1 month, and 3 months. Patients kept a daily log from post-operative day 0 to day 7, rating post-operative pain, bruising, and overall appearance on a scale of 1 to 5. Two blinded, independent plastic surgeons rated the arms’ appearance from 3-month postoperative photographs. Ratings were based on contour and symmetry. Evaluators selected which arm they thought had been treated with LAL.
Results/Complications: All patients completed the required follow-ups. Ten patients underwent LAL in the left arm, and nine patients underwent LAL in the right arm. The baseline arm circumference was higher in the LAL-treated arms (31.79cm vs. 31.32cm, p=0.035). However, there were no overall differences in arm circumference at 1 week, 1 month, at 3 months post-operatively (p=0.292, 0.693, and 0.448, respectively, 2-tailed t-test). On post-op day 1, the LAL-treated side was rated better in terms of appearance when compared to the SAL-treated side (2.87 vs. 2.39, p=0.025), 2-tailed t-test). However, there was no difference in appearance between the treatment groups after one week (p=0.086, 2-tailed t-test). No difference was noted between SAL- and LAL-treated arms with respect to pain or bruising at any point during the post-operative week. There were no significant differences between the overall ratings between LAL and SAL groups with respect to contour and symmetry (p=0.578 and 0.448, respectively, 2-tailed t-test). The physician raters correctly selected which arm had been treated with LAL 47.5% of the time.
No patient experienced a postoperative complication.
Conclusion: Post-operative pain and bruising is comparable between laser-assisted and traditional methods of liposuction. Laser-assisted lipectomy does not show a greater reduction in arm circumference (i.e., “skin tightening”) when compared to traditional liposuction. Plastic surgeon evaluators rated no difference in arm appearance between the laser-assisted and suction-assisted groups based on 3-month post-operative photographs. Plastic surgeon evaluators were not able to correctly determine which arm was treated with LAL, as the 47.5% accuracy is random to equal guessing. We conclude that laser-assisted liposuction does not show a measured benefit with respect to pain, bruising, skin tightening, or physician-rated photographic appearance when compared to traditional liposuction.