Laser lipolysis: the future of liposuction

Laser lipolysis: the future of liposuction

Robert A. Weiss

The combination of laser lipolysis and tumescent liposuction appears to have so many advantages over liposuction alone that the procedure could become widely adopted by physicians in the not-so-distant future. Growing expertise with the technique has begun to indicate that it can expand the base of patients who are candidates for liposuction as well as those in need of a liposuction revision. Many companies are now developing lasers at fat-selective wavelengths.

Some physicians who perform only tumescent liposuction question the benefits of and need for laser lipolysis. I acknowledge that we are still gaining experience with laser-assisted liposuction, and that there are many technologies, such as ultrasound, that have come and gone with liposuction to try to facilitate the procedure. But the improved cosmetic results that can be obtained with laser-assisted liposuction and its safety record so far seem to point to an expansion of its use.

The crisscross pattern of cannula movement used in normal liposuction often leaves pockets of fat behind that cannot be removed, but a laser can liquify these areas. In addition, the skin overlying the areas of fat removal contracts because the laser coagulates the tissue, inducing collagen retraction and tightening of tissue. This effect is an added benefit that is especially useful for liposuction candidates who would be able to reduce their fat volume with normal liposuction but would not have accompanying skin contraction.

The laser can break up fibrous tissue for scar subcision and be used without suction for the reduction of small areas of fat. We may also see a reduction in bruising and postoperative pain.

Some studies have found that laser-assisted lipolysis and liposuction produced less bleeding than did liposuction alone. Histologic analysis of laser-assisted lipolysis using 1,064 nm have shown coagulated blood vessels and a reorganization of the reticular dermis and collagen without nerve damage. Scanning electron microscopy images have shown specific ruptured adipocytes.

Like others, when I first started performing laser-assisted lipolysis with liposuction it took longer than regular liposuction because I had to get a feel for how many rounds of alternating laser and suction are necessary to achieve the desired effect. But now I have become aware enough so that I can do laser-assisted liposuction about 25% faster than I can do a similar liposuction procedure alone.

The laser can burn through the skin, creating a small scar, if you apply too much energy in smaller areas or areas of thinner skin, such as the submental area. The laser fiber is stiff and can break, posing potential risk of penetrating the skin. My patients have not had much bruising or tenderness in treated areas, but it is a possibility.

Light at 920 nm has four times greater selectivity for subcutaneous fat than dermis and seven times greater selectivity for fat than water. Other light wavelengths at which fat is selectively absorbed over dermis at a peak level include 1,205 nm, 1,064 nm, 1,700 nm, and 2,300 nm.

The SmartLipo system (Cynosure Inc.) uses a 1,064-nm Nd:YAG laser fiber that is threaded through a thin cannula and hand-piece. The CoolLipo system by CoolTouch Inc. combines a 1,320-nm Nd:YAG laser with simultaneous suction. The 1,320-nm wavelength tightens skin by preferentially heating the water around dermal collagen fibers.

Palomar Medical Technologies Inc. has a laser-assisted liposuction platform that is currently under review by the FDA for marketing approval, but it could potentially work extremely well for rapid fat melting in large body areas because fat absorbs the 920-nm wavelength light of the laser in the system seven times better than water. (I am a consultant for all three of these companies. I have received honoraria for speaking for CoolTouch and Palomar and have received research grants from Palomar and Cynosure.)

I recommend practicing on ex vivo abdominoplasty fat to get a feel of how the technique works, how fibrous the fat is, and how long it takes to melt. At my practice, we try to use slightly less tumescent anesthesia than we ordinarily would for normal liposuction. I lyse the fat in a back-and-forth fanning motion and suck up the melted fat, repeating this cycle until tactile sensations or pinching of the skin yields significant fat reduction. The pinching technique is something that must be learned over time if you do not have experience with liposuction.

All in all I am very enthusiastic about the use of laser-assisted liposuction. There are still some kinks to be ironed out, but overall there are many potential benefits.

BY ROBERT A. WEISS, M.D.

DR. WEISS of the department of dermatology at Johns Hopkins University, Baltimore, is a member of the editorial advisory board of SKIN & ALLERGY NEWS. Dr. Weiss’s views are his own and do not necessarily reflect the views of this publication.

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