Laser-assisted liposuction of the body and face is now routinely performed in conjunction with surgical procedures such as facelifts, as well as with fat injections to the face and body. This article will focus on three patients out of 144 laser-assisted liposuction patients. Two have had laser-assisted facelifts along with facial fat injections, and one patient underwent laser-assisted liposuction of the posterior thighs with fat injections for the treatment of skin indentations. Laser-assisted liposuction results have been satisfactory and safe with the combination of surgical procedures such as facelifts and fat injections.
Laser-assisted liposuction has become a popular method for body contouring worldwide. The safety of laser liposuction and the ease of its use with tumescent local anaesthesia is now well documented in the literature1–3. From the beginning of laser-assisted liposuction with Neira1, Badin2, Apfelberg3 and others, the use of lasers has expanded considerably. Laser-assisted liposuction of the body and face is now safely performed in conjunction with surgical procedures such as facelifts4–7, as well as with fat injections.
The destruction of adipocytes through laser treatment has been well documented with multiple histological studies. Neira showed with scanning electron microscopy that 6 minutes of laser treatment with an external 635 nm laser resulted in almost total disruption of the adipocyte membrane1. Goldman8 showed the rupture of adipocytes as well as coagulation of blood vessels after subcutaneous use of a 1064 nm laser, 300–600 µm optical fibre, and with a 1–1.4 mm diameter microcannula. Similar to our currently used system, the laser fibre extended 2 mm beyond the end of the cannula. Mordon et al9 found similar results with rupture of adipocytes, coagulation of collagen, and small vessel damage using a 1064 nm laser at 18 J. Ichikawa et al10 used the pulsed Nd:YAG laser on freshly excised adipose tissue, and scanning microscopy showed destruction of the adipocytes and heat-coagulated collagen fibres.
The potential therapeutic benefits of laser-assisted liposuction have been considered by a range of studies. A number of groups have suggested that laser-assisted liposuction results in better wound healing, better haemostasis, and less surgical trauma2,11,12. Alternatively, Prado et al13 found little clinical advantage of laser‑assisted liposuction over traditional liposuction with regard to bruising, oedema, and skin retraction. This group reported significantly reduced levels of pain associated with laser-assisted liposuction compared with liposuction alone. Conversely, Badin et al14, observed less cell swelling and decreased bleeding of adipose tissue using laser-assisted liposuction of the flank compared with traditional liposuction. Using a randomised, blinded, split abdomen study, DiBernardo15 found improved skin stiffness and tightening of the abdomen compared with traditional liposuction. Similarly, enhanced skin tightening was observed in a study following 10 patients who were treated with the 1064 nm Nd:YAG laser with a 300 µm fibre16. Goldman et al17 compared standard liposuction versus laser-assisted liposuction of the arms, and found that arm circumference reduction was significantly greater in the laser treated group compared with the no laser group17. In addition, some increased skin retraction was observed in the laser group. Therefore, laser-assisted liposuction in these studies shows some advantages over standard liposuction.
In summary, laser-assisted liposuction represents an efficacious alternative to traditional liposuction and has potential advantages in treating excess fat in areas that are small, highly vascularised, or demonstrate excess skin laxity. Overall, a strong consensus on the superiority of laser-assisted liposuction over traditional liposuction methods has yet to be established. This can be attributed to the lack of published comparative studies with laser-assisted liposuction versus standard tumescent liposuction. Currently, the authors have begun a comparative prospective, single-blinded study that will compare standard tumescent liposuction to laser-assisted liposuction.
This article will now present 3 case reports and demonstrate the safe and efficacious use of laser-assisted liposuction in patients undergoing facelifts and/or fat injections. All procedures were performed by the senior author, Dr Sherry S. Collawn.