Minimally invasive lipolasers are helping providers meet rising demand for safe, effective, and low-downtime aesthetic treatments
In recent years, minimally invasive lipolasers have emerged as transformative devices in the field of aesthetics, offering an alternative to traditional body contouring procedures. Leveraging the precision of advanced laser technology, laser lipolysis not only facilitates effective fat reduction but also promotes skin tightening, resulting in enhanced body sculpting outcomes for patients. As these advancements continue to evolve, providers are presented with new opportunities to refine their practices, meet growing patient demands, and set new benchmarks in aesthetic medicine.
Lipolaser technology: Laser lipolysis vs laser-assisted liposuction
While both laser lipolysis and laser-assisted liposuction utilise advanced laser technology for fat reduction, their methodologies and applications differ significantly. Laser lipolysis is a non-surgical technique wherein lasers are employed to liquefy fat cells, which are subsequently removed through the lymphatic system. In contrast, laser-assisted liposuction combines the laser’s fat-melting capabilities with traditional suction-based removal, offering a more immediate and substantial fat reduction solution, particularly for patients requiring larger-volume contouring. The distinction lies in the invasiveness of the procedures, with laser-assisted liposuction necessitating small incisions for fat extraction, while laser lipolysis focuses on natural metabolic processes for fat clearance, each catering to diverse patient needs and aesthetic goals.
‘Liposuction has long been the standard treatment for individuals with localised areas of undesirable fat,’ reported dermatologist and aesthetic surgeon, Dr. Klaus Hoffman. ‘Although surgery can result in remarkable clinical improvements, there is significant postoperative rehabilitation and financial cost. Many patients consider minimally invasive procedures with rapid recovery and a low side effect profile to be preferable if the outcome is evident. Laser-assisted liposuction is deemed more appropriate for areas that require both skin improvement and fat reduction, but only some lasers cause “significant” damage to the fat area as the energy is absorbed by the aqueous chromophores and fat cells, where it is then transformed into heat.’
‘Laser lipolysis with 1444nm is a relatively safe treatment with fewer associated risks and side effects than surgical liposuction and currently represents the gold standard for minimally invasive lipolaser devices,’ Dr. Hoffman continued. ‘With these devices, one can say there is an immediate shrinking effect of connective tissue, as well as the destruction of fat cells by destroying the membrane.’ He explained that this action takes place in all connective tissue, including the skin’s subcutaneous trabeculae and the Camper’s fascia, resulting in a three-dimensional improvement of the entire treated area. Additionally, heating the tissue increases the wound healing reaction, especially within the connective tissue structures of the skin, for better outcomes. ‘This was presented early on by Dr. DiBernardo in one of the first papers about a US-developed system in the Journal of the American Academy for Dermatology,’ Dr. Hoffman added.
In a preliminary report published in the Aesthetic Surgery Journal in 2009, Barry DiBernardo, MD, and Jennifer Reyes, PA-C, evaluated five female patients with abdominal adiposity treated using a 1064-/1320-nm laser. At three months post-operation, skin elasticity showed a 26% improvement, and skin shrinkage was measured at 17%. Both results were significantly higher than baseline (p < .01)1.
According to Dr. Hoffman, laser lipolysis treatments offer several advantages for body contouring, including precise remodeling interaction with fat, less bleeding, less pain and swelling, dermal tightening, minimal tissue damage, and early recovery compared to other fat reduction and contouring methods. ‘With the appropriate and consistent movement of the cannula or fibre, secondary conducted heat is reduced, creating a purely radiant heat effect and nonselective photo-thermolysis that helps prevent skin overheating and potential burn damage. This is crucial for laser-assisted facial contouring, as the fat layer and skin are much thinner than in other anatomical parts of the body.’
While each laser selects a specific chromophore as its target with a different level of effectiveness, Dr. Hoffman reported that some new laser wavelengths have a greater potential for fat destruction than others. ‘In particular, it has been hypothesised that laser lipolysis can be carried out more successfully with the 1444 nm wavelength since its affinity for fat is more than ten times greater than with other lasers.’ He cautioned that while laser lipolysis may be seen today as a standard procedure in aesthetics, it is important that ongoing temperature is measured on site. ‘A measurement from outside, for example by infrared devices, is not efficient enough,’ he clarified. ‘Today, there are various devices in the market that can measure the temperature under the skin to help control the laser energy delivery. A new device from Italy even regulates energy input using artificial intelligence (AI) to ensure optimal energy delivery by adjustments based on movement and temperature.’
The trend towards minimally invasive lipolasers has led manufacturers to embrace cutting-edge technologies to create effective treatments with less trauma, improved comfort and quicker recovery times. Some recent developments in lipolaser technologies include applicators which pass laser light directly through the skin, targeting and heating subcutaneous fat cells, which lose their integrity and die. According to some, the body will naturally pass the fat cells with other waste over the weeks following treatment. While the norm is to incorporate laser energy to break down and remove fat, another recent development includes a version of cool lipolysis that does not destroy fat cells but instead creates openings for fat to exit cells into the interstitial tissue and then the lymphatic system for removal.
New aesthetic trends create new patient needs
Barry DiBernardo, MD, medical director of New Jersey Plastic Surgery® (Montclair, NJ), explained that the original laser lipolysis device for which he did research on incorporated three different wavelengths, 1440nm, 1340 nm and 1064 nm, and marked the beginning of laser lipolysis. While he still uses traditional liposuction and his original lipolaser device for fat removal, he is noticing a need for physicians to not only help patients attain body contouring through fat reduction, but to also address the side effects of rapid weight loss.
According to Dr. DiBernardo, physicians can accommodate GLP-1 weight loss patients by incorporating minimally invasive lipolaser devices that remove the fat and preserve it. ‘The trend today is to lose weight by getting GLP-1 injections,’ he said and explained that these medications are associated with muscle deterioration. ‘If we liquify fat with a laser, we still have to remove it with liposuction, but a laser is hot and destroys the cells. Instead of destroying the cells, we can do the patient a service by removing fat cells and use them for fat grafting.’
According to a recent survey by the American Academy of Facial Plastic and Reconstructive Surgery, GLP-1 medications are significantly transforming the field of facial plastic surgery, leading to a 50% rise in fat grafting procedures driven by patients seeking to restore lost facial volume and enhance their contours after weight loss with GLP-1 injections2. Fat grafting involves transferring fat from other areas of the body, like the hips or thighs, into the face to restore lost volume and improve facial contours.
Today’s latest developments in minimally invasive body contouring include several laser-assisted liposuction devices that are designed to preserve fat cells for grafting. These include a laser liposuction platform that streamlines the process through simultaneous lasing with aspiration for reduced operation time, as well as an advanced system that uses 1470 nm radial fibre-assisted liposuction to extract fat from a donor area, process the extracted fat to purify it and then re-inject the purified fat into the desired recipient area for volume enhancement.
Addressing additional patient needs
As fat grafting techniques merge with lipolaser technologies to help address some side effects of weight loss with GLP-1 medications, Dr. DiBernardo also directs his attention to minimally invasive body contouring treatments to treat skin laxity and muscle deterioration due to rapid weight loss. To lift and tighten skin, he incorporates an advanced form of ultrasound along with an electrical muscle stimulation device for building and maintaining muscle mass. But in surgery he prefers a minimally invasive device that employs radiofrequency (RF) energy and helium plasma to contract and tighten loose skin. In Dr. DiBernardo’s opinion, one of the most exciting developments in aesthetics that physicians can look forward to includes an all-in-one platform that integrates RF and helium plasma with ultrasound-assisted liposuction, power-assisted liposuction, infiltration, aspiration, electrocoagulation, and fat transfer in a single device called the AYON Body Contouring System by Apyx Medical Corporation (Clearwater, FL, USA).
Also igniting innovative advancements in laser lipolysis is Eufoton® Medical Lasers (Trieste, Friuli-Venezia Giulia, Italy) with a non-surgical device that employs hair-thin optical fibres to deliver laser energy for fat reduction while stimulating collagen and treating skin laxity. ‘They found that the 1470nm wavelength is optimal for targeting water and fat,’ reported Gayane Arutunian, NP. ‘At this wavelength we are able to use a minimally invasive method to cause skin tightening and lipolysis with minimal downtime. The procedure targets adipose tissue for lipolysis, with a fractional non-ablative diode laser in the subdermal layer of the skin.’ Ms. Arutunian clarified that she prefers this one-time treatment to target fat reduction in the jawline, arms, stomach and inner thighs because it also tightens the skin, so there is no need to combine it with other treatments.
As advancements in laser lipolysis technologies continue to evolve, the possibilities for safer, more efficient, and minimally invasive fat reduction and body contouring procedures are expanding at an unprecedented pace. From revolutionary lipolaser devices that keep fat intact for grafting to cutting-edge lasers with AI-regulated energy delivery systems, the future of minimally invasive aesthetic treatments holds promises for enhanced precision, improved patient outcomes, and reduced recovery times. These innovations not only redefine the boundaries of fat removal procedures but also pave the way for holistic approaches in body contouring and skin tightening, ensuring that the needs of modern patients are met with sophistication and efficacy.
Written by Cindy J. Papp, contributing editor
Figure 1 © Klaus Hoffman, MD; Figure 2 © Barry DiBernardo, MD
References:
- DiBernardo BE, Reyes J, Chen B. Evaluation of tissue thermal effects from 1064/1320-nm laser-assisted lipolysis and its clinical implications. J Cosmet Laser Ther. 2009 Jun;11(2):62-9. doi: 10.1080/14764170902792181. PMID: 19484812.
- Kugler T. American Academy of Facial Plastic and Reconstructive Surgery [Internet]. American Academy of Facial Plastic and Reconstructive Surgery. 2024. Available from: https://www.aafprs.org/Media/Press_Releases/2024_Annual_Trends_Survey.aspx
