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P ro c e e d in g so fth eF a c ia l A e s th e tic s C o n fe r e n c e a n d E x h ib itio n
5 5
L aserlip o ly s is
D r
B ruce
K a tz,
C lin ic a l
P r o fe s s o r
o f
D e r m a to lo g y ,
M ount
S in a i
S c h o o l
o f
M e d ic in e ,
a n d
D ir e c to r
o f
C o sm e tic
S u r g e ,y
a n d
L a s e r
C lin ic ,
M ount
S in a i
H ospiw l, N ew
York, USA
L aserlip o ly s is
isperform ed
w ith
S m artlip o
( I a s e r l i
p o lis i),
a
m e d iu m -p u ls e
N d :Y A G
1 0 6 4 -n m
la s e r
th a tta rg e ts s e le c te d a re a so f fa t fo r d e s tru c tio n .T he
te c h n iq u e
rem oves
e x c e s s
f a t t y
tis s u e
b y
s e le c tiv e
in te rv e n tio n
o fa
la s e r
b e a m
w ith
a d ip o c y te s :
th is
results in disintegrationo fth e a d ip o c y tem em branes.
I tis a m inim ally invasivete c h n iq u e , em ploying a1
m m -diam eterc a n n u la w h ic hm akes it le sstrau m atic
th a nc o n v e n tio n a l lip o s c u lp tu re te c h n iq u e s .
T hem a in a p p lic a tio n fo r la s e r lip o ly s isis in la s e r
a s s is te d lip o s c u lp tu rea n db o d yc o n to u rin g .I tisa ls o
u s e d
a s
a n
a lte rn a tiv e
t o
lip o s c u lp tu re
w hen
la rg e
c a n n u la s
m ig h t
b e
p ro b le m a tic ;
a s
a
c o m b in e d
tre a tm e n tfor fat m elting
a n d
s k in
c o n to u rin g ;a n d
fo r
a r e a s
w here
lip o s c u lp tu re
is
in d ic a te d
b u ts k in
la x ity
m ig h t
b e
m ade
w orse.
S m artlip o
is
a ls o
in d ic a te d
for thetre a tm e n to fpseudogynaecom astia
a n d
in a x illa ry h y p e r h y d r o s is .
T heeffectso f high-peakpow er laser pulses aren o t
o n lyth erm alb u t also
p h o toa c o u s tic , w ithth e ra p id
a b s o rp tio n
b yth e
a d ip o c y te
m em brane
c re a tin ga n
o p e n in g
i n
th e
m em brane
w ith
d is c h a r g e
o f
th e
c e llu la r c o n te n ts .L aserlig h tis c o n v e y e d v ia al-m m
m icroc a n n u la
in to
w h ic h
a n
o p tic a l
fib re
o fo n ly
3 0 0
/1 m
is in s e rte d . S m a rtlip o d e liv e rs p o w e rfu la n d
(1 )
in s ta n ta n e o u s
p u ls e s .T i s s u e s
th a ta re
tre a te d
w ith
th ela s e rbeam su n d e r g o c o o lin g -
p u ls e w a v e le n g th
o n ly
r e p r e s e n ts
a sm all percentageo ftim e e la p s in g
b e tw e e n
tw o
p u ls e s .
A
s k in
in c is io n
o fo n ly
1m m
requires no sutures.
L aser
lip o ly s is
is
e ffe c tiv e ,
m in im ally
in v a s iv e ,
h a e m o s ta tic
a n d
a s s u r e s
a
ra p id
re c o v e ry .
I th a s
a
sh o rtle a rn in g
c u rv e . F ig u re4 6
s h o w sth e s ta g e s in
th e te c h n iq u e .
S m artlip oh a sth efo llo w in g a d v a n ta g e s :
•
u ltra s h o rt
p u ls e s
(o n e
te n -th o u s a n d th
o fa
s e c
o n d )
•
p e a k
pow ers
a re
e x tre m e ly
h ig h ,
th e re fo re ,
n o
tis s u ec h a rrin g
•
p o s itio n in g
o f
th e
c a n n u la
is
h ig h lig h te d
v ia
tra n s illu m in a tio n fro m
a re d g u id in gb e a m
•
sk inis tig h te n e d a fte rtre a tm e n t
•
le s strau m a t os u b c u ta n e o u s t i s s u e s
•
s im u lta n e o u sc o a g u la tio no f b lo o d v e sse ls, re s u lt
ing in lessb lo o dlo s s
•
ecchym osesa n doedem aa rer e d u c e d ,a n d
r e c o v -
ery tim e iss h o r te r
T he
a c tu a lte c h n iq u e
o fla s e r lip o ly s is
in v o lv e s
th e
fo llo w in g s te p s : p re o p e ra tiv e m a rk in go f th e a re a s to
b e tre a te d ; in filtra tio no flo c a l a n a e s th e tic ;a n d
th e n laser energy isa d m in is te re d via a layer technique.I n th e
p o s to p e ra tiv e
p e rio d , p a tie n ts
s h o u ld :
w ear
a n
e la s tic
com pression
garm ent
(4 -5
d a y s )
t o
r e d u c e
sw ellin g
o rfo r
1 -2
w eeks
if they
a re
a c tiv e ; ta k e
a
sh o rt-te rm
c o u r s e
o fa n tib io tic s ;
a n d
consider soft
m a s s a g e in
1 0 -1 2d a y s .
(2 )
- - - -'(4 )
F ig u rc
4 6 .
S ta g c s in
la s e r lip o ly s is .
1 )
la s e r a c tio n ; 2 ) b re a k in go f a d ip o c y tc
m em branc
(fat lcakso u t from
adipocy£cs); 3) increasc
o f
a d ip o c y tc sizc d u e to
a ltc ra tio no fm em brane p e rm e a b ili£ y (th e s e c c lls w ill d iein afc w
m o n th sa n d
b e c lim in a te d b y th e b o d y ); 4 ) fin a l
r e s u l e
(P h o to g ra p h s c o u rte s yo fB . K a tz .)
5 6
F .A .C .E . abstracts
F ig u r e4 7 .
(A )
Preoperative subm ental and
m a n d ib u la r fa t w ith
s k in
flaccidity; (B) 5 m onths pOSlsurgcry. good
s k in c o m o u r a n d
skin retraction after laser lipolysis. (Photographs courtesyo f A .Z .
D .B a d in .)
eccrine sw eat glands. M any treatm ents are available
fo r
th is
c o n d itio n ,
fo r
e x a m p le ,
a n tic h o lin e r g ic
a g e n ts ,
g iv e n
o r a lly
o r
b y
w ay
o f
p a t c h e s ,
o r
b o tu lin u m
to x in .
Surgical treatm ents
in c lu d e
sym
pathectom y, which
in v o lv e s
a b la tio n
o fthe sym pa
th e tic s u p p ly to
th esw eat glands. S m artlipo isb o th
effective and safe for this condition;it can obliterate
a
num ber
o f
sw eat
g la n d
d u c ts .
T he
c a n n u la
is
in s e r te d
th r o u g h
a sm all incision, and
there aren o
r e p o r te d
c o m p lic a tio n s .
L aser
lip o ly s is
w ith
th e
S m artlip o
la s e r
is
a
p r o m is in g p r o c e d u r e th a t p r o d u c e s sa fe a n d e ffe c tiv e results. Studies have show n that the laser action can r e le a s e
fa ta n d
cholesterol from
a d ip o c y te s in to th e
in te rc e llu la r s p a c e (s ).
F o llo w -u p
s tu d ie s ,
how ever,
a r eeagerly aw aited, anditis hoped that these will be
a v a ila b lein
a year.
F ig u r e
4 8 .
T issu e
r e tr a c tio n
b e f o r e
a n d
a fte r
la s e r
lip o ly s is .
(Photographs courtesyo fA .G o ld m a n , B r a z il.)
I n
a
s tu d y
o f2 4 5
p a tie n ts ,
s ix
m a le s
a n d
2 3 9
fem ales, where
the average age was3 5 years
(r a n g e
1 7 -5 5 ),
r e s u l t s
show ed
th a t
th is
m e th o d
w as
le s s
tr a u m a tic th a nc o n v e n tio n a l lip o s u c tio n .T hela s e r
tissu e
in te r a c tio n
a n d
th e
sm a ll-d ia m eter
c a n n u la
w ere
th em ain reasons for these effects (Figure4 7 ).
B leeding was less, resulting from
th e
c o a g u la tio n
o f
sm all vessels as a resulto f the lateralth e rm a l effects.
T he
c o n c lu s io n
w as
th a t
la s e r
lip o ly s is
is
le s s
tr a u m a tic
t o
t is s u e s ,
c a u s in g
le s s
sw ellin g
a n d
b r u is in g . S k in
r e tr a c tio n
im p r o v e s w h e n
th e te c h n i
q u eisu s e din a r e a so f fla c c id ity
(3 3 ).
A n o th e r
s tu d y
w as
o f
1 7 3 3
p a tie n ts
o v e r
2 8
m o n th s :
3 1 2
m a le s
a n d
1 4 2 1
fem ales;
a g e
r a n g e
w as1 5 -7 8years;a n d again Sm artlipo w asu s e d (34).
E cchym osesw ere lessa s w as blood loss, and patients
h a dg re a te rp o s to p e ra tiv ecom fort(F ig u re4 8 ).
F resh ly
e x c is e d
hum an
s k in
a n d
s u b c u ta n e o u s
tissu e
ir r a d ia te d
w ith
S m a r tlip o
w ere
e x a m in e d
h is to lo g ic a lly (3 5 ). T is s u e s w e res tu d ie d b ys c a n n in g
e le c tro n
m icroscopy
(S E M )
a n d
h a e m a to x y lin
a n d
e o s in
s ta in in g .
SE M
a fte r
la s e r
ir r a d ia tio n
show ed
d e s t r u c t iv e
c h a n g e s ,
tu n n e ls
o f
a b o u t
3 0 0tim ,
d e g e n e r a te dc e llm em branesa n d
d is p e r s e d lip id s .
A x illary
h y p e rh y d ro s is
is
e x c e s s iv e
u n d e ra rm
sw eatin g
th a t
is
a n n o y in g
a n d
em barrassing
fo r
it s
sufferers.I t affects 1%
o fth ep o p u la tio na n d
r e s u l t s
fr o m
excessive sym pathetic nerve stim ulation
o fth e
(A )
(8 )
E v o lv in gn ew
te c h n o lo g ie s :p r o sa n dc o n s
D r
B ru ce
K a tz)
C lin ic a l
P r o fe s s o r
o f
D erm acology,
M ount
S in a i
S c h o o l
o f
M e d ic in e ,
a n d
D ireccor
o f
C o sm e tic
S u r g e ly
a n d
L a s e r
C lin ic ,
M ount
S in a i
H o s p ita l, N e w
Y o r k ,
U SA
A ffirm™
is
a
n e w
fo rm
o fla s e r
te c h n o lo g y
th a t
d iffe r s
fr o m
c o n v e n tio n a l
m ethods
o f
la s e r
tr e a t
m entsin
th a titis a c o m b in a tio n
o fm u ltip le e n e r g y
s o u r c e s .
R e c e n tly
g r a n te d
FD A
c le a r a n c e ,
it
is
a n
N d :Y A G
la s e ra n d
isu s e dfo r m ic ro th e rm a l re ju v e
n a tio n .
I t s
w a v e le n g th
is
1 4 4 0nm ,
p u ls e
w id th
3 .0m s,s p o t sizes
1 0m m
a n d
m a x im a l flu e n c e
811
c m
2
.It c a n b e u s e d t o c o r r e c t p e r io r a l a n d p e r io c u la r
w r in k le s a n d to tr e a t d is o r d e r so f s k in p ig m e n ta tio n .
W ith
a n
id e a l
w a v e le n g th
(1 4 4 0nm )
t o
ta rg e t
dam aged
s k in ,
A ffirm
a ls o
h a s
a
s e le c te d
d e liv e ry
a p p r o a c hw ithc o m b in e d a p e x p u ls e(C A P ) te c h n o l
o g y .
C A P
is
a
s p e c ia liz e d
o p tic
w h ic h
g a u g e s
d is tr ib u tio n
o f
e n e r g y
t o
th e
treatm ent
a r e a .
I t
d e liv e rs
1 0 0 0
d iffra c tiv e
e le m e n ts ,
a ffe c tin g
m o re
surface areap e r pulse.C A P
p r o d u c e sv a r y in g le v e ls
o fh e a td is trib u tio n
i n
th e
s k in . A p e x
pulses create
h ig h -in te n s ity le s io n s in itia tin g c o lla g e n r e m o d e llin g ; lo w -le v e l h e a tin g s u r r o u n d s th e a p e x p u ls e s , a c tiv a t ing collagen stim ulation. L aser energy penetrates the
e p id e rm is
th ro u g h
th e
p a p illa ry
d erm is
t o
th e
derm is, a distanceo f1 0 0 -3 0 0 I'm .
A
s tu d y
a p p r o v e d
b y
th e
A m erican
S o c ie ty
fo r
L aser
M e d ic in e
a n d
S u rg e ry
(A S L M S
2 0 0 6
A c c e p te d
A bstract
[th e o ry ]
R
W eiss,
M D,
e t
a l.)
com pared
th e
h is to lo g ic a l
e ffe c ts
o f
fra c tio n in g
•
· t h
r e s u r fa c in g
u s in g
a
1 5 5 0 -n m
F r a x e l
la s e r
W I
a
M ic ro le n s1 4 4 0 -n mscattering device.F o rty biopsies
w ere
r e v ie w e d .T he
1 4 4 0 -n m -tr e a te d
a r e a s
c r e a te d
sm aller focio f injury w ith less epiderm al dam agea t
e q u iv a le n t
f lu e n c e s .
S e p a r a tio n
o f
th e
d e r m a l
e p id e r m a l
ju n c tio n
w as
le s s
p r o n o u n c e d ,
w ith
narrow er zones
o fth e rm a lin ju ry
fo r
th e
1 4 4 0 -n m
w a v e le n g th .
D e p th
o f
derm al
dam age
v a rie d
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