Laser lipolysis enhances body contouring and sculpting

The addition of laser to traditional liposuction results in a minimally-invasive procedure that provides more rapid recovery and skin tightening of any residual skin laxity, according to a plastic surgeon in Gatineau, Quebec, Canada.

Reviewing more than 200 cases of laser lipolysis (using SmartLipo), performed over a two-year period, Patricia Berbari, M.D., FRCSC, who is also an associate professor at the University of Ottawa in Ottawa, Ontario, Canada, discussed the advantages of the procedure at the 2016 annual meeting of the Canadian Laser and Aesthetic Specialists Society in Toronto.

"The laser helps me get better results with liposuction," says Dr. Berbari, explaining that the procedure liquefies and removes the fat. "The rationale [for using a laser] is to make sure the skin is not sagging [after fat is removed]. With the laser, through stimulation of collagen, you will achieve skin tightening."

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The patients in this series had an average age of 43, had an average body mass index of 26.5 kg/m², and more than 80% were female. Common sites where patients frequently request laser-assisted liposuction are the abdomen and thighs, notes Dr. Berbari.

The use of the laser improves body contouring and sculpting through avoiding the need for large, surgical excision to eliminate any excess, sagging skin that is common with tummy tuck or thigh lift, according to Dr. Berbari.

Indeed, an advantage with laser lipolysis is that smaller cannulas are used compared to traditional liposuction. "An advantage with laser lipolysis is that we can suction out the fat with smaller cannulas, and there is less trauma to the tissues," says Dr. Berbari.

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Dr. Berbari notes that some sites are more challenging than others, with the periumbilical zone being a challenge to treat. She also points out that the repetitive movements involved with performing the procedure can create challenges like shoulder pain for the clinician.

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Dr. Berbari points to one study that compared laser-assisted liposuction to liposuction alone in the treatment of abdominal adiposity and skin laxity. The laser emitted wavelengths of 1,064-nm and 1,320-nm. It measured outcomes such as skin shrinkage, measured by the changes in surface area of the regions, and skin tightening, calculated by changes in the skin stiffness index measured in the treated regions. The study found that there were statistically significant changes three months after treatment in skin shrinkage and skin tightening in the treated area.¹

Dr. Berbari cites other published data that support the use of laser-assisted liposuction, which involved 75 patients who underwent facial and body contouring and tissue tightening with devices that offered dual 1,064 nm/1,320nm wavelengths. The laser energy was designed to increase contraction of tissue, affect unwanted deposits of fat, and contour the body.²       

The procedure is performed using tumescent anesthesia rather than general anesthesia, notes Dr. Berbari.

Ideal treatment sites

Laser lipolysis is also an ideal treatment for sites like the neck and arm, says Dr. Berbari. It also presents decreased risk of complications such as ecchymosis, scarring, and seromas, compared to the use of liposuction alone, added Dr. Berbari. The seroma rate was 0.97% in her series.

Dr. Berbari recommends that clinicians not use laser-assisted liposuction above the jaw line, to avoid the possibility of mandibular nerve paresthesia. "It is better to stop at the mandibular margin for the neck," she says.

"Overall, there is less bleeding, less bruising, less swelling, and less pain with laser-assisted liposuction than with liposuction performed in the traditional way," she says.

In her series, 92% of patients required minimal pain medication, taking medications like acetaminophen or codeine. Dr. Berbari found that after two days of treatment, 50% of patients who underwent laser-assisted liposuction returned to work. "This is a big difference compared to recovery with traditional liposuction, which is usually about six days," says Dr. Berbari.

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Dr. Berbari says patient selection is a key factor in success with laser lipolysis and that it is not for all comers. Patients who are regarded as obese-that is, who have a body mass index that is greater than 30 kg/m²-are not suitable candidates for laser-assisted liposuction, says Dr. Berbari.

The age of the patient is also a consideration in terms of patient selection. "I have done the procedure on patients as old as 69," says Dr. Berbari. "There is a question about how much skin tightening can occur if the patient is older, whether or not they will produce enough collagen to achieve skin tightening."

To maintain the outcome achieved with laser-assisted liposuction, patients need to adopt a healthy lifestyle with proper diet and exercise, says Dr. Berbari. "The result won't last if the patient gains weight," she says.

Dr. Berbari has no relevant disclosures.

References

1. DiBernardo BE. Randomized, blinded split abdomen study evaluating skin shrinkage and skin tightening in laser-assisted liposuction versus liposuction control. Aesthet Surg J. 2010;30(4):593-602.

2. Sasaki GH, Tevez A. Laser-assisted liposuction for facial and body contouring and tissue tightening: a 2-year experience with 75 consecutive patients. Semin Cutan Med Surg. 2009;28(4):226-35.