Naples, Fla. — With a myriad technologies and devices available for liposuction, laser lipolysis finds a greater role for skin tightening in the hands of Dr. Katharina Russe-Wilflingseder.

Laser lipolysis (SmartLipo, Cynosure) results in less pain, swelling, and bruising than traditional liposuction, she said. Patients also experience faster, smoother recovery.

Photos courtesy Dr. Katharina Russe-Wilflingseder Prior to laser lipolysis, the patient's arm shows laxity.

“For me it is not a fat lipolysis device, it is more of a tightening device,” Dr. Russe-Wilflingseder said, while providing an aesthetic plastic surgeon’s perspective at the the annual meeting of the Florida Society of Dermatology & Dermatologic Surgery.

Laser lipolysis is an “excellent technique ... not only for lipodystrophy, but also skin laxity,” she said, adding that the treatments are particularly well suited for certain anatomic areas, such as the submental area and upper arms. For example, postprocedure outcomes are aesthetically better with laser lipolysis of the upper arms, an area where traditional liposuction leaves large scars that are difficult to conceal.

For addressing submental fat and/or skin laxity, “we can improve our results by combining our treatments,” said Dr. Russe-Wilflingseder, who has a private practice in Innsbruck, Austria. For example, results are even better with addition of bipolar radiofrequency therapy.

Photo courtesy Dr. Katharina Russe-Wilflingseder Eight months after treatment, the outcome is excellent, with no scars.

Like many techniques for fat removal and skin tightening, there are drawbacks that need to be considered. For example, results with laser lipolysis are not predictable compared with outcomes following surgery. In addition, improvements are not immediate and sometimes take up to 6 months.

The device uses heat, so there is a concern about risk of burns if used improperly, she said. The temperature threshold is important. You want enough to get tissue tightening, but not so much that it produces epidermal necrosis or thickening of subdermal fat. A beneficial feature of the device in this regard is an accelerometer. This technology determines the appropriate laser energy based on speed of movement to provide even and consistent treatment.

Treatment of cellulite, striae, and gynecomastia are among other suitable indications for the laser lipolysis technique, though careful patient selection and pretreatment counseling and photography are important, Dr. Russe-Wilflingseder said. This is especially true for patients who choose skin tightening with laser lipolysis although they are better candidates for a face or neck lift surgical procedure. Results will not be as dramatic, although they can still get some improvements from minimally invasive laser lipolysis.

Another reason Dr. Russe-Wilflingseder uses laser lipolysis primarily for skin tightening is the abundance of technologies already available for liposuction. In addition to laser-assisted liposuction, options include suction-assisted, power-assisted, ultrasound-assisted, water-jet-assisted, and radiofrequency-assisted technologies.

The original 1,064-nm Nd:YAG laser lipolysis system was cleared by the Food and Drug Administration in 2006. The laser system uses photomechanical and photothermal effects to disrupt fat cells and coagulate tissue, resulting in skin tightening.

08/25/10  

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