Evaluation of the Safety and Efficacy of a Novel 1440nm Nd:YAG Laser for Neck Contouring and Skin Tightening Without Liposuction

December 2013 | Volume 12 | Issue 12 | Original Article | 1382 | Copyright © 2013

Deborah S. Sarnoff MD FAAD FACP

Clinical Professor, Department of Dermatology, New York University School of Medicine, New York, NY
Cosmetique Dermatology, Laser & Plastic Surgery, LLP, New York, NY

Abstract

BACKGROUND: Laser lipolysis is a less invasive approach to neck rejuvenation than open surgery or liposuction. Wavelengths utilized for lipolysis liquefy fat and induce collagen remodeling, which tightens skin. A new Nd:YAG device has recently been developed that emits energy at a wavelength of 1440nm; this wavelength is more highly absorbed by adipose tissue and water than other wavelengths currently available.
OBJECTIVE: To test the safety and efficacy of a pulsed 1440nm Nd:YAG wavelength and side-firing fiber for the treatment of subcutaneous fat and skin laxity associated with the aging neck.
METHODS: Twenty-four subjects aged 40 to 65 years underwent laser lipolysis of the submental and anterior cervical areas. An average of 1205J per 5x5cm square was delivered, with a maximum internal temperature setting of 47 degrees C. Cervicomental Angle Score (CAS), Global Aesthetic Improvement Scale (GAIS), subject and investigator satisfaction, and safety were assessed.
RESULTS: At six months post-treatment, 79% of subjects had a significant improvement in the CAS (P<.001) and 79% demonstrated an improvement on the GAIS. Clinical improvement was marked and evident for all but one subject, with physician and patient satisfaction scores indicating overall satisfaction with the procedure and outcomes. Adverse events were mild and transient with no incidence of burns, seromas, hematomas, infection, or nerve damage.
CONCLUSION: The 1440nm Nd:YAG device with the side-firing fiber was safe and effective for the treatment of subcutaneous fat and skin laxity in the neck. This device offers an alternative to selected individuals aged 40 and over who do not wish to undergo rhytidectomy.

J Drugs Dermatol. 2013;12(12):1382-1388.

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INTRODUCTION

Neck rejuvenation is becoming increasingly popular for individuals in their 40’s and older. As the neck ages, it loses the well-defined contours seen in youth. One apparent change is in the cervicomental angle—the angle formed by the horizontal plane of the submental region and the vertical plane of the neck. In classical beauty, a cervicomental angle of 105° is generally considered the “ideal” representation of a youthful and beautiful neck.1 Over time, the cervicomental angle becomes blunted and more obtuse, resulting in the loss of the youthful-appearing neck. In addition, descent of the skin and soft tissues of the lower face create jowls and the loss of a well-defined, youthful jawline. Subcutaneous and sub-platysmal fat deposits can progressively increase, leading to excessive fullness in the submental area.

Until recently, surgery has been the mainstay of neck rejuvenation. 2 However, many individuals are reluctant to undergo surgery due to various factors including the invasiveness and recovery time, while others may not be good candidates for surgery due to medical contraindications such as uncontrolled hypertension or use of anticoagulant medications.3

Laser lipolysis has emerged as a proven modality for treatment of excess fat and cellulite for those who do not wish to undergo open surgery. For neck rejuvenation, laser lipolysis provides the benefits of both removal of subcutaneous fat as well as tightening of the skin to reduce skin laxity. These results are achieved via two primary mechanisms: liquefaction of the adipose tissue and collagen remodeling.4 The laser delivers energy in the form of heat to the tissue via an optical fiber within a cannula. This heat is absorbed by adipocytes resulting in damage to the cell membranes. The cell membranes rupture and the liquefied fat can then be removed via simple manual manipulation.5 The laser energy also serves to denature adipose and dermal collagen, resulting in its remodeling and contraction. This becomes clinically evident as skin tightening.5,6

Multiple laser lipolysis devices are available. There are two main systems–diode and neodymium-dosed yttrium aluminum garnet (Nd:YAG)—with the primary difference being that the diode devices deliver shorter wavelengths in the electromagnetic spectrum than the Nd:YAG devices. The wavelengths delivered by these devices range from 920nm to 1444nm. There has been much dis-

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