ports in the literature documenting incidence of bacterial and mycobacterial endocarditis in patients undergoing dental, orthodontic, and other surgical procedures.33-41
Laser Assisted Liposuction
Current studies are underway to evaluate the ability to liquefy or rupture fat cells using various lasers.43-51 The laser devices most widely utilized to assist with liposuction include a helium-neon laser (635<nm), a diode laser (600-800 nm), and most recently, a 1064 nm neodynium:yttrium aluminum garnet (Nd:YAG) laser.43-51 The studies utilizing a 635 nm diode laser to release fat from adipocytes demonstrated changes in the adipose structure when analyzed by electron microscopy and magnetic resonance imaging (MRI).43 Six minutes of exposure to the 635 nm diode laser at 1.2 J/cm2 resulted in a temporary pore in the cell membrane with resultant release of the fat into the interstitial space.43
Recent studies have evaluated both the clinical and histopathologic effects of the 1064 nm Nd:YAG laser and 980 nm diode laser in laser-assisted lipolysis.44 A recent study by Mordon and colleagues43 demonstrated both enhanced lipolysis and skin contraction with the laser-assisted devices. Using an optimal thermal modeling approach, the authors demonstrated that increased heat generated by the laser in the deep reticular dermis may result in collagen and elastin synthesis and resultant skin tightening which they observed clinically after laser lipolysis. Goldman demonstrated skin contraction and enhanced lipolysis with the use of the 1064 nm Nd:YAG laser for submental liposuction.44 Clinical results of tissue tightening were correlated with histologic analysis confirming laser-induced rupture of the adipocyte membrane. Kim and colleagues45 reported the results of 29 patients treated with laser lipolysis with the 1064 nm Nd:YAG device and demonstrated clinical improvement (at 3 months, average of 37%) as well as decreased adiposity as measured by MRI (average of 17% reduction in volume). Greater improvement was noted in smaller volume areas, such as the submentum, in both clinical outcome, and dermal tightening. However, several other recent comparative trials evaluating laser-assisted liposuction with the 1064 nm Nd:YAG laser have shown equivocal results with laser-assisted liposuction relative to liposuction alone.49-51
While laser assisted TL (LAL) is still in evolution, theoretical benefits of LAL include less mechanical trauma associated with the procedure, resulting in a theoretical risk of less bacteremia. Two recent studies have evaluated the complication rate and safety, including incidence of infections with laser assisted TL (LAL). A total of 537 consecutive TL cases with LAL were evaluated retrospectively to determine the number of adverse events associated with the LAL procedure and the number of touch-up procedures performed.48 No systemic complications were identified and only five local complications were found. These complications included one local infection and four skin burns. This represents a complication rate of 0.93%.
Similarly, a recent study by Reynaud JP and colleagues evaluated 534 LAL procedures retrospectively performed on 334 patients.51 Different areas were treated: hips (197), inner thighs (86), abdomen (86), knees (61), flanks (57), buttocks (28), chin (22), arms (18), back (4).51 Mean cumulative energy was area-dependent, ranging from a minimum of 2200 J (knee) to a maximum of 51,000 J (abdomen).47 Contour correction and skin retraction were observed almost immediately in most patients. There was no incidence of scarring, infection, burns, hypopigmentation, bruising, swelling, or edema.51 Ecchymoses were observed in almost all patients but resolved in under one week for 322 patients. Patient satisfaction was very high.51 Because LAL is an outpatient procedure, patients were able to resume normal daily activities after 24 hours.51 Ultrasound imaging confirmed that the thermal effect generated by the laser results in melting and rupture of the collagenous and subdermal bands.51
LAL has been purported to result in both mechanical cavitation of fat resulting in greater ease of suction and greater skin retraction after the procedure resulting in enhanced tightening. However, further studies are highly needed to evaluate scientifically the benefits of pretreatment with lasers for ease of adipose removal, enhanced cosmesis and safety profile, including incidence of transient bacteremia and infection.39-47
Tumescent liposuction is a procedure that was designed and developed by dermatologic surgeons. The safety profile for liposuction is significantly improved when tumescent local anesthesia technique is employed. Tumescent local anesthesia utilizing lidocaine with epinephrine allows the removal of large volumes of fat with minimal associated blood loss and postoperative morbidity.
The authors have no relevant conflicts of interest to disclose.
- Fischer G. Liposculpture: the correct history of liposuction, part I. J Dermatol Surg Oncol. 1990;16:1087-1089.
- Ilouz Z. Body contouring by lipolysis: a 5 year experience with over 3000 cases. Plast Reconstr Surg. 1983;72:591-597.
- Fournier P. Body sculpting through syringe liposuction and autologous fat re-injection. Corona del Mar: Samuel Rolf International, 1987.
- Klein JA. Tumescent technique for regional anesthesia permits lidocaine doses of 35-55 mg/kg for liposuction. Peak plasma levels are diminished and delayed for 12 hours. J Dermatol Surg Oncol. 1990;16:248-263.
- Bernstein G, Hanke CW. Safety of liposuction: a review of 9478 cases performed by dermatologists. J Dermatol Surg Oncol. 1988;14(10):1112-1114.
- Hanke CW, Bernstein G, Bullock S. Safety of tumescent liposuction in 15,336 patients: national survey results. Dermatol Surg. 1995;21:459-462.