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 © December 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
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.
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-