Fat Layer Reduction Forum

Laser-assisted liposuction is the “wave of the future for liposuction, liposculpting, and tissue tightening,” write two physicians in a recent review article in the journal Seminars in Cutaneous Medicine and Surgery.

After noting that body contouring with fat removal was first reported in 1921, the authors describe how liposculpting has evolved over the years, and particularly how the safety profile of the technique significantly improved with the advent of tumescent anesthesia, which reduced the risk of bleeding complications and the need for general anesthesia and hospital stays.

The article then reviews current laser-assisted lipolysis technology and techniques, comparing the different protocols of various devices and wavelengths. The success of the technique, the authors note, often depends on the skill and training of the practitioner: “Proper understanding of the laser systems is necessary to reduce the associated risks of the laser. Thermal skin damage can occur if energy is delivered imperfectly or too highly concentrated.”

As new laser lipolysis technology is developed, the techniques will become more efficient, safer and cosmetically pleasing, the authors add. “Laser-assisted lipolysis is a rapidly expanding field of interest,” they conclude. “Its potential may be enormous and could radically change the paradigm of liposculpture. As experience and technology grow together, efficacy and safety will likely become less and less operator dependent.”

Source: Parlette EC, Kaminer ME. Laser-assisted liposuction: here’s the skinny. Semin Cutan Med Surg. 2008;27:259-263.

The information found on this website is not designed to replace the patient/physician relationship.

In a provocative article in the journal Aesthetic Plastic Surgery, three physicians discuss how cosmetic surgery is “passing through an identity crisis as well as an acute ethical dilemma.”

Here’s an excerpt:

“Aesthetic surgery that works only according to market categories runs the risk of losing the view for the real need of patients and will be nothing else than a part of a beauty industry which has the only aim to sell something, not to help people. Such an aesthetic surgery is losing sight of real values and makes profit from the ideology of a society that serves only vanity, youthfulness, and personal success. Unfortunately, some colleagues brag that they chose the plastic surgery specialty just to become rich aesthetic surgeons, using marketing tactics to promote their practice. This is, at present, the image we project. As rightly proposed, going back a little to Hippocrates, to the basics of being a physician, is urgently warranted! Being a physician is all that a ‘cosmetic’ surgeon should be. In the long run, how one skillfully and ethically practices the art of plastic surgery will always speak louder than any words.”

Source: Atiyeh BS, Rubeiz MT, Hayek SN. Aesthetic/cosmetic surgery and ethical challenges. Aesthetic Plast Surg. 2008:32:829-839.

The information found on this website is not designed to replace the patient/physician relationship.

Another study from Anderson, Manstein et al has been published on the new technology of cryolysis and its potential for removing unwanted fat.

In this latest study, which appears in the journal Lasers in Surgery and Medicine, the researchers from the Wellman Center for Photomedicine at Massachusetts General Hospital describe the non-invasive cold-induced selective destruction of subcutaneous fat in anesthesized Black Yucatan pigs.

The results: There was a “grossly obvious loss of several mm of subcutaneous fat occurring gradually during the 3.5 months study period,” the authors write. Furthermore, “there was no clinical or histological evidence of injury to skin, and no scarring. Serum lipids were not significantly increased.”

The authors conclude that “prolonged, controlled local skin cooling can induce selective damage and subsequent loss of subcutaneous fat, without damaging the overlying skin. Selective cryolysis warrants further study as a local treatment for removal of adipose tissue.”

Stay tuned.

Source: Manstein D, Laubach H, Watanabe K, Farinelli W, Zurakowski D, Anderson RR. Selective cryolysis: a novel method of non-invasive fat removal. Lasers Surg Med. 2008:40:595-604.

Learn more about cryolipolysis devices at the Patient’s Guide to Body Contouring

The information found on this website is not designed to replace the patient/physician relationship.

A new study suggests that ultrasound imaging can help guide and monitor a laser during treatments to remove subcutaneous fat, thus possibly ensuring even safer and more effective results.

The study, published in the journal Lasers in Surgery and Medicine, used pig skin and fat samples. It found that ultrasound imaging aided laser procedures in two specific ways: First, ultrasound helped identify the boundary between the skin’s dermis (the inner layer of skin just below the surface layer, or epidermis) and subcutaneous fat (the adipose fat just under the skin). The dermal-fat boundary can vary in depth from one individual to another (usually from 0.5 to 4 millimeters). Knowing the precise composition of the tissue and the depth at which the dermis level ends and subcutaneous fat begins can help the physician select the proper fluence, irradiation wavelength, pulse duration and exposure time of the laser for a particular patient’s treatment.

Ultrasound imaging also helps monitor the increase in skin temperature that occurs in response to the laser therapy, the study found. Such monitoring is important to ensure surrounding tissue structures do not become damaged during treatment.

Source: Shah J, Thomsen S, Milner TE, Emelianov SY. Ultrasound guidance and monitoring of laser-based fat removal. Lasers Surg Med. 2008;40:680-687.

The information found on this website is not designed to replace the patient/physician relationship.

Fat removal is one of the hottest topics in aesthetic medicine today.  Below is an excerpt from Dermatology Times E-News covering this topic at the Winter Clinical Dermatology Conference in Hawaii.  There are several advantages to laserlipolysis over traditional liposuction.  Among these are less bleeding and bruising, lasers are minimally invasive, there is less pain associated with the procedure and there is little to no downtime.  With FDA approval of devices such as Cynosure’s Smartlipo device, the flood gates may be opening for new advances in the removal of fat.

January 19, 2009
Source: Dermatology Times

Kohala Coast, HI — At the Winter Clinical Dermatology Conference, Mark Nestor, M.D., started his talk about minimally invasive fat reduction by asking attendees to raise their hands if they have specific areas of fat they’d like to alleviate. Many hands in the audience went up. But when he asked who would consider liposuction to achieve their fat-reduction goals, most of those hands went down.

That response is not surprising, Dr. Nestor said, seeing as liposuction is an invasive, painful procedure. Like the dermatologists in the audience, patients continue to seek both cosmetic and clinical improvement that results in minimal or no down-time and little procedural risk.

When it comes to excess adipose tissue, basic areas of aesthetic concern include the face (submental area, mandibular border, malar fat pad), upper body (arms and dorsal region, abdomen, hips, love handles) and lower body (saddle bags, buttocks, pubic region, knees). While tumescent liposuction remains the “gold standard” for achieving fat reduction in these and other areas, physicians should consider newer, less-invasive options for many of their patients, Dr. Nestor said.

Read more at Dermatology Times

The information found on this website is not designed to replace the patient/physician relationship.

Liposuction has for many years been the gold standard of fat reduction, providing predictable outcomes, some downtime, and generally happy patients. The development of laser lipolysis has increased patient satisfaction by decreasing downtime and improving skin laxity.

A new article in the journal Biomedical Engineering Online has published a mathematical model for laser lipolysis. This model was developed by French researchers Mordon, Wassmer, Reynaud & Zemmouri at the Lille University Hospital. Here is an excerpt from the article:

Laser lipolysis can be described by a theoretical model. Fat volume reduction observed in patients is in accordance with model calculations. Due to heat diffusion, temperature elevation is also produced inside the lower reticular dermis. This interesting observation can explain remodeling of the collagenous tissue, with clinically evident skin tightening.

In conclusion, while the heat generated by interstitial laser irradiation provides stimulate lipolysis of the fat cells, the collagen and elastin are also stimulated resulting in a tightening in the skin. This mathematical model should serve as a useful tool to simulate and better understand the mechanism of action of the laser lipolysis.

Laser lipolysis has become an incredibly popular treatment option for the reduction of fat. New treatment alternatives are also on the horizon which offer some interesting potential as well. We shall see!

The information found on this website is not designed to replace the patient/physician relationship.

Laser Lipolysis (or SmartLipo™ as its known thanks to Cynosure’s marketing) is a method of removing fat. It involves the cutting of the skin under local anesthesia and the insertion of a cannula containing a laser. The cannula is passed back and forth to deliver laser energy to destroy the fat cell. The fat is then removed from the skin through small holes in the skin.

There are advantages to laser lipo over traditional liposuction. First off the cannula inserted into the skin is smaller than in traditional liposuction so the incision is smaller in the skin (smaller scarring). Also the heat generated by the laser can cause contraction of the wound in the skin, a desirable side-effect that we don’t see in liposuction.

The procedure is still surgery and therefore carries some of the similar risks as traditional liposuction. There are common complications such as bruising and infection, blood pooling beneath the skin (may appear as varicose or types of spider veins), and scarring. Less common are shock, burning of the tissue around the treatment area, and excessive bleeding.

The downtime following Smart Lipo is 24 to 48 hours.

The information found on this website is not designed to replace the patient/physician relationship.

Earlier on this blog we made mention of a study by Anderson, Manstein et al reviewing selective photothermolysis as a way to damage and remove the subcutaneous fat layer in a targeted way. This method has now been coined as “cryolipolysis”.

Essentially they discovered that fat cells could be selectively targeted and removed by the use of FEL. We are excited to see the new technology hit the market. A company has been formed to bring it to market, Zeltiq.

The information found on this website is not designed to replace the patient/physician relationship.

The amount of fat in a patient’s diet can be a very hard thing to pin down. Assessing diet and disease risk are major steps towards development of better habits and management of weight, however accuracy of patient’s own dietary habits is notoriously imprecise.

Researchers at the Oxford Centre for Diabetes recently published an article which reviewed evidence from a wide variety of cross-sectional and intervention studies and summaries typical values for fatty acid composition. They found that:

Studies in which dietary intake was strictly controlled confirm that fatty acid biomarkers can complement dietary assessment methodologies and have the potential to be used more quantitatively. Factors affecting adipose tissue and blood lipid composition are discussed, such as the physical properties of triacylglycerol, total dietary fat intake and endogenous fatty acid synthesis. The relationship between plasma lipoprotein concentrations and total plasma fatty acid composition, and the use of fatty acid ratios as indices of enzyme activity are also addressed.

The information found on this website is not designed to replace the patient/physician relationship.

A study published in the Journal of Laser in Surgery and Medicine reported on the effects of a Free Electron Laser (FEL) when targeted at the subcutaneous fat layer at 1,210nm and 1,720nm. The researchers from Wellman Center for Photomedicine, Harvard Medical School, assessed that the excitation of fat was twice that of the dermis, and the fat layer was damaged without any apparent injury to the dermis. Here is an excerpt:

Absorption spectra of human fat were measured, identifying promising bands near 1,210 and 1,720 nm. Photothermal excitation of porcine fat and dermis were measured with a 3.5-5 microm thermal camera during exposure to the free electron laser (FEL) at Jefferson National Laboratory. Thermal damage to full-thickness samples exposed at approximately 1,210 nm through a cold contact window, was assessed by nitrobluetetrazolium chloride staining in situ and by light microscopy. RESULTS: Photothermal excitation of fat was twice that of dermis, at lipid absorption bands (1,210, 1,720 nm). At 1,210 nm, a subcutaneous fat layer several mm thick was damaged by FEL exposure, without apparent injury to overlying skin. CONCLUSION: Selective photothermal targeting of fatty tissues is feasible using infrared lipid absorption bands. Potential clinical applications are suggested by this FEL study. (c) 2006 Wiley-Liss, Inc.

Pretty exciting stuff. The scientists involved are some of the most prominent in the world. If brought to market, we could see the dream of noninvasive fat removal become a reality.

The information found on this website is not designed to replace the patient/physician relationship.