Last updated date: 12-May-2023
Originally Written in English
For the elimination of undesirable fatty tissue, laser liposuction is currently a widely used and accepted procedure. Research has continued to support initial clinical results of decreased adiposity, shorter recovery times, and enhanced skin tightness since it was approved by the US Food and Drug Administration (FDA). We've learned that laser liposuction liquefies fatty tissue, coagulates little blood vessels, causes collagenesis with remodeling, and improves tissue tightness.
Despite these findings, some practitioners have been hesitant to accept laser liposuction because of the extended procedure times, greater risk of adverse effects, and absence of evidence that it is superior to standard liposuction. Doctors who are already experienced with laser technology, on the other hand, maybe more excited about using laser liposuction as an additional technique to meet the increasing need for noninvasive technologies that improve body contouring and skin tightening without leaving distressing scars.
Many investigational and histopathological publications, according to Sasaki et al, have reported that topical application of laser energy sources, such as 1064nm, 1320nm, and 1444nm (Accusculpt energy) wavelengths, and radiofrequency devices increase fibroblast numbers, stimulate new connective tissue, and improve tissue tightness and elasticity. Minimal laser treatment and cryolipolysis are two novel methods that promise external lipolysis and collagenesis. Internal use of laser radiation may be the most effective approach of decreasing fatty tissue and improving skin tightness till further improvement of these systems comes and penetration and absorption through the skin are easily achieved.
What is Accusculpt?
Lutronic's Accusculpt Laser Lipo-Sculpting System is the first pulsating laser for lipolysis and liposuction to use the groundbreaking 1444 nm wavelength for a new level of fat deposit emulsification and body sculpting safety, speed, and efficiency. The revolutionary 1444 nm technology, is the most precise and successful wavelength for fat reduction, making the Accusculpt the most powerful body sculpting tool on the market today.
Compared to standard liposuction, the Accusculpt technique uses fewer cuts and dissolves fat with far less difficulty. It targets fat tissue more precisely, causing less scattering and unintended heat to adjacent tissues. Patients are pleased with the results, and they recover more quickly.
The Accusculpt has been approved by the FDA to reach optimal contours while softly sculpting the face and body without the negative impacts of other liposuction treatments. The tummy, face, neck, thighs, flanks, buttocks, knees, back, and arms are all safe regions to use.
The technique has been shown to be effective in reducing male gynecomastia and treating saddlebags in women. "Fat is removed just from fatty compartments without harming other critical components like nerves and arteries since the Accusculpt is more exact, It decreases postoperative discomfort or pain greatly. Patients generally return to work and other activities after only a few days of recovery.
Accusculpt Features and Benefits
- Focused tissue-specific wavelength with enhanced efficiency
- Because thermal collateral damage is considerably decreased, there is less disruption.
- Treatments are rapid and straightforward due to the enhanced photo-acoustic action.
- It's ideal for contouring techniques all over the body.
Accusculpt Advantages Compared to Traditional Liposuction
- More accurate: lower collateral tissue damage allows for more precise treatment.
- More Potent: a powerful photo-acoustic action targets and melts fat in a targeted manner.
- Safer: many experienced doctors believe it is more effective in removing fat while causing less trauma to patients, making it a safer surgery.
- Easier to use: during therapy, quick passing through connective tissue necessitates less effort.
Overcomes Limitations of Traditional Sculpting and Tightening Method
Patients today are looking for ways to recover their youthful facial and body shapes. To date, there were only two options: surgical contouring by internal fat-dissolving operations or external skin tightening with unpredictable and poor accurate results. In both circumstances, the patient's or physician's cost-benefit ratios are far from optimal. Within a single session, the ACCULIFT method allows you to provide reproducible and natural contouring that will meet the patient's expectations.
Mechanism of Laser Liposuction
Goldman argued that while evaluating the efficacy of laser liposuction with certain equipment, two properties must be examined. Different wavelengths for laser liposuction have been chosen in an attempt to crush fat, collagen (water), and blood vessels precisely. These chromophores will selectively absorb laser energy based on their reflection coefficient at various wavelengths, according to a selective photo-thermolysis hypothesis. Various wavelengths have been tested for interactions within the subcutaneous layer, including 924, 968, 980, 1064, 1319, 1320, 1344, and 1444 nm.
Certain wavelengths lead to better lipolysis. The 924 nm wavelength delivers the greatest selectivity for fat dissolving; however, it may not be as successful for skin tightening as other techniques until paired with another wavelength. They go on to say that the wavelength of 1064 nm has strong permeation but minimal fat absorption.
The 1064 nm wavelength's reduced fat absorption may be compensated by its improved heat dispersion and hence skin tightening function. Finally, the 1320 nm wavelength exhibits more fat absorption with less tissue permeation and dispersion, making it potentially safer for use on more delicate areas like the neck, inner thighs, and arms.
Additional mechanisms of action in laser lipolysis include photoacoustic, photomechanical, and photothermal effects. Heat, on the other hand, is the key stimulant for lipolytic and skin-tightening actions. McBean and Katz measured temperature changes within a defined treatment region during a 2008 pilot investigation on the safety and efficacy of a combination 1064nm/1320nm device. When compared to the external temperature as recorded by an infrared thermometer, inside temperatures differed by several degrees Celsius. According to Mordon's mathematical analysis and additional thermoregulatory investigations, collagen thermal degradation and consequent skin tightening require an internal temperature of 48 to 50°C. External temperatures of 38°C to 41°C were shown to be safe and effective. New collagen ﬁbers, myofibroblasts, and lipolyzed fat cells were seen on histological slides taken from skin biopsies.
Indications of Laser Liposuction
Body contouring via dissolution of localized aggregates and skin tightening via new collagen production are the two main indications for laser lipolysis. Any area with undesirable fatty tissue and moderate skin laxity is a candidate for laser lipolysis. The submandibular area, upper arm, abdomen, back hip, thigh, knee, calf, and ankle are all examples of these. Individuals who have had past liposuction or other surgical techniques, such as abdominoplasties, and have abnormalities or uneven areas are great candidates.
Further than the typical liposuction candidates, laser lipolysis may have a special function to play in specific situations, settings, or scenarios. Fibrous tissues like the male breast, hips, and back, for example, maybe well-suited to laser lipolysis. The smaller cannula size used for lipolysis may help fat dissolve in fibrous areas without causing the extra pressure that bigger cannulas cause.
Small patches of fat may not have been eliminated by earlier lipoplasty or other body reshaping procedures, therefore laser lipolysis is appropriate for revision surgeries. Stebbins and Hanke published publications that discuss the use of laser lipolysis for lipoma ablation. Lipomas larger than 10cm may leave distressing marks. They present a step-by-step procedure for removing big lipomas using laser lipolysis alone or in combination with suction aspiration.
Another idea that laser liposuction surgeons are adopting into their treatment regimens is combining modalities. Stebbins and Hanke discuss how they combined fractionated carbon dioxide laser rejuvenation with laser lipolysis of the submandibular area to improve new collagen production and skin tightening both internally and externally.
How to Choose the Right Patients?
A patient who is slim, healthy, and has discrete areas of biodegradable fat is a great candidate for laser liposuction. Prior to undergoing the surgery, a thorough examination and patient education are required. Individuals with excessive body fat are less likely to obtain significant effects. Laser liposuction should not be used as a substitute for a healthy diet and exercise program.
A complete history should be collected during the counseling session, and the patient's objectives should be clearly expressed. For example, a patient may be having laser liposuction for a specific purpose. " I've had this area since adolescence, and it's always hurt me,". "I eat well and exercise consistently, but I can't seem to shed this last pound." "I'm going to get married the following weekend." Patients that make the first two statements will have a reasonable expectation of their outcomes, however, the third patient will need to be educated on how quickly outcomes should be anticipated. The doctor can better understand the chances of fulfillment from the treatment by assessing the patient's motivation.
Patients should, once again, be in good general health. Some organizations need medical clearance for patients over the age of 60 or for those who have heart disease, hypertension, or diabetes. Lidocaine overdose and decreased lidocaine metabolism put individuals with liver problems, prior chemotherapy, and antiretroviral medications at risk. It's also a good idea to check for medication allergies. Prior to the surgery, patients should be given a list of drugs to avoid that may affect lidocaine absorption. Blood-thinning medications like warfarin, clopidogrel bisulfate, aspirin, and nonsteroidal anti-inflammatory drugs are all contraindicated. Lidocaine metabolism can also be slowed by drugs that block the cytochrome P450 liver enzymes, such as selective serotonin reuptake inhibitors antidepressants, or azole antifungal treatments. Hepatitis panel, complete blood count with differential, partial thromboplastin time (PTT), prothrombin time (PT), platelets, human immunodeficiency virus (HIV), pregnancy test, and serum chemistry should all be included in the laboratory evaluation.
The patient should be seated in a well-lit environment wearing only a disposable paper suit for the physical examination. The surrounding liposuction cosmetic areas, in addition to the treatment area, should be evaluated. Even if a patient's initial concern was with his or her tummy, treatment of both the abdomen and hips may be beneficial for ideal body contouring. Any abnormalities, dimples, or scars should be recognized before the treatment to avoid them being misinterpreted as postoperative faults.
Advantages of Laser Liposuction
The most frequently reported benefits are the ease with which patients can recuperate. When compared to traditional liposuction, laser liposuction may reduce post-operative pain and the amount of swelling and hyperpigmentation. The decrease in the degree of discoloration and swelling after laser lipolysis could be explained by laser-induced clotting of blood vessels and blockage of lymphatic vessels. Liposuction with a laser decreases tissue damage during fat extraction, resulting in faster tissue repair. As a result, patients are able to resume their normal activities more quickly. Overall, when compared to traditional liposuction, the safety of body reshaping with laser liposuction may be increased. The procedure improves the safety of both the surgeon and the client.
Fat emulsification provides for more efficient fat extraction while reducing hand fatigue. When compared to traditional liposuction done by qualified surgeons, the number of touch-up treatments may be reduced. Laser liposuction is preferable over liposuction because of two distinct clinical goals. Laser liposuction is the best option for stimulating collagen synthesis and consequent skin contraction when the primary objective of the surgical treatment is to cure skin elasticity rather than body contouring. Laser liposuction may help with volume debulking in greater volume cases of body contouring by dissolving the fat before suction and reducing blood loss during the process.
Disadvantages of Laser liposuction
Laser lipolysis has a number of disadvantages. Although laser liposuction has been used effectively as a stand-alone operation for body sculpting, some doctors argue that it is a complement to traditional liposuction rather than a replacement. Because many experiments do not evaluate this variable, under correction following laser liposuction could be caused by insufficient total energies. Concentrated energy transfer, like any new technology, comes with a steep learning curve, but it reduces the risk of unintended tissue injury. Although the slope is relatively steep in expert hands, there is a large learning curve involved with laser liposuction.8 As a result, concentrated energy transmission occurs, reducing the risk of unintended tissue injury.
The concept that high-temperature impacts on tissue are the principal mechanism of action in laser liposuction has substituted or replaced most of these proposed actions. Khoury et al., for example, argued that photoacoustic ablation causes thermal damage, despite the fact that photoacoustic damage is difficult to assess histologically. Photothermal effects are also secondary to photo-stimulatory effects on tissue. As a result, a solely thermal effect termed "photo-hyperthermia," is the preferred mode of action for laser liposuction. Coagulation of collagen fibers, thrombosis of arteries, damage to nerve endings, and reversible (tumefaction) and irreversible (lysis) damage to adipocytes are all thermal effects after laser liposuction, depending on the energy utilized. Fat cell tumefaction is caused by a change in intracellular and extracellular sodium and potassium balance caused by low laser energy.
As a result of the heat generated by laser radiation in the tissue, cellular membrane disintegration (adipolysis) occurs as a result of protein denaturation. The thermomechanical effect may potentially play a role in laser liposuction, according to some scientists, because laser treatment of fat tissue causes fat cell rupture. Skin contraction was indicated by a heating effect in a recent mathematical model of laser lipolysis employing systems with wavelengths of 980 nm and 1064 nm. Mordon et colleagues revealed that collagen remodeling was caused by bioheat transfer induced by laser light. In other terms, the adipose layer converts laser light energy into heat energy. This spreads through the dermis and then to the epidermis, finally reaching the skin's surface. Temperatures of 48°C-50°C must be attained within the dermis, according to the mathematical model, to cause collagen contraction and skin tightening.
What are the Side Effects of Laser Treatment?
According to a prospective trial of 537 patients, the complication rate after laser liposuction is exceedingly low inexperienced hands, estimated at approximately 1 percent. The most common side effects are ecchymoses, swelling, and pain, which are identical to those anticipated following liposuction and are usually minor in intensity.
Hyperpigmentation and numbness or tingling have also been recorded. Seroma, infection, neurotoxicity, and small contour problems are all potential adverse effects that are identical to liposuction-related sequelae.
The heat created by the laser fiber is often the source of some of the most common side effects associated with laser liposuction. The chance of a heat injury rises if the laser energy is too great or the local temperature goes above 47°C. Skin burns were observed in this study of 537 patients who were treated with a 1064 nm Nd: YAG laser.
Although most studies on laser liposuction state that it has a noticeable benefit over classical liposuction in terms of less bruising, the experts have refuted this statement with a case-reports and retrospective analysis. After laser liposuction with an Nd: YAG system, three of 44 patients in the study developed significant ecchymoses with soreness that lasted beyond the disappearance of bruises. Lack also discovered that laser liposuction patients had more swelling, ecchymosis, skin irritation, and pain than those who had classical liposuction, however. no scientific analysis was done. Blistering of the skin is a direct outcome of heat damage to the skin surface. Treatment that is applied to the surface of the skin is more likely to cause epidermal damage. When the skin surface temperature hits 47°C, epidermal damage is common, with blisters occurring at temperatures of 58°C or higher. In actual practice, however, epidermal blisters have been observed at temperatures well below 58°C. As a result, continuous thermal monitoring is essential, with the temperature goal not exceeding 40°C
The presence of tumescent fluid may help to protect the epidermis. Cooled tumescent fluid infiltration significantly lowers skin surface temperature. The huge volume of tumescent fluid used for anesthesia acts as a heat transfer storage. Similarly, to how cooled tumescent fluid reduces skin surface temperature, tumescent fluid warmed by laser light from bioheat transfer may promote epidermal heating, with temperatures rising beyond the treatment time. As a result, we recommend using an infrared temperature sensor or equivalent technology to keep a close eye on skin surface temperatures. When a temperature of 38°C-40°C is reached, we often stop laser lipolysis in that location, knowing that the maximum temperature may reach 41°C several minutes later. If this happens, we use an ice bath to immediately cool the region.
The consequences of laser lipolysis on serum lipid levels are a theoretical concern. The release of intracellular components from laser-induced fat cell rupture, and how it is processed by the body are unknown. There has been no alteration in serum lipid levels after laser lipolysis. Mordon et al. looked at sequential lipid profiles in four individuals for 30 days after laser liposuction and observed no differences from baseline. Goldman et al used a 1064 nm laser to perform laser liposuction and found no rise in cholesterol or triglyceride levels afterward. In 39 patients who had laser liposuction with 1064, 1320 nm, or multiplex (1064 and 1320 nm) devices, Woodhall et al showed no difference in triglycerides. There appears to be no lipid-related kidney or liver toxicity risk following laser liposuction because blood lipid levels do not rise. Although mechanisms of action have been proposed, lipid metabolism following laser liposuction has not been explored. Lipid metabolism can take place slowly, preventing fluctuations in serum lipid levels, or lipids can be removed via phagocytic digestion by macrophages.
Liposuction is now one of the most sophisticated cosmetic procedures in the world, having been around for more than four decades. The surgical procedure is straightforward and has a low risk of complications. However, if you want to achieve excellent aesthetic results while avoiding the most serious complications, you will need a thorough technical education and a lot of expertise.
Liposuction has a wide range of therapeutic applications in both cosmetic and functional and corrective surgery. Obesity, which had previously been a definite criterion for exclusion, was no longer seen as such.
Liposculpture is an excellent way to reshape the body's contour in patients who have lost a large amount of weight. However, in order to get excellent cosmetic outcomes, excision operation to remove excess skin must always be combined. The suction of adipose tissue allows for the creation of empty spaces, which makes treatment easier, faster, and less prone to complications.
Liposuction has recently become very popular as a procedure for harvesting endogenous fat and adipose-derived stem cells (ASCs). Lipofilling is usually applied procedure in a variety of clinical conditions, including asymmetry and contour abnormalities, volume loss, improving retrograde or atrophic scars, and regenerative medicine for the management of chronic wounds.
Adipose tissue has received a lot of attention lately. Many research in the last few years have shown that adipose-derived stem cells have a wide range of differentiation and regeneration potential.