Journal of Clinical and Aesthetic Dermatology

JUL 2011

An evidence-based, peer-reviewed journal for practicing clinicians in the field of dermatology

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adipose tissue. Jackson et al38 then applied LLLT externally prior to liposuction procedure. The objective of Jackson’s study was to determine whether LLLT impacted the procedure or patient recovery experience. The study noted that for LLLT-treated patients, a greater volume of fat was extracted. In addition, patients experienced a reduction in postoperative edema and pain. Finally, when blinded physicians were asked to rate their ease of extraction, the emulsified fat induced by the laser treatment was easier removed. While an increasing number of studies evaluated the effects of LLLT through the early 2000s, controversy remains regarding the efficacy of this treatment at a clinical level. A recent 2011 study by Zelickson et al39 evaluated five patients who underwent LLLT (Zerona System, Santa Barbra Medical Innovations, Dallas, Texas) independent of liposuction. Study participants received six treatments over a two- week period and patients were evaluated by three blinded dermatologists one week and one month after treatment. Circumference measurements failed to reveal statistically significant reduction. Ultrasound evaluation did not demonstrate significant reduction in fat layer thickness. The three blinded dermatologists who evaluated the patients identified treatment photographs correctly 51.1 percent of the time. Three of the five patients recorded a “dissatisfied” rating on satisfaction questionnaires and all subjects reported the effects of treatment were less than expected. The authors concluded that more studies were required to show clinical circumferential reduction before LLLT can be AESTHETIC UPDATE 32 [ July 2011 • Volume 4 • Number 7] recommended as an effective therapeutic option. Cryolipolysis is an additional modality that has been shown to selectively damage subcutaneous fat without causing damage to the overlying skin. The method is felt to occur via cold-induced apoptosis of adipocytes.38 Still in its infancy, this procedure shows promise. However, additional studies are underway to clarify treatment parameters and safety profile. These two systems are not yet on par with the current safety and efficacy data of laser lipolysis. Latest Development and Future Considerations A new 1444nm device was recently FDA approved for the surgical incision, excision, vaporization, ablation, and coagulation of soft tissue. This latest device comes after the publication of a 2009 Korean study suggesting superior lipolytic effect of this wavelength over other devices by quantifying oil production and histological evaluation.40 Further studies are necessary to substantiate these conclusions. Surgeons are now combining procedures, such as fractional laser or radiofrequency devices, with laser lipolysis to create a synergistic effect of skin tightening. An additional laser lipolysis device (Cynosure’s Triplex Workstation, Cynosure) has been introduced to the market. It utilizes three wavelengths: 1064, 1320, and 1440nm. The objective behind adding three wavelengths in one system is to enhance the efficacy and rate of lipolysis and improve skin tightening, reducing operative time. Safety measures that include a subcutaneous temperature monitoring system and motion sensing devices have also been implemented to minimize overtreatment and thermal complications. Clinicians are also excited about the possibility of laser lipolysis for cellulite reduction. Many surgeons have noted an improvement of cellulite after laser lipolysis procedures. They believe that the causes of cellulite are multifactorial, including conformational changes in fibrous septae within the hypodermis that lead to herniation of subcutaneous fat into the dermis.41 Goldman42 recently published an article combining 1064nm pulsed Nd:YAG laser and autologous fat transfer demonstrating improvement of this elusive condition. Additional laser and light devices will continue to advance in an effort to optimize patient safety and clinical efficacy. Current devices are already being investigated for additional purposes such as cellulite treatment, hyperhidrosis, facial sculpting, and periorbital adipose tissue and skin tightening. Future considerations will include more precise laser and light devices, improved technology, and a reduced side effect profile. For laser lipolysis specifically, treatments will be designed to optimize energy output while minimizing side effects, hastening recovery, and improving operator time. References 1. http://www.fda.gov/consumer/ updates/liposuction082007.html. 2. Goldman A, Schavelzon DE, Blugerman GS. Laser lipolysis: liposuction using Nd:YAG laser. Rev Soc Bras Cir Plast. 2002;17:17–26. 3. Badin A, Moraes L, Gondek L, et al. Laser lipolysis: flaccidity under control. Aesthetic Plast Surg.

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