Methods

Since 2009, the senior author had performed laser‑assisted liposuction on more than 144 patients in an outpatient setting using tumescent anaesthesia. Forty-six of these patients have had laser-assisted facelifts. The facelift procedure is usually a 3 hour procedure and there have been no complications with the facelift flaps — even following laser-assisted lipolysis. Laser liposuction in combination with surgical procedures or fat injections has not resulted in complications.

Results

The patient shown in Figure 1a underwent a surgical necklift under tumescent anaesthesia following the use of laser liposuction. The laser device used (1064 nm and 1320 nm) was the Smartlipo MPX™ (Cynosure, Westford, MA, USA) at a setting of 10 watts (4 Watts of 1320 nm and 6 Watts of 1064 nm) with the 600 µm fibre. Skin temperatures were up to 36 °C, and a total of 1506 J was delivered. The tumescent solution was infiltrated subcutaneously followed by use of the laser in the same plane. The laser fibre and cannula were helpful in developing the facelift/necklift plane. The laser was also used subcutaneously on the cheeks and temples. After the 20-minute laser treatment, the patient underwent a standard surgical necklift with plication of the platysma laterally and submentally. This patient had no delayed healing. She is shown in Figure 1b 7 months postoperatively with excellent rejuvenation of the neck.

The laser fibre, which projects 2–3 mm beyond the cannula tip, allows the sequential delivery of the energy from the 1064 nm and 1320 nm wavelengths. In the face, much of the delivery is very close to the dermis and skin temperatures are monitored superficially with an external hand-held device, as well as deeply with the SmartSense™ (Cynosure, Westford, MA, USA). Most commonly, only one laser treatment is used in the face prior to fat injections and/or facelift flap elevation. Adipose tissue for injection is harvested from non-laser treated sites. For other areas of the body, such as the thighs, the initial treatment with a larger fibre is at least one or more centimetres in depth from the dermis. Following the first laser treatment of the thighs, standard tumescent liposuction is performed to remove adipose tissue and lysis products from the laser treatment. A second laser treatment is then performed more superficially for increased dermal heating.

Figure 3 (A) Before treatment, (B) with preoperative marks applied, and (C) 5 months after laser-assisted liposuction of the posterior thighs and knees with fat grafting areas of depression in her posterior thighs

Figure 3 (A) Before treatment, (B) with preoperative marks applied, and (C) 5 months after laser-assisted liposuction of the posterior thighs and knees with fat grafting areas of depression in her posterior thighs

Patient number two (Figure 2) underwent laser treatment of the face with the 1064 nm/1320 nm laser prior to her facelift. Settings were the same as in the previous patient. Skin temperature was up to 37 °C during laser treatment. A total of 1507 J was delivered to the face and neck. During her facelift, fat was harvested from her abdomen and injected into her face for treatment of the lips, nasolabial folds, marionette lines, chin crease, and cheeks. Figure 2a shows her preoperatively and Figure 2b with her preoperative marks applied. At 2 weeks postoperatively she underwent CO2 resurfacing of the face. In Figure 2c, it is 2 months after the procedure and she shows good correction of the neck and face, but has some erythema of the surgical scars. By 9 months the erythema has diminished (Figure 2d).

Patients undergoing liposuction of areas other than the face and neck have also benefited from use of the laser combined with fat grafting (Figure 3). The patient shown in Figure 3a is preoperative. Figure 3c is 5 months after laser‑assisted liposuction of the posterior thighs and knees with fat grafting areas of depression in her posterior thighs. The laser was used at a setting of 36 Watts (12 Watts of 1320 nm and 24 Watts of 1064 nm), and the 1000 µm fibre was used. At 5 months there is improved smoothness of the thighs and good improvement of the knees.

Conclusions

A number of studies have demonstrated that laser-assisted liposuction represents a safe and efficacious alternative to traditional liposuction with the potential advantages being decreased surgical trauma and subsequent patient pain, decreased swelling, and enhanced skin retraction. The authors did not compare the therapeutic advantages of laser-assisted liposuction to traditional liposuction. However, consistent with other reports in the literature, the authors observed excellent skin retraction as well as minimal bruising and swelling.

This article reports and highlights the use of laser‑assisted liposuction in small, highly vascularised areas such as the neck, jowls, cheeks, and knees, and documents its safety when used concurrently with facelifts and just prior to fat injections. The facelift procedure is generally a 3 hour procedure and there have been no complications with the facelift flaps — even following judiciously used laser-assisted lipolysis. Overall, the authors report that laser-assisted liposuction represents a safe, useful modality in the removal of excess fat in a select patient population, and can easily be combined with other surgical procedures.