Laser Lipolysis Technology

Liposuction, which became popular in this country during the late 1970’s has undergone many technological changes during the last 3 decades.  The improvements achievable with modern liposuction techniques include:

• Improved body contouring
• Less irregularities in body contouring
• Easier treatment procedure for the patient
• Treatment of areas previously resistant to traditional liposuction
• Faster recovery time for patients

Advanced handpiece gives patients better results
The original cannulae (the hollow handpiece held by the surgeon and placed under the skin and used to remove the fat) were disposable, large bore plastic devices readily available in the operating room. These were soon displaced by more refined and narrower metal cannulae. This helped limit the size of the skin incision that was required as well as give the surgeon more control in sculpting the fat to be removed. This, thus, decreased the incidence of irregularities in contour.

Improved methods enabled more areas to be treated
The next changes involved the energy that was used to remove the fat in the area to be suctioned. Initially, a combination of mechanical energy (the back-and-forth motion of the cannulae created by the surgeon) and a negative vacuum applied by an external machine were employed.  The introduction of ultrasonic machines and power-assisted machines supplemented or replaced the mechanical energy of the surgeon. These not only made the removal of fat during liposuction easier but made in possible to treat areas that were more resistant to treatment by traditional liposuction alone.

Lasers Represent Latest Frontier in Fat Removal
Lasers are a form of light energy that have been used to treat patients by plastic surgeons and dermatologist with both medical and cosmetic practices. The application of laser technology to aid in the care of the liposuction patient, thus, represents a logical next step in the technological improvements that have been seen in the devices used to treat the patient seeking liposuction.

Focused Laser Absorption Gives Precise Results for Patients
A laser device generally emits a single wavelength of light at a time (although as we shall see later there are definitely exceptions to that statement). The surgeon chooses a device that emits a wavelength of light that is highly absorbed by the tissue being targeted. The energy in the absorbed light is converted to heat which can injure, alter or vaporize the targeted tissue. The greater the percentage of light that is absorbed, the greater the energy released, and, thus, the greater the effect on the targeted tissue.

Ideal Frequencies
In 2006, Dr. Rox Anderson of Massachusetts General Hospital and the Wellman Laboratories published a paper in the Journal of the American Society of Laser Medicine and Surgery which documented the absorption curve for lipid (fat). Peak absorptions for lipids were found at 915, 1210, and 1720 nm.

More Information on the Science of Laser Liposuction

When one considers using lasers as an aid in the treatment of the patient seeking liposuction, there are, however, two other chromophores (targets) to consider in addition to lipid. These are water and hemoglobin and they each have there own pattern of light absorption. Why are these important if it is fat (lipid) that the surgeon is trying to reduce?

1. Water is important because a laser that could target water in addition to lipid may allow the surgeon to tighten the overlying skin in addition to reducing the volume of the subcutaneous fat.
   
2. Hemoglobin is important because a laser that could target hemoglobin in addition to lipid and water might reduce the incidence of bruising after the procedure by sealing the small blood vessels in the area.

CHROMOPHORE (TARGET)	CLINICAL EFFECT (GOAL)
LIPID	FAT REDUCTION
WATER	SKIN TIGHTENING
HEMOGLOBIN	REDUCED BRUISING

The last several years had seen the introduction of many devices whose goal is just that which has been described above:

1. easier and less traumatic removal of fat
2. simultaneous tightening of the overlying skin
3. reduction of bruising
   

Each of these devices has tried to accomplish the above goals by selecting a wavelength that give them what their developers feel might be an ideal mixture of absorption by lipid, water, and hemoglobin. Naturally, as with all competing devices with the same goal, some do this better than others and all surgeons have their favorite.

Some of these devices and the wavelengths they operate at include:

1. SlimLipo™ (924nm and 975nm),
2. CoolLipo™ (1320nm),
3. SmoothLipo™(980nm), and
4. SmartLipo™(original-1064 and modified-1064/1320nm)
   

Although most of these devices actually work on the lower ends of the lipid absorption curve, enough heat is generated that the adipocytes (lipid cells) are “ruptured” by a process known as tumefaction. SlimLipo™ is the only of these devices that operates near a peak aborption for lipid). The energy of the 924 nm allows the lipid in the cell to go from a viscous to a more watery state. This is what the manufacturer (Palomar Medical Technologies) refers to as “selective lipid melting.” During the time that the lipid within the adipocyte is melting, another effect is taking place. The membrane of the cell – the outer lining that keeps the contents of the cell inside and everything else outside – is getting hotter. When the cell membrane of adipocytes are heated to about 43 °-45 ° centigrade they become leaky. The heated water lipid is, thus, able to leak out through the heated and altered cell membrane of the adipocyte. The SlimLipo™ laser can simultaneously be used at 975 nm to heat water (tighten skin), seal blood vessels, and accerlerate further the removal of fat.