Prs Journal

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COSMETIC

A Prospective, Randomized, Double-Blind,Controlled Clinical Trial Comparing

Laser-Assisted Lipoplasty withSuction-Assisted LipoplastyArturo Prado, M.D.

Patricio Andrades, M.D.Stefan Danilla, M.D.

Patricio Leniz, M.D., Ph.D.Paulo Castillo, M.D.

Fancy Gaete, M.D.

Santiago, Chile

Background: The authors randomized and prospectively analyzed their clinicalexperience with the use of internal neodymium:yttrium-aluminum-garnet low-level laser-assisted lipoplasty compared with suction-assisted lipoplasty.Methods: Suction-assisted lipoplasty was generated through a SmartLipo ma-chine and delivered into the subcutaneous tissues through 2-mm solid opticalprobes. Ipsilateral suction-assisted lipoplasty and contralateral laser-assisted li-poplasty were performed on one or more comparable topographic areas of thebody in the same patient. Laser-assisted lipoplasty and suction-assisted lipoplasty

sides of 25 patients were compared with preoperative and postoperative pho-tographs at 3 to 5 days, 12 to 15 days, and 6 to 11 months. Statistical analysisconsidered surgeon and patient satisfaction, time used in the procedures, learn-ing curves, lipocrits, operative technique, postoperative pain, edema, ecchymo-sis, time of recovery, body mass index, DNA proteins, free fatty acids, andcytologic patterns of postlaser-assisted lipoplasty and suction-assisted lipoplastyadipocyte architecture. Photographs were sent to the patients (blinded to theoperated sides) and two plastic surgeons unfamiliar with the cases for evaluationof results.Results: All patients completed the preestablished follow-ups. No complications

were observed. Less pain, lower lipocrits, higher triglycerides, and DNA cellularmembrane traces were detected in the laser-assisted lipoplasty sides. All otherconsiderations studied showed no differences with either technique in the threeperiods of the follow-up controls. Cytologic studies showed more damage of theadipocytes in the laser-assisted lipoplasty sides.Conclusions: No major clinical differences for suction-assisted lipoplasty versuslaser-assisted lipoplasty were found. Higher concentrations of free-fatty acidsafter laser-assisted lipoplasty must alert us to possible hepatic and renaltoxicity. (Plast. Reconstr. Surg. 118: 1032, 2006.)

Since 1980 and after its presentation in themedical literature,1,2 traditional suction-assisted lipoplasty has today become the

most commonly performed aesthetic surgical

procedure3 and is executed with preference inaccredited outpatient plastic surgery facilities.4

When suction-assisted lipoplasty is performed af-ter competent training, it has low rates of com-plications, predictable recovery periods, andhigh patient satisfaction.5 8 Body contouringprocedures that use low-energy neodymium:yttrium-aluminum-garnet laserassisted lipo-plasty devices have recently gained considerableattention in Europe and South America,9,10

claiming many benefits over the traditionalmethod.11

Laser has been used extensively in many fieldsof plastic surgery,12 but only a few reports haveaddressed its role in liposuction. Credit for thedevelopment of neodymium:yttrium-aluminum-

From the Division of Plastic Surgery, School of Medicine,University of Chile.Received for publication June 22, 2005; accepted August 19,2005.Presented in Hot Topics in Plastic Surgery and discussedby Dr. Nolan Karp at the combined American Society of Plastic Surgeons/Plastic Surgery Education Foundation/American Society of Maxillofacial Surgeons 73rd AnnualScientific Meeting, Plastic Surgery 2004, in Philadelphia,Pennsylvania, October 10 through 13, 2004.Copyright 2006 by the American Society of Plastic Surgeons

DOI: 10.1097/01.prs.0000232428.37926.48

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garnet fibers and special cannulas used for laser-assisted lipoplasty must be given to Apfelbergand Fodor, who arduously guided multicenterU.S. Food and Drug Administrationapprovedclinical studies in the United States from 1994 to1996 that failed to show any advantages oversuction-assisted lipoplasty.1315

A la ser de vice called SmartLipo (Deka,Calenzano, Florence, Italy) was introduced to

the market some years ago and was supposed to

work (as stated by the manufacturer) for inter-stitial laserlipolysis provoking a breakdown ofthe membranes of the adipocytes transformingthem into an oily substance. This was substan-tially different from the studies presented byNeira et al.,22,23 who had proposed the use ofexternal (and not internal) low-level laser ther-apy as an adjunct to suction-assisted lipoplasty.In South America, sumptuous marketing made

in favor of this specific laser has promoted many

Fig. 1. A 38-kg SmartLipo laser device (Deka) with a helium-neon source of energy for as-

sistance with lipoplasty.

Fig. 2. Energy is delivered subcutaneously through a neodymium:yttrium-alumi-

num-garnet 2-mm protected (Teflon) optical fiber (above) with a diode marker on

the tip of the probe that must be cut and discarded after the procedure. Nonpro-

tected optical fiber (below).

Volume 118, Number 4 Comparison of Lipoplasty Techniques

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unproven benefits over the traditional method.11

No scientific evidence supports the use of thistechnology, and there are still many unansweredquestions.

As advertising in our local media introducedthis explosive blend of laser and liposuctionas an extraordinary innovative operation, ourcosmetic patients are still overwhelmed. Theuse of any prototype machine in humansshould follow the principle of research beforecommerce.38 For this reason, a prospective,randomized, double-blind, controlled clinicaltrial was designed to compare outcomes be-tween suction-assisted lipoplasty and laser-assisted lipoplasty in patients undergoing aes-thetic body contouring surgery.

PATIENTS AND METHODS

Patients

Between July of 2004 and February of 2005,we consecutively operated on 25 patients se-lected for having localized body lipodystrophies,body mass index in normal ranges (20 to 25kg/m2), and less than 1800 ml of preoperativeestimated suction volumes (3 percent of the pa-tients weight in kilograms). All the procedureswere performed by the senior author in accred-ited outpatient plastic surgery facilities, with lo-cal anesthesia, but always under the surveillanceof an anesthesiologist.

Study Design

A double-blind, randomized, matched, con-trolled trial was designed. The patients wererandomly allocated to undergo suction-assistedlipoplasty and laser-assisted lipoplasty on the leftand right body halves (ipsilateral suction-as-sisted lipoplasty and contralateral laser-assistedlipoplasty) in one or more comparable body

areas. Specially designed informed consent

forms for this prospective and randomized clin-ical study were signed by all the patients underthe supervision and acceptance of the ethical

board of our clinical hospital.

Table 1. Topographic Front and Back Body Areas and Minimum/Maximum Energy Delivered

Laser Energy (J) Time (sec)

Zone Minimal MaximalCycles

per Second (Hz) Minimum Maximum

Submental 200 400 6 40 70Posterior axilla 400 700 6 70 110

Subscapular 400 700 6 70 110Lumbar 700 1000 6 110 180Arms 350 750 6 70 110Medial thighs 400 700 6 70 110Trochanter 700 1000 6 110 180Medial knees 400 700 6 70 110

Ankles 400 700 6 70 110Abdomen 750 1000 6 110 180

Fig. 3. Immediately after finishing the operation, the aspirated

specimens of each side (suction-assisted lipoplasty on the left

and laser-assisted lipoplasty on the right) were photographed.

(Above) Colors were different;laser-assisted lipoplastysides (left)

hada lighter yellow color when compared with suction-assisted

lipoplasty sides(right). Samples for DNAcellularmembrane, free

fatty acids and triglycerides and lipocrits were taken and mea-

sured (below).

Plastic and Reconstructive Surgery September 15, 2006

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Surgical Technique

The laser-assisted lipoplasty instruments con-sisted of a 38-kg SmartLipo laser device with ahelium-neon source of energy for the assistance oflipoplasty (Fig. 1). The energy was delivered sub-cutaneously through a 2-mm fiber that after the

procedure had to be cut and discarded (Fig. 2).The procedure started with the tumescent infil-tration (1000 cc of lactated Ringers solution, 1 ccof adrenaline, and 60 cc of 2% lidocaine). Afterwaiting 10 minutes, we introduced the 2-mm op-tical fiber through 1- to 2-mm skin punctures. Thefiber has a diode marker on the tip that can beseen from the undersurface of the skin whenpassed with the neodymium:yttrium-aluminum-garnet laser working over localized zones. We ap-plied 500 J for each zone and equivalent to thepatients palm of the hand (Table 1). After fin-

ishing each zone with the laser, we aspirated thecontent with a multifenestrated 3-mm cannula un-til the volume was equal to the infiltration rate (1:1ratio). The cannulas were moved gently, to allowthe liquefied fat to be suctioned rather thatavulsed. Then, 6-0 nylon sutures were used to closethe 2-mm puncture wounds.

The suction-assisted lipoplasty instrumentsconsisted of multifenestrated 3-mm cannulas andan aspiration machine (Eastern ES-700; EasternMedical Apparatus Works, Taipei, Taiwan) thatwas regulated to give a vacuum pressure of 35 to

50 cmHg. The same tumescent infiltration and 1:1

suction ratio was used with the traditional methodof suction-avulsion of fatty tissue. To comparesides, we used the pinch test, observing symmetryfrom the top and caudal extremes of the operatingtable, finishing the operation with a wraparoundTopiFoam (Byron Medical Inc., Tucson, Ariz.) or

Reston (3M, St. Paul, Minn.) and elastic garments.We uncovered the zones at days 3 to 5, taking off

Table 2. Patient Characteristics and Outcomes by Group*

Variable SAL (n 25) LAL (n 25) p

Duration of surgery, minutes 0.0005Median 45 60IQR 4055 5575Range 4080 4580

Strasser score NSMedian 3 3IQR 34 34Range 19 013

Pain (VAS) 6.7 0.9 6.0 1.1 0.0001Ecchymosis (five-point scale) NS

Median 2 2IQR 23 23Range 15 15

Edema (five-point scale) NSMedian 3 3IQR 33 33Range 15 14

Retraction (five-point scale) NSMedian 1 1IQR 11 11Range 12 12

Lipocrit 22.5 0.5 14.9 0.7 0.0001

SAL, suction-assisted lipoplasty; LAL, laser-assisted lipoplasty; IQR, interquartile range; NS, not significant; VAS, visual analogue scale; BMI,body mass index.*Mean age, 36.5 9.5 years; female gender, 100 percent; mean body mass index, 24.5 2.5.

Fig. 4. Box-plot of pain (visual analogue scale) by technique at

first and second and follow-up visits: left, suction-assisted lipo-

plasty; right, laser-assisted lipoplasty. Box-plot explanation: up-

per horizontal line, 75thcentile; lowerhorizontalline, 25th centile;

horizontal bar(thicker line within box), median; upper horizontal

baroutsidebox,90thcentile; lowerbaroutsidebox,10thcentile.In

this case, the median and 75th centile have the same value, de-

noted by the thicker line.


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the foams and leaving only the elastic clothingover plain skin.

Outcomes

Laser-assisted lipoplasty and suction-assisted li-poplasty sides were compared with preoperative

photographs, and after postoperative days 3 to 5and 12 to 15 and at 6 to 11 months, 25 patientscompleted all the preestablished postoperativecontrols and their results were sent to two blindedplastic surgeons (unfamiliar with all the cases andthe patients) for evaluation of the results for thesuction-assisted lipoplasty and laser-assisted lipo-plasty sides.

Cosmetic ResultsCosmetic results were assessed by an objective

grading system according to the method de-

scribed by Strasser.24,25 This scale has five items:malposition, distortion, asymmetry, contour de-formity, and scar. Each item is graded as excellent(0 points), good (1 point), mediocre (5 points), orpoor (15 points). The addition of all graded itemsshowed a final result ranging from 0 to 75. This

final score was considered excellent if it was equalto zero, good between 1 and 4, mediocre between5 and 14 points, or poor with more than 15. Thecosmetic outcome was assessed independently foreach side at the follow-up visits.

Symptoms and SignsPostoperative pain was assessed by the senior

surgeon, separately for each side, 24 hours afterthe operation and then at days 3 to 5, using a visualanalogue scale ranging from 0 to 10 (where 0 no pain at all and 10 maximum imaginablepain). Edema, ecchymosis, and retraction were

scored (1 none, 2 less, 3 moderate, 4 excessive, and 5 maximum).

Time of RecoveryTime of recovery was measured in days, with

recovery being defined as the day after which thepatient was able to work with no pain.

Fig. 5. Microscopic formalin fixation (hematoxylin and eosin)

study of the suction-assisted lipoplasty and laser-assisted lipo-

plasty infranatant aspirate cellularity performed under 20 and

40magnifications revealed two groups of results: group I, 25

suction-assisted lipoplasty sides with 90 percent conserved ar-

chitecture of the adipocytes with intact nuclear cellular mem-

branes (above); and group II, 25 laser-assisted lipoplasty sides

with 90 percent disrupted architecture of the adipocytes and

rupture of the nuclear cellular membranes (below).

Fig. 6. Both groups showed intact capillary vessels.(Above)Suc-

tion-assisted lipoplasty and (below) laser-assisted lipoplasty.


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Body Mass IndexBody mass index was assessed at the beginning

and at the last follow-up control as follows: 18.5 to19.9, lean; 20 to 25, normal; 25.1 to 29.9, over-weight; 30 to 34.9, obese range; 35 to 39.9, mor-bidly obese; 40 or greater, extremely obese.

Surgical Operative TimeSurgical operative time was measured sepa-

rately for each side, in minutes.

LipocritThe lipocrit is the volume (measured as a

percentage of the suspension) of packed redblood cells in a sample taken from the infrana-tant portion of the decanted aspirate after wait-ing 1 hour and was performed immediately afterfinishing the laser-assisted lipoplasty/suction-as-sisted lipoplasty operation and was also photo-

graphed (Fig. 3).Histopathologic StudyCytologic patterns (hematoxylin and eosin

tinctures) of postlaser-assisted lipoplasty and suc-tion-assisted lipoplasty infranatant specimenswere taken to determine adipocyte architecture(10 to 40 microscopy). A masked pathologistevaluated the level of disruption of the fatty aspi-rate, reflecting the level of damage inflicted to thetissue.

Other Studies

Other studies included study of DNA cellularmembrane proteins, free fatty acids, and triglyc-erides measured in milligrams per deciliter (gaschromatography) of the infranatant lipoaspiratedspecimen.

Statistical AnalysisFor paired comparisons within groups (suc-

tion-assisted lipoplasty or laser-assisted lipoplasty),the paired t test and Wilcoxon matched-pairssigned-rank test was used according to the distri-bution of variables (Shapiro-Wilk test). For re-peated measures comparisons between groups,

generalized estimating equation models wereused, adjusted for possible confounders such asage, sex, pain, and others. For nonpaired com-parisons, standard tand Wilcoxon tests were used.Normally distributed continuous variables weredescribed by mean SD. Nonparametric contin-uous and ordinal variables were described by me-dian and ranges. Categorical variables were de-scribed in percentages. All reported pvalues weretwo-sided and not adjusted for multiple testing. Analpha level of0.05 was considered statisticallysignificant. All confidence intervals were calcu-

lated at 95 percent.26

For statistical analysis, the

Stata software was used (Version 8.0; Stata Corp.,College Station, Texas).

RESULTSAll of the patients were female (100 percent).

The mean age was 36.5 9.4 years. A total of 220sides were treated, 110 with laser-assisted lipo-plasty and 110 with suction-assisted lipoplasty, witha mean lipoaspirate volume of 512 cc (125 to 900cc per side). No complications were observed inthe series (Table 2).

Cosmetic Results

Considering the four final groups and the fiveheadings of the Strasser scale for the evaluation ofcosmetic results, there were no differences be-tween laser-assisted lipoplasty and suction-assistedlipoplasty. Also, the Strasser score did not changewith the follow-up visits (p not significant, gen-eralized estimating equations). Furthermore, in amultivariated model made to control for the ef-fects of age, ecchymosis, edema, retraction, andpain as possible confounders, no significantchange was seen in favor of laser-assisted lipoplastyor suction-assisted lipoplasty regarding aestheticoutcomes.

Symptoms and Signs

Ecchymosis (median, 2; range, 1 to 5), edema(median, 3; range, 1 to 4), and retraction (me-dian, 1; range, 1 to 2), did not differ betweengroups and suffered no changes in the first andsecond postoperative follow-up visits (p notsignificant, generalized estimating equations).Postoperative pain was higher in the suction-assisted lipoplasty side versus the laser-assistedlipoplasty side at the first follow-up visit (6.8 0.8 versus 5.7 0.9, p 0.0001, t test) but was

no different at the second follow-up visit (com-bined: 6.5 1.0, p 0.4179, t test); however,pain was higher at the second visit comparedwith the first on the laser-assisted lipoplasty side(5.7 0.9 versus 6.4 1.1, p 0.0014, pairedttest) without differences in the suction-assistedlipoplasty sides (6.8 0.8 versus 6.6 1.0, p0.3563, paired ttest). Overall, there was less painin the laser-assisted lipoplasty side when com-pared with the suction-assisted lipoplasty, side asseen in Figure 4 (coefficient, 0.66; 95 percentconfidence interval, 0.9 to 0.4; p 0.0001,

generalized estimating equations).


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Recovery Periods

Recovery after the surgery was 16.6 4.0 days.We were not able to compare the groups becauseeach patient received both interventions.

Body Mass Index

With a mean body mass index of 24.4 2.5

kg/m2

for the group, there was no difference be-

tween the preoperative and postoperative finalcontrols.

Surgical Time

Surgical time was longer for the laser-assistedlipoplasty sides (median, 60 minutes; range, 45 to80 minutes) when compared with the suction-as-sisted lipoplasty sides (median, 45 minutes; range,

40 to 80 minutes) (p

0.0005, Wilcoxon).

Fig. 7. Suction-assisted lipoplasty (on the patients left side) and laser-assisted lipoplasty (on

the patients right). Strasser objective grading system for the evaluation of cosmetic surgical

results rated asgoodin this 26-year-old woman, with a body massindex of 24. A total of 2100

J was delivered, anda1300-ml volume wasaspirated. Preoperatively (above) and 4 days post-operatively (below).


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LipocritsThe laser-assisted lipoplasty sides had lower

lipocrits when compared with the suction-assistedlipoplasty sides (14.9 3.3 versus 22.5 2.7; p0.0001, t test with statistical significative differ-ence).

Histopathologic Study

Microscopic formalin fixation and tincture ofthe samples with hematoxylin and eosin study ofthe suction-assisted lipoplasty and laser-assisted li-

poplasty infranatant aspirate cellularity per-

formed under 20 and 40 magnifications re-vealed two groups of results (Fig. 5).

Group IGroup I consisted of 25 suction-assisted lipo-

plasty sides with 90 percent conservedarchitectureof the adipocytes with intact nuclear cellular mem-brane.

Group IIGroup II consisted of laser-assisted lipoplasty

sides with 90 percent disrupted architecture of the

adipocytes and rupture of the nuclear cellular

Fig. 8. The same patient as shown in Figure 7, 15 days postoperatively (above) and 6 months

postoperatively (below).


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membrane. Both groups showed intact capillaryvessels (Fig. 6).

Other Studies

Of 50 infranatant postlipoplasty samples, 17

were randomly allocated and sent for the study ofDNA cellular membrane proteins (specific mark-ers for DNA), triglycerides, and free fatty acids(gas chromatography). Ten samples were positivefor DNA proteins and coincidently had elevatedconcentrations of triglycerides, and all matchedwith the laser-assisted lipoplasty sides.

Illustrative Cases

Three clinical cases with Strasser scale resultswere rated as good, mediocre, and poor (Figs. 7

through 12).

DISCUSSIONLipoplasty procedures predominantly are indi-

cated to treat localized fat deposits and not for obesitycorrection. Consequently, our sample had medianlipoaspiration volumes of 512 ml per side and onlyincluded patients with normal body mass indexes.

To determine which is the best way of assistingliposuction techniques, standardized clinical, pro-spective, and randomized protocols that comparetwo different techniques should be made on pa-tients serving as their own control,2730 and the twomethods should be applied to comparable con-tralateral topographic and symmetric body parts.This could be considered an arguable procedureafter operating on the same patient but perform-ing separate techniques on each side of the bodythat could eventually produce asymmetry, but thiswas not the case after this trial. The question then

is, compare it to what? To the standard technique

Fig. 9. Suction-assisted lipoplasty (on the patients right side) and laser-assisted lipoplasty (on the patients left). Strasser objective

grading system for the evaluation of cosmetic surgical results rated as a mediocre result in this 32-year-old woman, with a body mass

index of 26. A total of 2800 J was delivered, and a 1600-ml volume was aspirated. (Above) Preoperatively and (below) 5 days

postoperatively.


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in existence? This is suction-assisted lipoplasty,which has worked well and is safe and effective.6

Thus, a new surgical approach that could eventu-ally replace another in use must be proven to beat least equal or superior to traditional suction-assisted lipoplasty,27 and this was the main purposeof this study. Early in this trial, we found that ourmain concern was to avoid producing asymme-tries, and this led us to develop a range of power

for laser-assisted lipoplasty used at each side.Therefore, it was difficult to compare the twomethods by using the amount of fat removed be-cause suction-assisted lipoplasty was suctioningand avulsing the fat and laser-assisted lipoplastywas internally burning the adipocytes, so thecollected lipoaspirates were not only different incolor but also in density. Times used to remove 500cc of fat with suction-assisted lipoplasty or laser-assisted lipoplasty were different (more time forlaser-assisted lipoplasty). Therefore, the endpointof effectiveness between the two techniques could

not rely on the amount of fat removed by each

method because the fat mass quality/total volumewas different for suction-assisted lipoplasty com-pared with laser-assisted lipoplasty, as seen in thephotographs taken after the procedures in all ofour patients. Despite this major issue of the study,the Strasser score showed no asymmetries in theclinical findings by blinded observers and the pa-tients themselves.

The disadvantages of suction-assisted lipo-

plasty can be divided into problems related to thetechnique, the patient, and the surgeon. Techni-cal issues depend on the suction machine, theeffect on the adipocytes, and the cannulas. Suc-tion-assisted lipoplasty, using increasing machineor syringe vacuum, avulses fat without major dam-age up to 45 cmHg. Higher vacuum pressuresdisrupt the architecture of the adipocyte, compro-mising its nuclear membrane.45 Using cannulaswith reduced diameters is important for the finaloutcome of the corporal contour. For patients,suction-assisted lipoplasty is painful; produces ec-

chymosis, edema, and blood loss; and requires at

Fig. 10. The same patient as shown in Figure 9, 15 days postoperatively (above) and 11 months postoperatively (below).


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least a 15-day recovery period. Treating secondarycases and fibroadipose zones is difficult with suc-tion-assisted lipoplasty. Some retraction can beobtained in young patients. Finally, for the sur-geon, suction-assisted lipoplasty is a demandingoperation that requires great physical effort.

Laser-assisted lipoplasty should then improveon the disadvantages of suction-assisted lipoplasty

or at least be equal or superior to be considered

as an alternative procedure. For this trial, laser-assisted lipoplasty demanded the use of an expen-sive laser machine, longer learning curves, moreoperating time, fiber optics that needed to be cutand discarded, and suction requirements afterneodymium:yttrium-aluminum-garnet laser appli-cation.

The discussion of the physical principles and

biological tissue interactions of neodymium:yttri-

Fig.11. Suction-assisted lipoplasty(on the patientsleft side) andlaser-assisted lipoplasty(on

the patients right). Strasser objective grading system for the evaluation of cosmetic surgical

results rated as a poor result in this 44-year-oldwoman, with a body mass index of 22. A total

of 2000 J were delivered, and an 1800-ml volume was aspirated. (Above) Preoperatively and(below) 5 days postoperatively.


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um-aluminum-garnet laser were only referred toin this article.1621 The mechanism of action of theinterstitial neodymium:yttrium-aluminum-garnetlaser to assist lipoplasty is not clear.21 Tumescentinfiltration solutions3135 are necessary for theaction of neodymium:yttrium-aluminum-garnetlaser in subcutaneous tissues, and also to minimizeblood loss and potential complications. The in-fluence of tumescence in the evolution of lip-ocrits, operative technique, postoperative pain,edema, ecchymosis, and time of recovery, has to be

determined in laser-assisted lipoplasty cases as has

been done for suction-assisted lipoplasty and ul-trasound-assisted lipoplasty.29

The wavelength and the chromophore targetof the neodymium:yttrium-aluminum-garnet lasercould explain its affinity for fat (yellow color), butto go as far as to say that it is selective for disin-tegrating the membrane of the adipocyte23 is, atleast, uncertain.3638 Hypotheses that attempt toexplain the reasons for less pain, bruising, andedema and faster recovery after laser-assisted li-poplasty emphasize the supposed protective ef-

fects of laser on perforator vessels and sensitive

Fig. 12. The same patient as shown in Figure 11, 15 days postoperatively (above) and 11

months postoperatively (below).


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nerves and the sealing that the neodymium:yttri-um-aluminum-garnet laser produces on lymphaticand arteriovenous vessels.39,40 Perhaps the answerlies in the cytologic studies that showed, in thistrial, nuclear indemnity in suction-assisted lipo-plasty but not for laser-assisted lipoplasty (both

methods showed no damage to the capillary bloodvessels). This must be considered as another draw-back of laser-assisted lipoplasty: the impossibilityof reusing fat for lipofilling purposes.

On a short term basis, laser-assisted lipoplastyseems to be secure for patients when indicated totreat localized fat deposits. However, it producesmore damage to the anatomical integrity of theadipocytes, where 90 percent disrupted architec-ture and rupture of the nuclear cellular mem-brane was found and reinforced with our studiesthat looked for DNA nuclear markers and free

fatty acids liberated when the cellular structurewas destroyed, explaining the higher chromato-graphic findings of triglycerides (positive for 10sides, all of which were treated with laser-assistedlipoplasty).41 This is a major issue, because laser-assisted lipoplasty complications arise when fatemulsification is not aspirated after the applica-tion of neodymium:yttrium-aluminum-garnet en-ergy, and this is attributable to the liberation offree fatty acids from the adipocytes that couldaffect renal and hepatic function. In contrast, su-perficial laser-assisted lipoplasty does not result in

more skin retraction after the supposed heatingeffect that reaches the subdermis. Laser-assistedlipoplasty also adds more time to the procedure ascompared with suction-assisted lipoplasty alone,but this point was not statistically significantly dif-ferent. Laser-assisted lipoplasty decanted aspirateswere not as yellow as the suction-assisted lipoplastysides and had statistically significantly lower lip-ocrits. The only variable with a statistically signif-icant difference was less pain on the laser-assistedlipoplasty sides, and the explanation is uncertain.

CONCLUSIONSThis study failed to demonstrate clinical ad-

vantages of laser-assisted lipoplasty over the tradi-tional suction-assisted lipoplasty method, butlower lipocrits on the laser-assisted lipoplasty sidescould expand this technology for more cases.More studies of the ultramicroscopy of adipocytesafter use of increasing laser-assisted lipoplasty en-ergy should be conducted, as has been the case forother forms of lipoplasty.4244 Refinement in laserinstrumentation must evolve and prove to be more

cost-effective than the traditional method before

it can be promoted as a proved technology for theassistance of lipoplasty.

Arturo Prado, M.D.Manquehue Norte 1707, Suite 210

Las CondesSantiago, Chile

[email protected]

DISCLOSURE

The authors do not have any financial involvementwith the manufacturers of these devices.

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