Laser lipolysis with medical fibers:medfibers

Keywords:medical, fibers, lipolysis,  Time:22-12-2015

INTRODUCTION

Since the first descriptions of the liposuction technique, the principle of vacuum removal of fat tissue has remai  ned. Initially, a dry technique was performed, consisting of direct aspiration without infiltration, which was efficient in the removal of fat. However, the trauma caused by friction against tissue resulted in hematomas with severe blood loss, bruises, and therefore long-lasting inflammatory processes, triggering fibrosis and skin irregularities. With the availability of infiltration solutions with vasoconstrictors in various concentrations, the results became more uniform, with less bleeding, less risk, and shorter recovery periods

2. Nevertheless, it was still a traumatic and aggressive technique, with a high percentage of complications, some of which were fatal. Technological advances seen in recent years, such as the development of ultrasonic liposuction and vibroliposuction, has brought benefits to patients, such as decreased tissue trauma, and also largely to surgeons, with a reduction in the physical stress of the surgery. The introduction of laser technology in liposuction ini  tially generated considerable doubts about its effectiveness in the treatment of tissue, owing to the use of inadequate equipment with unsuitable wavelengths or without water affinity/absorption in the target fat tissue

3. Relevant scientific studies that relate some wavelengths (e.g., 980 nm) to a high affinity/absorption of the water con-  tained in the adipocytes have demonstrated the efficacy and safety of the use of laser in liposuction

4,5. With the application of laser liposuction, there is a re   duction of mechanical trauma to the surrounding tissues, which translates into less fibrosis and reduced bleeding due to clotting of the blood vessels. This provides the benefits of postoperative comfort and a more rapid recovery

6. In addition, considerable tissue retraction, both immediate and delayed, is achieved by stimulating collagen formation

7.it is only recently being used as a treatment for joint optimization of the results of lipoplasty

8. The use of this technology for lipolysis and stimulation of collagen formation has been shown to be effective

9. The aim of this article is to present the experience of 400 consecutive cases of medical fibers lipolysis performed by the authors using a 980-nm diode laser, as an adjuvant procedure in liposuction.

METHODS

In this retrospective, observational study, 400 patients who underwent laser lipolysis, between July 2007 and July 2012, were evaluated.

Of them, 285 patients were operated on in the private practice of one of the authors (P.C.) in Peru, and 115 patients were from private clinics of the other authors in Brazil. Two hundred eighty patients underwent surgical treatment with laser lipolysis liposuction only, and the rest received surgical fibers lipolysis as an adjuvant treatment with other surgeries such as abdominoplasty and mammoplasty. The average age of the patients at operation was 29 years (range 18–52 years).

Twenty-eight patients were men and 257 were women. All patients completed an informed consent form and underwent preoperative routine exams with hematology and cardiology assessment.

The treated areas varied and included the abdomen, flanks, back, submental area, inner thighs, and inner arms. The procedures were performed in the hospital, and the type of anesthesia was general, regional (epidural), or local with sedation, according to the extent and indications of each case. The standard infiltration technique of Centurion et al.5 was used, using a 0.9% saline solution with a temperature of around 4°C, and 1:500,000 epinephrine.

The infiltration was performed preferably with the aid of a continuous pressure system at 150 mm Hg, provided by placing the reservoir solution with a cuff pressure drop, to allow a homogeneous distribution during infusion with a 2-mm-diameter Klein needle. A uniform deposit was performed only in the deepest layer, parallel to the muscular plane, to avoid tunneling the fat tissue. The infused volume was equivalent to the estimated volume drawn from each region. This infiltration technique took 7 to 8 min to infuse 1 liter into each decubitus, an ade  quate period for vasoconstriction. A 980-nm-wavelength diode laser (ORLight®) equipment was used in all treatments. A 2-mm-diameter rigid cannula with a 600-µm optical fiber was used to transfer energy to the tissues. The passage of the laser was initiated in the deep layers, with slow fan-shaped movements, at a rate of about 2.5 cm/s, from the incision, with application of back-and- forth laser movements, always with the free control of the operator’s hand on the treated region to maintain the distance from the end of the fiber to the surface.

RESULTS

The complications observed in this series of patients who underwent laser lipolysis are listed in Table 1. The bruises observed did not account for the total aspirated area but for 2% or more of the affected body surface area. We followed the measurement convention that the size of a palm is equivalent to 1% of the total body surface. Hospitalization ranged from outpatient to overnight surgery. The use of non-opioid analgesics was sufficient for pain control.