Serum lipid changes following laser lipolysis - Medical Fibers

Keywords:medical, fiber, fibers,  Time:07-01-2016

Laser lipolysis  with a pulsed 1064-nm Nd:YAG laser and more recently with a continuous wave (CW) 980-nm  diode laser has proven to be a safe and effective method (3–5). After adequate infiltration of an  anesthetic solution, a flexible fiber optic delivered through a small caliber cannula is inserted inside fat tissue. Trans-illumination from a red aiming beam makes the 1-mm cannula easily visible. Medical fibers energy is transmitted to and absorbed by the adipocytes, leading to volume expansion and rupture (6).  Histologic analyses of the effects of lasers on human fat tissue have shown areas of reversible cellular  damage (tumefaction), irreversible tissue damage (lysis) and a reduction in bleeding when compared to conventional liposuction (7–9).

The safety of the procedure has been addressed regarding patient selection, complications and  results (3–5). Little is known about the impact  of laser lipolysis on lipid metabolism during and immediately after the procedure. This study aims to evaluate, in patients operated on for large-volume laser lipolysis, the levels of total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol and triglycerides at different intervals after the procedure (1 day, 7 days, 14 days and 30 days).

Methods

A consecutive series of four patients undergoing medical fibers lipolysis in a private clinical practice consented to participate in the study. After marking the treatment site with a surgical marker, patients were prepped and draped in a sterile fashion. Local anesthesia was performed using the wet infiltration technique with adrenaline 1:500 000. After infiltration of the tumescent fluid, a small incision of 1–2 mm was made with an 18-gauge needle. A 1-mm-micro-canulla was  then inserted through the incision into the subcutaneous fat. A 980-nm diode laser (Pharaon, Osyris, France) was used in continuous emission. Since jodhpurs were treated, the power was tuned at  18 W. The medical laser light was conveyed into the fat  layer using a 1-mm micro-cannula which incorporated a 600-µm optical fiber. Transcutaneous  illumination of the aiming beam ensured precise visualization of the region where the energy was delivered. During the procedure, liquified fat was not aspirated. Only massage was performed immediately after the procedure. Micropore™ adhesive was affixed to skin to better compress and remodel the external thigh. The tape remained in place for 1 week,  and the patients were asked to wear compression  garments for 1 month. There were no restrictions  to activity – except sun exposure, which had to be avoided for a month. On the morning of laser procedure a fasting blood sample was obtained. Patients returned after 1 day, 3 days, 2 weeks and 1 month to provide another fasting morning blood sample. Results of the original serum lipid tests were not revealed until the postoperative samples had been obtained. A standard lipid profile (total cholesterol, HDL cholesterol, LDL cholesterol and triglycerides) was done using the same laboratory facility for all tests (BioQu@lys, Lille, France). Patients were instructed to maintain their usual diet and lifestyle during the study period.

Results

Four consecutive patients were included in the  study. All of the patients were women. In all four patients the right and left jodhpurs were treated. Injected tumescent volume and laser parameters  are reported in Table I. Cumulative energy was, respectively, 46 500 J, 22 000 J, 28 300 J and 50 150 J. No peri-operative complications occurred and all patients were satisfied with the aesthetic outcome. Lipid profile measurements are displayed in  Figure 1 (total cholesterol: normal level between 1.55 and 2.4 g/l), Figure 2 (HDL cholesterol: normal level between 0.4 and 0.8 g/l), Figure 3 (LDL  cholesterol: normal level between 0.6 and 1.4 g/l) and Figure 4 (triglycerides: normal level between 0.35 and 1.4 g/l).

For all patients, whatever the interval, both total cholesterol, HDL, LDL and triglycerides remained within normal values.

Discussion

This limited study was undertaken to evaluate the impact of laser lipolysis on lipid metabolism at  different intervals after the procedure. Since lipid metabolism could be affected by the laser damaged volume, medium to high energy levels were used in this study.