Laser Fibers:Creating Skin Surface Area Reduction During Abdominal Liposuction by Adding Radiofrequency Heating

Keywords:medical fibers, fiber, laser fiber,  Time:15-02-2016

Many patients with a desire for abdominal fat reduction and skin tightening decline abdominoplasty because of the long scar, lengthy recovery, and associated morbidity and numbness. While traditional suction-assisted liposuction (SAL) has been reported to offer mild skin tightening, residual skin laxity and superficial contour irregularities can often occur when liposuction is performed in patients with moderate to severe skin laxity and poor skin quality. Physical indicators of a less-than-optimal aesthetic SAL outcome include the presence of a pendulous soft tissue overhang at the suprapubic crease and “rolls” of skin and fat that the patient can easily pull away from the underlying fascia. Massive weight loss patients are especially affected by these problems.

These soft tissue laxity issues often go uncorrected with SAL, power-assisted medical fibers liposuction (PAL), and even ultrasound-assisted liposuction (UAL).1-4 Although some degree of skin tightening is observed  following SAL, the tightening mechanism is based on  a nonthermal inflammatory process resulting from subdermal stimulation and elastic contraction of skin, after removing the internal turgor created by excessive adipose tissue. Suction-assisted liposuction skin contraction is limited.

While the amount of contraction depends on the inherent skin elasticity, the average amount of surface area reduction achieved with SAL is about 10%.5 Patients are increasingly demanding better results and tighter skin from less invasive, nonexcisional procedures with minimal scarring. Certain ethnic groups are especially intolerant of any procedure that leaves a visible scar. The introduction of laser fibers -assisted liposuction (LAL), followed by SAL, has added thermal stimulation to lipocontouring and has shown some ability to cause more skin tightening than SAL alone.6,7 DiBernardo8 reported mean area soft tissue contraction of 17.2% with LAL followed by SAL compared with a 10.6% skin surface area reduction obtained with SAL alone. Some tightening results were reported after UAL,9-13 but the studies were not randomized, the outcomes were not statistically significant, and the results have not been confirmed in peer-reviewed studies by other investigators. Radiofrequency-assisted liposuction (RFAL) followed by SAL has been used to treat subcutaneous adipose regions with a combination of soft tissue and skin heating to induce tissue contraction. The BodyTite RFAL device (Invasix, Yokneam, Israel) was introduced in 2008; it consists of a cannula-type probe with a heated tip plus a hollow tube and is capable of performing synchronous heating and aspiration of fat.

The internally located cannula tip emits radiofrequency (RF) energy directed toward an external electrode that reflects heat back to the epidermis (Figure 1). The skin tightening and soft tissue contraction induced by RFAL14,15 is due to its effect on the fibroseptal network (FSN). Yoshimura16 showed that while adipocytes contribute volume to the fatty layer, more than 80% of cells in the region reside in the FSN. Thermal stimulation of the FSN by RF heating has been shown to cause skin surface contraction of up to 45%.17 In a prospective study reported in 2011,18 the longevity of RFAL-induced contraction measured with the Vectra computerized measurement system (Canfield Scientific, Inc, Fairfield, New Jersey) averaged 34.5% at 1 year posttreatment. The purpose of our current institutional review board (IRB)–approved study was to evaluate skin surface area contraction following SAL alone compared with the results following RFAL plus SAL.