Background and Objective. There has been a heightened interest in laser-assisted fat reduction procedures. We aimed to determine if lipolysis with the 1,320？nm Nd-YAG short-pulsed laser without subsequent suction results in satisfactory contouring of the upper extremity. Materials and Methods. Unilateral laser lipolysis of the upper arm was performed on 5 patients. Subcutaneous, subdermal, and skin surface temperatures were monitored with flexible thermocouples throughout the procedure to aid in the establishment of a treatment endpoint. Photographs and arm circumference measurements were evaluated before and 3 months after laser lipolysis. Patients were given the choice of undergoing the procedure on the contralateral arm at 3 months. Results. All patients achieved no improvement to minimal improvement in upper arm contour. One of five patients was elected to have lipolysis performed on the contralateral arm. Conclusion. Laser lipolysis may be safely performed with the parameters utilized in this pilot study, although minimal improvement was seen in upper extremity contour. 1. Introduction A number of fat-reduction procedures have emerged over recent years to address a demand for less invasive approaches, with an ultimate goal of imparting less risk while producing favorable results. These include the use of tumescent solutions [1], smaller gauge cannulas [2], external ultrasound [3], low-level external laser [4], injection lipolysis [5, 6], cryolipolysis [7], external radiofrequency energy [8], and percutaneous laser lipolysis [9]. Laser lipolysis has been described with and without concurrent suction lipectomy [9, 10]. Laser energy passes through an optical fiber and is directed at the subcutaneous fat layer. Adipocyte damage, or more specifically adipocyte cell membrane damage, can lead to cell content leakage to the interstitial compartment with potential irreversible cell collapse. Suction applied to the area can clear the interstitial fatty debris or this material can be allowed to be handled by innate metabolic mechanisms. The current pilot study aimed to evaluate patient satisfaction after laser lipolysis without suction of the proximal upper extremity with a treatment endpoint of 41 degrees Celsius in the subcutaneous layer. This temperature was selected based on previous determinations that higher sustained dermal temperatures can lead to irreversible necrosis [11]. 2. Materials and Methods Five female patients who expressed a desire for improved upper arm contour were included in this prospective pilot study which was performed according to
References
[1]
J. A. Klein, “Anesthetic formulation of tumescent solutions,” Dermatologic Clinics, vol. 17, no. 4, pp. 751–759, 1999.
[2]
W. P. Coleman, R. G. Glogau, J. A. Klein et al., “Guidelines of care for liposuction,” Journal of the American Academy of Dermatology, vol. 45, no. 3, pp. 438–447, 2001.
[3]
K. M. Coleman, W. P. Coleman, and A. Benchetrit, “Non-invasive, external ultrasonic lipolysis,” Seminars in Cutaneous Medicine and Surgery, vol. 28, no. 4, pp. 263–267, 2009.
[4]
R. F. Jackson, D. D. Dedo, G. C. Roche, D. I. Turok, and R. J. Maloney, “Low-level laser therapy as a non-invasive approach for body contouring: a randomized, controlled study,” Lasers in Surgery and Medicine, vol. 41, no. 10, pp. 799–809, 2009.
[5]
A. M. Rotunda, “Injectable lipolysis: speculation vs. science,” Journal of Cosmetic Dermatology, vol. 5, no. 4, p. 302, 2006.
[6]
A. M. Rotunda, “Injectable treatments for adipose tissue: terminology, mechanism, and tissue interaction,” Lasers in Surgery and Medicine, vol. 41, no. 10, pp. 714–720, 2009.
[7]
B. Zelickson, B. M. Egbert, J. Preciado et al., “Cryolipolysis for noninvasive fat cell destruction: initial results from a pig model,” Dermatologic Surgery, vol. 35, no. 10, pp. 1462–1470, 2009.
[8]
L. Brightman, E. Weiss, A. M. Chapas et al., “Improvement in arm and post-partum abdominal and flank subcutaneous fat deposits and skin laxity using a bipolar radiofrequency, infrared, vacuum and mechanical massage device,” Lasers in Surgery and Medicine, vol. 41, no. 10, pp. 791–798, 2009.
[9]
K. H. Kim and R. G. Geronemus, “Laser lipolysis using a novel 1,064 nm Nd:YAG laser,” Dermatologic Surgery, vol. 32, no. 2, pp. 241–247, 2006.
[10]
J. Dudelzak, M. Hussain, and D. J. Goldberg, “Laser lipolysis of the arm, with and without suction aspiration: clinical and histologic changes,” Journal of Cosmetic and Laser Therapy, vol. 11, no. 2, pp. 70–73, 2009.
[11]
J. G. Khoury, R. Saluja, D. Keel, S. Detwiler, and M. P. Goldman, “Histologic evaluation of interstitial lipolysis comparing a 1064, 1320 and 2100？nm laser in an ex vivo model,” Lasers in Surgery and Medicine, vol. 40, no. 6, pp. 402–406, 2008.
[12]
B. Wassmer, J. Zemmouri, P. Rochon, and S. Mordon, “Comparative study of wavelengths for laser lipolysis,” Photomedicine and Laser Surgery, vol. 28, no. 2, pp. 185–188, 2010.
[13]
J. A. Klein, “Tumescent technique chronicles: local anesthesia, liposuction, and beyond,” Dermatologic Surgery, vol. 21, no. 5, pp. 449–457, 1995.
[14]
G. H. Sasaki, “Quantification of human abdominal tissue tightening and contraction after component treatments with 1064-nm/1320-nm laser-assisted lipolysis: clinical implications,” Aesthetic Surgery Journal, vol. 30, no. 2, pp. 239–245, 2010.
[15]
D. E. Bank and M. I. Perez, “Skin retraction after liposuction in patients over the age of 40,” Dermatologic Surgery, vol. 25, no. 9, pp. 673–676, 1999.
