While traditional liposuction may remove unwanted fat, one of its disadvantages is that it produces skin laxity. Contemporary treatment modalities such as laser lipolysis are minimally invasive, tighten the skin and produce less blood loss than traditional liposuction.
"There is also less edema and a shorter recovery time compared to traditional liposuction," he says.
Speaking to fellow clinicians at the first Pan-American Congress on Aesthetic and Anti-Aging Medicine in early September, Dr. Katz described the history of liposuction and noted milestones such as the emergence of the manual hollow cannula, first used in 1987.
The concept of laser lipolysis was first described in 1990, but the technology to perform laser lipolysis at that time, involving large cannulas, was rather crude and did not produce significant benefit, according to Dr. Katz, past president of the Dermatologic Society of New York and a fellow of the American Society for Laser Medicine & Surgery and the American Society for Dermatologic Surgery.
Currently, SmartLipo (Cynosure), approved by the Food and Drug Administration in November 2006 and by Health Canada in the summer of 2007, is a suitable complement to power liposuction because it is minimally invasive. It is appropriate for body sculpture and body contouring.
Whereas the initial use of laser lipolysis focused on small areas of local adiposity, new lasers with higher power now permit large areas to be treated.
Describing how the SmartLipo procedure is performed, Dr. Katz says he applies a local anesthetic before making any incision. He uses a 1,064 nm (Nd:YAG) laser to insert under the skin. The procedure involves the use of a very small cannula or tube of approximately 1.0 mm in diameter.
That cannula contains the laser fiber and is inserted into the skin. The cannula is moved back and forth as the energy from the laser travels directly to the fat cells.
The energy ruptures the membranes of adipose cells, changing them into an oily substance that is aspirated. The energy from the laser comes into contact with the dermis, leading to skin shrinkage or tightening.
Traditional liposuction is effective in removing fat, but it typically results in laxity of the skin. Laser lipolysis removes fat and also tightens the skin, Dr. Katz tells Dermatology Times.
"With laser lipolysis, you look better both in your clothes and without your clothes on," Dr. Katz says. "We can achieve fat melting and skin tightening."
While traditional liposuction would eliminate an abdominal "pouch" for a patient - such as a female who has had several children - patients were often left with wrinkled skin after the procedure.
"If you take a female patient who has had children and wants to get rid of her abdominal pouch, the procedure takes away that pouch, as well as tightening the skin to accent the abdominal muscles because of the precision with the technique," Dr. Katz says.
With ongoing studies, clinicians are assessing the optimal parameters to generate consistent results with the use of laser lipolysis systems such as SmartLipo.
In a study to be published in a peer-reviewed journal, Dr. Katz demonstrated the skin-tightening ability of SmartLipo. The research involved placing small tattoos on patients and using the SmartLipo MPX technology, which incorporates 1,320 nm and 1,064 nm wavelengths, to remove fat under the tattooed area.
Dr. Katz observed an 18 percent skin-tightening improvement in the areas surrounding the temporary tattoos.
He says new collagen growth was discovered in biopsies taken from the patients.
"The device can be used for skin tightening alone," Dr. Katz says.
Disclosure: Dr. Katz is a consultant for El-En Engineering.