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Physicians are relying on ultrasound and laser energy, the latter sometimes in combination with radiofrequency (RF) energy, to provide the minimally invasive fat treatments patients crave. In particular, the addition of lasers has reduced the invasiveness of liposuction.
Washington - Physicians are relying on ultrasound and laser energy, the latter sometimes in combination with radiofrequency (RF) energy, to provide the minimally invasive fat treatments patients crave.
In particular, the addition of lasers has reduced the invasiveness of liposuction, says Hema Sundaram, M.D., a Washington dermatologist and cosmetic surgeon in private practice.
"The power demographic of patients coming to our offices is now baby boomers and older members of Generation X. They have the 'Whole Foods' lifestyle - they want to live healthy and eat organically." Their desire for nonsurgical treatments ties into this philosophy, she says.
A major advantage of laser lipolysis over traditional liposuction is that the former may achieve more significant skin tightening, she says. Laser lipolysis also provides thorough coagulation, "which means there's potentially less bleeding and bruising."
Laser lipolysis devices include the LipoLite (Syneron), which incorporates a 1,064 nm Nd:YAG laser. Dr. Sundaram says it serves as one paradigm for the laser lipolysis category, but other devices in this category perform equally well.
Dr. Sundaram says she often combines laser lipolysis with other treatments such as the eMatrix device (Syneron), a fractional bipolar RF device that she uses for facial resurfacing, or the Ulthera (Ulthera Inc.), a microfocused ultrasound device that is approved by the Food and Drug Administration (FDA) for nonsurgical lifting. She says both devices provide further skin tightening and can help in the healing process after laser lipolysis.
Typically, Dr. Sundaram begins the eMatrix or Ulthera procedure two to four weeks after the LipoLite. "We do three or four sessions with the eMatrix, spaced at three-week intervals. One Ulthera procedure may suffice," she says.
In a pilot study with the eMatrix device, Dr. Sundaram and a colleague treated 10 subjects ages 29 to 62 with Fitzpatrick skin types 1 through 3 who scored between two and six on the Fitzpatrick classification of wrinkling and skin elastosis scale. Patients underwent three treatment sessions, spaced four to six weeks apart. Six weeks after the final treatment, blinded investigators evaluated results.
In this analysis, half the patients had achieved 51 to 75 percent global improvement; the rest achieved 76 to 100 percent global improvement (Sundaram H, Truslow S. Poster presentation. American Society for Dermatologic Surgery/American Society of Cosmetic Dermatology and Aesthetic Surgery Joint Annual Meeting; October 21-24, 2010; Chicago).
"For the body, I'm adding the VelaShape II (Syneron), which is a noninvasive body contouring device combining bipolar RF, infrared light, negative mechanical pressure and tissue manipulation," Dr. Sundaram says. "It helps to optimize contour, smooth out lumps and bumps and possibly helps with the healing process. We start the VelaShape treatments one to three weeks after the LipoLite, as tolerated by the patient. We perform three or four sessions at intervals of one to three weeks."
In a pilot study, Dr. Sundaram used the LipoLite and VelaShape devices in six female patients ages 38 to 53 who were poor candidates for traditional liposuction because they had undergone previous intra-abdominal procedures and therefore developed some scarring, which can lead to contour irregularities.
Patients underwent LipoLite treatment of the abdomen, flanks and/or outer thighs. For these treatments, investigators set laser power at 12 W and delivered long, high-energy pulses (800 mJ, 15 Hz, 800 ms) combined, where appropriate, with shorter, lower-power pulses (240 mJ, 50 Hz, 240 ms).
Investigators then gave patients four to five sessions with the VelaShape device (bipolar RF: 40 W to 60 W; infrared: 11 W to 23 W). After these treatments, "Minor contour irregularities and tissue induration following laser-assisted liposuction resolved or improved significantly," she says. In fact, patients achieved total reductions in circumference ranging from 10 cm to 20 cm (Sundaram H, Elbashir R. Poster 629. American Society for Laser Medicine & Surgery Annual Meeting; April 16-18, 2010; Phoenix).
Disclosures: Syneron sponsored the studies discussed by Dr. Sundaram. She is an FDA phase ¾ study investigator for Syneron (LipoLite, eMatrix, VelaShape) and an FDA phase 4 study investigator for Ulthera.