Tissue Shrinkage and Skin Elasticity with Smartlipo
Introduction
Lasers utilized for emulsification of fat and coagulation of small blood vessels in conjunction with lipo-aspiration have provided a new approach to body contouring. Papers by Ichikawa1, Badin2 and Goldman3 substantiated the lipolysis and coagulative effect of the Nd:YAG laser through histologic analysis of irradiated fat and tissue sections.
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SmartLipo Introduction
Written by Barry DiBernardo, MD and Alberto Goldman, MD
Introduction
Laser-assisted lipolysis, or the use of laser technology to treat localized fat deposits, was first introduced to the medical community in 1994 by Apfelberg (Apfelberg, 1994).(1)
While not a total replacement for tumescent liposuction, laser-assisted lipolysis benefits patients specifically looking to treat stubborn areas of fat, or who are not indicated, receptive or in need of more invasive traditional liposuction which uses larger cannulas. In contrast, the use of a laser-guided technique affords patients less blood loss, a shorter recovery time frame, less edema, and decreased pain and discomfort in the post-treatment period.
The most extensively studied, used and validated laser- assisted lipolysis system is the Smartlipo LaserBody- SculptingSM Workstation (Cynosure, Inc, Westford, MA). The first platform of the Smartlipo technology used a 6 Watt 1064 nanometer neodyminium-doped yttrium aluminum garnet (Nd:YAG) laser. Today’s platform includes the use of two clinically proven wavelengths (1064nm and 1320nm) delivered in a blended fashion that utilizes the benefits of both wavelengths. Most importantly, these wavelengths are delivered utilizing high peak powers to deliver the optimal energy to disrupt fat and coagulate blood vessels. Extensive clinical and histological data support the effectiveness of this laser, and while numerous other lasers have followed Smartlipo to market, none are supported with the substantial body of evidence that Smartlipo has accumulated.
According to the Centers for Disease Control and Prevention, nearly two-thirds of US adults are overweight, and nearly one-third of the population is considered obese. Given these trends, patient demand for laser-assisted lipolysis is only likely to rise. Recognizing the trend for minimally invasive procedures, physicians have utilized laser-assisted lipolysis to help patients achieve their desired body contour, with minimal downtime and a high degree of satisfaction. Due to patient satisfaction and the minimally invasive nature of this procedure, there is a new set of patients considering a laser lipolysis treatment.
This compendium was designed to present clinical and histological research and results that demonstrate the benefits and applications of the Smartlipo technology as a safe, effective treatment for the removal of unwanted fat. We have divided the research findings into five main categories:
Scientific Rationale
This section outlines the science-backed basis behind the 1064 nm Nd:YAG technology and the blending of the 1064 nm and the 1320 nm wavelengths in performing laser-assisted lipolysis. In our experience, the action of photothermia, in which laser light is converted into heat energy when absorbed by adipose tissue, is what makes the Smartlipo laser effective in the disruption of fat. Furthermore, the positive benefits of the blended 1064 nm and 1320 nm wavelengths have been clearly demonstrated in recent clinical studies.
Clinical Utility
In this section, we review how Smartlipo, the first laser introduced to the market for interstitial laser lipolysis, has been shown to produce less pain, bruising and edema, and faster recovery times than liposuction alone. Goldman, Kim and others observed that the use of Smartlipo results in a less traumatic outcome than with conventional liposuction.
Optimal Patient Selection
In our experience, and as with any medical intervention or treatment, the success of Smartlipo depends on determining the best candidate, area for the procedure, skill of the physician and setting the right expectation for the patient. In initial studies it has been shown that patients looking to treat only localized areas or who are hesitant to proceed with more aggressive procedures represent the ideal target group. In addition, patients with areas of skin laxity are ideal candidates for Smartlipo treatments. Goldman, et al. observed that for patients who are already close to their ideal weight and for whom maximum aspired volume doesn’t exceed 5% of body weight, laser-assisted lipolysis is a favorable course of treatment (Goldman, 2003).(3) Since that time, the technology has evolved, allowing physicians to treat larger areas.
Recent Smartlipo Advancements
The 1064 nm Nd:YAG laser has been shown in clinical research to deliver reproducible results. The Smartlipo MultiPlex (MPX), a next-generation system offering both 1064 and 1320 nm wavelengths, has been shown in documented clinical use to provide faster, safer and more effective delivery of energy. Furthermore, physicians report that the current Smartlipo workstation is useful for an expanding range of cosmetic procedures, including SmartLiftingTM and ablation of sweatglands in treating hyperhidrosis and improving gynecomastia. Further studies are underway to explore other applications in the use of this technology.
The Future of Smartlipo
Laser lipolysis is an exciting area in the field of aesthetic medicine, and is poised for continued expansion and scientific advancement.
In addition to an overview of peer-reviewed articles, this compendium also provides patient case studies featuring before-and-after photos, as well as a series of white papers. We invite you to review these materials thoroughly and discover how, with the support of extensive clinical and histological evidence, the Smartlipo MPX is a technology you can use with confidence for your patients, both today and tomorrow.