MIAMI BEACH Sure, it's nice to tell patients that laser-assisted lipolysis will tighten their skin, but now there is evidence to prove it.
Dr. Bruce E. Katz and his colleagues demonstrated the tightening effects of laser-assisted lipolysis by tattooing a 4-by 4-cm square on the abdomen, arms, hips, or thighs of 30 patients.
At 3 months' follow-up, a mean 18% reduction was observed in an ongoing, multicenter study, accroding to Dr. Katz.
"This is the first evidence of skin tightening," he said at the South Beach Symposium. "And we've seen similar findings out to 6 months."
The investigators also performed punch biopsies to examine the histology at treated sites. Results showed new fibrosis, adipocytes, histiocytes, and markers of fat-cell lysis, said Dr. Katz of the department of dermatology at Mount Sinai School of Medicine, New York.
Patients were treated using the Smartlipo system (Cynosure Inc.), which features a hollow, 1- to 2-mm cannula inserted through a small incision to deliver Nd:YAG laser energy. After the laser liquefies fat cells, they are drained away through the same cannula.
This device combines a 1,064-nm wavelength for a gradual thermal effect and to mediate coagulation of blood vessels, as well as a 1,320-nm wavelength to promote energy absorption by fat and water. For this study, Dr. Katz set the system to deliver 20 W of the 1,064-nm energy and 12 W of the 1,320-nm wavelength.
The tightening results are supported by another study in process by Dr. Barry E. DiBernardo, a plastic surgeon in private practice in Montclair, N.J. Dr. DiBernardo compared laser-assisted lipolysis with liposuction in a split-treatment study of 10 women.
Dr. DiBernardo tattooed a 5- by 5-cm square on areas to be treated and found 37% greater skin tightening with laser-assisted lipolysis versus liposuction alone at 1 month. "At 3 months, he found 54% greater tightening with laser lipolysis," Dr. Katz said.
In addition to a stand-alone treatment for skin tightening, the system could be a nice alternative for patients who are candidates for face and neck tightening surgery, Dr. Katz said. Laser lipolysis is indicated for all areas with localized adipocyte deposits, as well as places where liposuction is indicated but the treatment could worsen skin laxity.
With any technology it is important to ask: "Do the risks outweigh the benefits?" Dr. Katz said. "We saw this in ultrasonic liposuction years ago."
To find out, he and a colleague assessed the incidence of adverse events and touch-up treatments required by 537 patients treated over 18 months at a single center (J. Cosmet. Laser Ther. 2008;10:2313). They found a 1% complication rate, including one local infection and three minor burns, all of which resolved, Dr. Katz said at the meeting.
There were 19 touch-up procedures for a 3.4% rate, versus the 10%-12% reported in the liposuction literature. "The most important finding was there were no serious side effects at all," he said.
Dr. Katz disclosed that he is a Cynosure stockholder.
Two studies provide the "first evidence of skin tightening," with laser-assisted lipolysis. The above patient is shown before and after undergoing the procedure. Photos courtesy Dr. Bruce E. Katz