ARTICLE | FACIAL REJUVENATION | syringe liposuction applied to the jowl using an
infrajowl approach. Despite the reasoned approaches, these minimally invasive techniques for direct contouring of the mid- and lower face did not gain widespread acceptance among surgeons at the time1 Both from a medical perspective and from that of the
.
patient, an ideal alternative to the many procedures reported should fulfil the following requirements1
:
■ Direct and efficacious approach to the origin of the problem; namely, sagging fat
■ Tightening of the surrounding skin ■ Short duration ■ Outpatient basis ■ Local anaesthetic only ■ Generally does not need to be repeated ■ Short or no downtime ■ Acceptable risk profile and safety margin.
Study background At the authorsÕ institution (Instituto M• dico L‰ ser, Madrid, Spain), it is considered that the ideal technique
The initial
heat generated by the laser alters the sodiumÐ potassium balance in the cell membrane, enabling extracellular tissue to pass through to the intracellular space and increase adipocyte volume.
should focus directly on the problem of sagging fat, by combining correction with contraction of the surrounding skin. The technique should be performed under local anaesthetic on an outpatient basis and should be low-risk with a short recovery period1
. The
authorsÕ new technique for facial contouring ® laser- assisted facial contouring ® can reduce the appearance of nasolabial folds and jowls. This minimally-invasive approach fulfils all the criteria previously mentioned. Laser-assisted facial contouring minimises
postoperative tissue injury and oedema, enables complete treatment of accumulated sagging fat, and facilitates substantial contraction of the surrounding skin. It improves the appearance of the oval of the face without the need for filling, skin resurfacing, or lifting. In general, plastic surgeons agree that laser-assisted
lipoplasty is a less traumatic procedure compared with conventional liposuction (suction-assisted lipoplasty)5, 6 In 1994, Apfelberg et al7
. treated one side of the face with
suction-assisted lipoplasty and the other with laser-assisted lipoplasty, and observed reduced ecchymosis, pain, and oedema on the side treated with the laser-assisted method. Laser-assisted lipoplasty is characterised by greater patient satisfaction, shorter recovery time, good skin contraction, and minimal side-effects. At the authorsÕ institution, laser-assisted facial
contouring is performed using the Aspire dual-emission laser (SlimLipo, Palomar). Emission is continuous at 924 nm and 975 nm, both simultaneously and separately: 924 nm is a selective wavelength for the destruction of adipocytes, and 975 nm can heat connective tissue to achieve effective skin retraction8
. The laser fibre (1.5 mm in diameter) is cannula-free and
comes in different lengths. Continuous emission has a limit of 20 W for each wavelength. The tipÕs elasticity and cone shape reduce mechanical resistance when passing through fibrous tissue (Figure 1). The initial heat generated by the laser alters the
sodiumÐ potassium balance in the cell membrane, enabling extracellular tissue to pass through to the intracellular space and increase adipocyte volume. At higher powers, the adipocytes rupture and the collagen fibres and smaller vessels coagulate. The lipases released after rupture of the membrane liquefy the tissue, facilitating aspiration. The coagulation of the smaller vessels reduces postoperative trauma. Compared with traditional cannulae, the smooth
penetration of the tip into fibrous tissue allows for less forced and more regular movements which, together with the flexibility of the tip, make it possible to reach distant areas. Continuous emission and selectivity for lipids reduces temperature peaks9
in the dermis, with the result that there 22 ❚
Figure 1 48-year-old female patient before (A) and after (B) treatment
April/May 2012 |
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is no burning at the dermoÐ epidermal junction. The effect of this mechanism of action during lipolysis accounts for the low incidence of injury and short recovery time. Conventional liposuction removes both fat and large amounts of blood and serum, and requires larger-calibre cannulae. In addition, sweeping movements are more
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