PEER-REVIEW | BODY CONTOURING |


Liposculpture A liposculture is a technique for fat tissue extirpation through blunt 2–4 mm cannula, and suction may be carried out with 20 or 60 cc syringes or a suction pump. It aims to remodel contours to restore the juvenile and harmonic forms of the face or body by working with the hypodermic fatty tissues42


.


Laserlipolysis Laserlipolysis is an advanced technique for the removal of localised excess of fatty tissue that can be used alongside or in combination with traditional liposuction to improve results. The technique uses the high peak


power of the laser emission to rupture the membrane of the adipocytes. The effect is not only thermal but also thermomechanical, and the rapid and elevated absorption by the adipocyte membrane allows for creating an opening in the membrane itself with the spilling out of the cellular contents. The mix of the cell contents and the fluids from the tumescent anaesthesia result in the production of an oily, low-viscosity aggregate which facilitates body modelling, and can be easily removed with low-pressure micro-pumps. The author suggests removing the emulsion with a 2 mm cannula and a 20 cc syringe. The first device was a Nd:YAG laser, at a 1064 nm wave-length, using 6 W power, 40 Hz frequency, 150 mJ energy, and 100 ms pulse. Today we have 10 W, 18 W, and 30 W devices43,44


. There are new Laserlipolysis devices that work with two


different wavelengths and claim to treat cellulite in just one session. These lasers only release the fibrotic retraction of the connective tissue; they do not alter the ECM. Whilst it is important to share experiences with other


colleagues at meetings it is essential to practice the skills that any surgical techniques require to maximise patient safety and results. Technological advances in surgical procedures continue apace and physicians should have up-to-date knowledge and skills prior to incorporating any new techniques to their practices. As President of the International Union of Lipoplasty,


the author is keen to promote, support, and encourage the learning process in this area to ensure patient safety and raise the standards across the industry.


Protocols To improve the results of cellulite treatments it is useful to combine different techniques and so benefit from the different actions/effects.


Steps in the treatment Step 1: Keep the connective tissues elastic and soft. Improve the ECM PRP Endermologie


48 ❚


Carboxytherapy MLD Step 2: Improve the microcirculation Carboxytherapy Endermologie Mesotherapy


Step 3: Action to increase fibroblast activity Endermologie Mesotherapy Carboxytherapy PRP


Step 4: Action to tighten the skin Radiofrequency Carboxytherapy Mesotherapy


Step 5: Anti-inflammatory action Endermologie


Step 6: Anti-fibrotic action Endermologie


There are new


Laserlipolysis devices that work with two different wavelengths and claim to treat cellulite in just one session. These lasers only


release the fibrotic retraction of the connective tissue; they do not alter the ECM.


Step 7: Reduction of the fat tissue NON-SURGICAL Mesotherapy Carboxytherapy Endermologie Cryolipolysis (there are


doubts about the physiology action) HIFU (there are doubts about the physiology


action) SURGICAL Lipoplasty Laserlipolysis.


Conclusions Today, the pathophysiology of cellulite is well


known and there is a good body of research on the subject. It is impossible to say that a single method or medical device can treat it and there are many variables that must be taken into account to achieve a good medical aesthetic results for patients. In summary, the author recommends the following


Key points Restore efficient


microcirculation Restructure the EMC


and the connective tissue Stimulate the


fibroblasts


Block the free radicals Restore the lymphatic


function Reduce the lipo


oedema Increase the lipolysis


(the physiology lipolysis) January/February 2015 | prime-journal.com


treatment scheme: Restore local microcirculation Favour local metabolic exchanges Reduce the oedema Clean the ECM Increase local proteoglycan-level Increase venolymphatic drainage Increase lipolytic action (physiology action over fat


tissue) Diminish fibrous trapping of adipocytes.


Declaration of interest None Figures 1,2,4,5, Table 1 data © Gustavo Leibaschoff,


redrawn by Prime Journal Figure 3 © Eclipse Aesthetics, LLC, redrawn by Prime with permision


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