Bruce E. Katz

Laser‐assisted lipolysis: A report on complications

Background: As reported elsewhere, there are several drawbacks associated with traditional liposuction: increased blood loss, ecchymoses, long recovery times with increased postoperative discomfort, and skin laxity. Laser‐assisted lipolysis (LAL) is an emerging technology, but the level of safety associated with this device has not been reported. In October 2006, a 1064‐nm Nd:YAG laser was approved by the United States Food and Drug Administration for the surgical incision, excision, vaporization, ablation, and coagulation of all soft tissues and has been used for LAL as well as improvement of areas of flaccidity. The objective of this new device is to melt fat while also reducing the blood loss, ecchymoses, long recovery times and skin laxity. It achieves these improvements by destruction of adipocytes, coagulating small blood vessels and collagen, the end result being reduced adiposity, skin retraction and decreased flaccidity. Objective: To determine the number of adverse events associated with LAL and the frequency with which secondary procedures had to be performed after the primary one to correct defects (touch‐up rate). Methods: A total of 537 consecutive LAL cases were performed with tumescent anesthesia between January 2006 and November 2007 at one center. These 537 cases were reviewed retrospectively to determine the number of adverse events associated with the LAL procedure and the number of touch‐up procedures performed. Results: No systemic complications were identified and only five local complications were found. These complications included one local infection and four skin burns. This represents a complication rate of 0.93%. Nineteen touch‐up procedures were necessary: a rate of 3.5%. Conclusion: Laser‐assisted lipolysis (LAL) is a safe adjunct to traditional tumescent liposuction which assists in melting fat and tightening the skin. LAL may serve as a useful tool for the surgeon performing liposuction.

A pilot study of the efficacy of a 1,064 and 1,320 nm sequentially firing Nd:YAG laser device for lipolysis and skin tightening.

Laser‐assisted lipolysis with a medium pulsed 1,064 nm Neodymium:Yttrium–Aluminum–Garnet (Nd:YAG) system has been used since FDA approval in October 2006 [1]. Since then, this technology has been advanced to include an additional wavelength (1,320 nm) and an accelerometer designed to improve efficacy and safety.

The new laser liposuction for men

ABSTRACT:  Laser‐assisted lipolysis with a medium‐pulsed 1064‐nanometer neodymium‐doped yttrium aluminum garnet (Nd:YAG) system is a new FDA‐approved method of removing localized areas of fat with the added benefit of skin tightening. This new method is particularly useful in treating the lower abdomen and submental areas where skin laxity may occur after the removal of adipose tissue. In addition, decreased bruising and scrotal edema after treating men is possible with use of the tumescent technique and the added benefit of coagulation produced by the laser. Experience in treating men with this modality is reviewed.

A Multicenter Study for a Single, Three-Step Laser Treatment for Cellulite Using a 1440-nm Nd:YAG Laser, a Novel Side-Firing Fiber, and a Temperature-Sensing Cannula

BACKGROUND Historically, treatments for cellulite have not been able to address all of its physiological components and require multiple sessions. OBJECTIVE The authors evaluate the safety and efficacy of a single, subdermal procedure to treat the underlying structure of cellulite. METHODS Fifty-seven patients underwent a 3-step cellulite treatment with a 1440-nm Nd:YAG laser with a side-firing fiber and temperature-sensing cannula. Efficacy was measured by the ability of blinded evaluators to distinguish baseline photos from those taken at 3 and 6 months posttreatment, as well as their rating of the results on a 5-point, 2-category ordinal photonumeric scale when comparing baseline photos to those taken at 2, 3, and 6 months posttreatment. Patient and physician satisfaction was assessed based on completion of a satisfaction survey at 2, 3, and 6 months posttreatment. Adverse events (AE) were recorded throughout the study. RESULTS At 6 months posttreatment, blinded evaluators rated at least a 1-point improvement in the appearance of cellulite in 96% of treated sites. Blinded evaluators were also able to correctly identify baseline versus posttreatment photos in 95% of cases. At least 90% of patients and physicians reported satisfaction with the results of treatment throughout 6 months. AE were mild in intensity and transient to treatment. CONCLUSIONS A single, 3-step, minimally invasive laser treatment using a 1440-nm Nd:YAG laser, side-firing fiber, and temperature-sensing cannula to treat the underlying structure of cellulite proved to be safe and maintained effectiveness at least 6 months posttreatment. LEVEL OF EVIDENCE 2.

Efficacy of a new fractional CO2 laser in the treatment of photodamage and acne scarring

This study evaluates the efficacy and safety of a novel fractional CO2 laser device for improving facial rhytids, hyperpigmentation, enlarged pores, skin laxity, and acne scarring. Subjects (n= 15) were treated three to five times at 3‐week intervals. Biopsy specimens were used to evaluate healing response and neocollagenesis. Clinical improvement was rated on a quartile rating scale from digital photographs. Subject discomfort during treatment was evaluated on a scale of 0 to 5. Fourteen subjects who completed the study achieved good to excellent improvement in overall appearance, with 60% rated excellent. Improvement in photodamage was good to excellent in 92% of subjects, and reduction in rhytids was good to excellent in 85%. A total of 79% of subjects achieved good to excellent improvement in pore sizes and skin laxity. Subject discomfort during treatment was 3.0 ± 0.7. Erythema persisted for 2–3 days, and subjects resumed normal activities 1–2 days after the procedure. Histological slides after a single treatment showed new collagen formation. The SmartSkin fractional CO2 system (Cynosure, Inc., Westford, MA, USA) provides significant improvement for the treatment of facial wrinkles, hyperpigmentation, pore size, and skin laxity associated with photodamage.

A Modern Approach to the Treatment of Cellulite

Cellulite is a prevalent, multifactorial, condition that is extremely recalcitrant to a wide array of treatments. This article discusses patient characteristics, selection, and the vast armamentarium in the treatment of cellulite.

Photobiomodulation with non-thermal lasers: Mechanisms of action and therapeutic uses in dermatology and aesthetic medicine

ABSTRACT Background: Non-thermal laser therapy in dermatology, is a growing field in medical technology by which therapeutic effects are achieved by exposing tissues to specific wavelengths of light. Objectives: The purpose of this review was to gain a better understanding of the science behind non-thermal laser and the evidence supporting its use in dermatology. Methods: A group of dermatologists and surgeons recently convened to review the evidence supporting the use of non-thermal laser for body sculpting, improving the appearance of cellulite, and treating onychomycosis. Results: The use of non-thermal laser for body sculpting is supported by three randomized, double-blind, sham-controlled studies (N = 161), one prospective open-label study (N = 54), and two retrospective studies (N = 775). Non-thermal laser application for improving the appearance of cellulite is supported by one randomized, double-blind, sham-controlled study (N = 38). The use of non-thermal laser for the treatment of onychomycosis is supported by an analysis of three non-randomized, open-label studies demonstrating clinical improvement of nails (N = 292). Conclusions: Non-thermal laser is steadily moving into mainstream medical practice, such as dermatology. Although present studies have demonstrated the safety and efficacy of non-thermal laser for body sculpting, cellulite reduction and onychomycosis treatment, studies demonstrating the efficacy of non-thermal laser as a stand-alone procedure are still inadequate.

Incorporating a medical spa into a physician-run practice.

The age-old spa concept is no less valuable today than it was during the time of Julius Caesar. Over the centuries, there have been many iterations of the concept of the spa. The most recent is the medical spa, which has become the fastest-growing segment of the spa industry. Many physicians including dermatologists wish to incorporate a medical spa into their practices. This article discusses the key elements that should be considered to make this venture successful.