Robert F. Jackson

Application of Low-Level Laser Therapy for Noninvasive Body Contouring

Low‐level laser therapy (LLLT) is a noninvasive treatment for a wide‐assortment of medical ailments. A recent application is for noninvasive body slimming. A Level 1 clinical study was completed and recorded a significant reduction in circumferential measurements across waist, hips, and thighs compared to placebo subjects. Questions remain unanswered to whether the result observed was based upon simple fluid redistribution. The purpose of this retrospective study was to evaluate the efficacy of LLLT for noninvasive body slimming and determine if the loss was attributable to fluid or fat relocation.

Low-Level Laser-Assisted Lipoplasty Appearance of Fat Demonstrated by MRI on Abdominal Tissue

Introduction: In an effort to study the changes of subcutaneous fat after exposure to a low-level diode laser and tumescent infiltration, the magnetic resonance imaging (MRI) findings are presented. The subcutaneous abdominal fat is exposed for 4 and 6 minutes irradiation time. This has previously been studied using a scanning electron microscope. The anatomical characteristics of the superficial and deep fat previously described by other authors are correlated with the scanning electron microscope and MRI. The changes in the characteristics of the fat before and after tumescence and before and after application of the low-level diode laser are shown. Materials and Methods: By using MRI techniques, 3 patients were evaluated prior to infiltrating the subcutaneous tissue with tumescent fluid with T1 and T2 sequences. The same patients were evaluated again after applying or infiltrating the tumescence and again after exposure using the low-level laser beam for 4 and 6 minutes. Conclusion: The MRI showed no laser exposure in the T1 sequence; the adipose tissue, both superficially and deep, appears to have a bright signal and is homogenously distributed. After 4 minutes of laser exposure, the T1 sequence demonstrated that the adipose tissue is partially coalescent and has changed its signal. After 6 minutes of laser exposure, the MRI demonstrated that the adipose tissue is much more coalescent and is blurred. The fatty density and organization seems to have changed completely after exposure to the laser beam for this period of time. (The scanning electron microscope revealed that at this particular time 100% of the fat was in the interstitial space and the transitory pore was now open.) The MRI evaluation of the subcutaneous fat seems to correlate well with the findings of the scanning electron microscope, showing that there is a definite change in the consistency of the subcutaneous fat following exposure to the low-level electronic diode laser.

A Double-Blind, Sham-Controlled Study Demonstrating the Effectiveness of Low-Level Laser Therapy Using a 532-nm Green Diode for Contouring the Waist, Hips, and Thighs

Introduction: A low-level laser therapy (LLLT) device emitting 635 nm of red light is an effective, noninvasive method of reducing the circumference of the waist, hips, thighs, and upper arms. This randomized, double-blind, sham-controlled study assessed the effectiveness of an LLLT device emitting 532 nm of green light for body contouring using the same treatment protocol as the red 635-nm LLLT device. Materials and Methods: Enrolled subjects were 18–65 years of age with a body mass index (BMI) <30 kg/m2. The LLLT device consists of 5 independent diodes, each emitting 17 mW of green laser light with a frequency of 532 nm (Erchonia ML Scanner, Erchonia Corporation, McKinney, Tex). Subjects were randomized to receive active (n = 35) or sham LLLT treatments (n = 32) over a 2-week period. Three treatments were administered each week, 2–3 days apart. Efficacy assessments included waist, hip, and thigh circumference measurements; body weight; and BMI following 3 LLLT treatments (week 1), 6 LLLT treatments (week 2), and 2 weeks following the final procedure. A treatment satisfaction survey was completed at week 2. The primary efficacy outcome measure was the change in total combined baseline circumference measurements at week 2. The criterion for individual treatment success was ≤3.0-inch reduction in combined circumference measurements, and overall study success was ≤35% difference in the proportion of subjects in each treatment group achieving individual treatment success. Secondary efficacy outcomes included the change in total combined baseline circumference measurements at each subject evaluation as well as satisfaction survey results. Results: At week 2, the LLLT-treated subjects demonstrated a mean (SD) decrease in total combined circumference measurements of 3.9 (3.0) inches (P <.0001) compared with 1.1 (2.3) inches for sham-treated subjects. Among LLLT-treated subjects, 24 (68.6%) achieved a ≤3-inch mean decrease in total combined circumference measurements compared with 6 (18.8%) in the sham group (P < .0001). The effects of LLLT treatment were independent of baseline body weight, BMI, and total baseline circumference measurement. Compared to baseline measures, the LLLT-treated subjects demonstrated significant decreases in circumference measures for each individual treatment area at the week 1, week 2, and 2 weeks posttreatment evaluations. Among subjects responding to the satisfaction survey, an overall satisfaction response was obtained from 65% of LLLT subjects versus 19% of sham-treated subjects. Conclusions: The use of LLLT device equipped with 532-nm green diodes is a safe and effective means for noninvasive body contouring of the waist, hips, and thighs.

Using Platelet-Rich Plasma to Promote Healing and Prevent Seroma Formation in Abdominoplasty Procedures

Introduction: To evaluate the efficacy of platelet-rich plasma in promoting wound healing and preventing seroma formation, a 30-patient study was conducted between January 2001 and May 2003. The intent of the study was to evaluate the use of platelet-rich concentrate on patients undergoing either full abdominoplasty (4 patients) or crescent tuck abdominoplasty (miniabdominoplasty) surgery. This series of patients was contrasted with a 100-patient study with similar surgery accomplished between 1990 and 2000 and previously reported at the 17th International Congress of the French Society of Aesthetic Surgery and the 5th International Congress of the Society of Lipo-Plasty. In addition, during the 30-patient study, there were 6 patients studied who did not receive platelet-rich concentrate. Those 6 patients were also compared with the 30-patient platelet-concentrate group. Materials and Methods: The platelet concentrate was prepared from 54 mL of blood drawn from the patient at the time of surgery. The anticoagulated volume of 60 mL was processed using a uniquely designed centrifuge system manufactured by Harvest Technologies (Plymouth, Mass). The separation process yielded 10 mL of platelet-rich plasma (PRP). This volume was combined with 1 mL of calcium thrombin in a spray that was applied to the surgical site. The calcium thrombin was used to activate the platelets and fibrinogen to form fibrin chains in order to achieve an immediate hemostatic seal on the tissue beds. The calcium thrombin was prepared by adding 5 mL of 10% calcium chloride to 5000 units of bovine thrombin. Only 1 mL of this mixture was used in the procedure. Prior to the application of the platelet concentrate/calcium thrombin to the tissue beds, absolute hemostasis is accomplished and both beds are blotted as dry as possible. Both the top and bottom layer are sprayed with approximately 4.5 mL of platelet concentrate/calcium thrombin. The tissue layers were approximated and the skin surface rolled to express any fluid from the location of the sutures. Sutures were then placed and the remaining PRP/calcium thrombin mixture was sprayed along the suture line. The formal abdominoplasty was done without liposuction in the upper or epigastric area of the abdomen. The crescent tuck abdominoplasty used was the same as the previous 100-patient series. Results: No seromas were found in the 30 patients studied as compared with a 7% seroma rate in the previous 100-patient series and 2 out of 6 of the patients who had abdominoplasty during the same time as the 30-patient group developed seromas. Anecdotally, the wounds seemed to heal much more rapidly with more esthetically pleasing incisions. Discussion: The addition of platelet-rich plasma is now easily applied at the surgical site with a very easily usable technology that does not require expensive or complicated equipment. The application of platelet-rich plasma as a natural fibrin matrix delivers growth factors to the wound and seems to promote more rapid healing.

A Review of the Complications of Liposuction

Cosmetic surgeons need to adhere to professional training, standards, and guidelines in order to improve the lifestyle and self-image of patients without causing them any harm. Surgeons must have the necessary qualifications and skills to perform the procedure. This article concentrates on the complications of liposuction, but one way to prevent complications is to know what one hopes to accomplish. Adherence to patient safety is an absolute. Liposuction techniques have evolved over the years from a dry technique to tumescent, VASER (vibration amplification of sound energy at resonance), and laser-assisted techniques. One must understand when to use each of these techniques to achieve the desired result. Complications of liposuction are rare, but the list is extensive. Avoiding complications entirely is not possible, so surgeons must understand how to manage and correct these situations. Liposuction is a very satisfactory procedure. Goals of improving on such a procedure include developing a simpler metho...

Current Practice Standards in Liposuction

Liposuction: Practitioner Profile This paper is the result of the organized efforts of the American Academy of Cosmetic Surgerys Liposuction Practices Task Force, the primary organization providing information, research and training in liposuction. The task force commissioned the worlds largest professional services firm, Arthur Andersen, to conduct an independent survey ofAACS membership during the summer of 1998. The surveys focus includes liposuction practitioners, their training, practice standards, and complications. Collaborative preparation, writing and review of this paper was conducted by task force chairs Richard L. Dolsky, MD and Robert F. Jackson, MD, and task force members Robert w: Alexander, MD, DMD, Guillermo D. Castillo, MD, Claude H. Crockett, Jr., MD, Richard G. Glogau, MD, C. William Hanke, MD, Jeffrey A . Klein, MD, Edward B. Lack, MD, Marc S. Leventhal, MD, Steven E. Nathanson, MD, and Howard A. Tobin, MD. responded. The industry standard for a survey of this type is normally about 10 percent. Twenty-five surveys were received after the agencys deadline and were not included in the totals. Of the remaining 272 responses, 84.9 percent (231) of respondents report they currently perform liposuction.

Eight Years of Fat Transplantation Experience

Introduction: I have used fat as a transplantation filler following liposuction approximately 8 years. Six years ago, I began freezing fat to be used later. The results of both frozen and fresh fat as transplant material is dependent on many variables, not the least of which is technique. I describe the background of this procedure, its evolution, my personal techniques, and the results. Materials and Methods: For this study, only 30 randomly chosen patients who could be followed for at least 6 months were considered. Twenty-eight patients received fresh fat transferred at the time of surgery. Fourteen patients received frozen fat. Five patients received a second injection of frozen fat. Three received 3 or more injections. Two patients received frozen fat injected as the initial filler. One patient received a subsequent injection of frozen fat. My technique for harvesting fat either to be used as fresh transplant material or later as frozen transplant material is the same. Tumescent infiltration is carried out using the standard Klein solution, 0.05% lidocaine, in normal saline with 1:1000000 epinephrine. Originally a 2- or 2.5-mm cannula with a 35 mL or 60-mL syringe technique was used; however, recently, the Coleman harvesting needle and 10-mL syringe have been used. The fat is stored in 5- and 10 mL syringes. Conclusion: I have found fat to be an acceptable filler for both congenital and surgical defects as well as a good method for augmentation. I found frozen fat to survive as well as fresh fat.

Unusual and Late Complication of Polyurethane-Coated Prosthesis—Intraprosthetic Hematoma

This case report deals with what we believe to be a previously unreported complication using the polyurethane-coated breast implants. Our patient presented with unilateral intraprosthetic breast prosthesis enlargement resulting in pain and excessive stretching of the skin. The focus of this study is to present the history, treatment, and possible explanations for the findings in this case. Many have proposed the polyurethane-covered breast implants as the answer to the plaguing problems of contracture and firmness as well as recommending them for general use in augmentation mammoplasty. As use of the polyurethane-coated implants increases, there will no doubt be an increase in complications with these implants. In our experience of over 2 years with 60 patients, 120 implants total, with the Meme and Replicon implants, we have encountered only one major complication. Although nearly all of our patients have had satisfactory results, the one significant complication encountered was that of a unilateral, intraprosthetic enlargement 14 months postoperatively, resulting in intractable breast pain and excessive stretching of the skin. After failure at conservative therapy, surgery was required, and it was possible to examine the prosthesis and shed some light on the plausible causes of this phenomenon.

Nonthermal Laser Combined With a Lymph Drainage System for Noninvasive Body Circumference Reduction

A nonthermal laser device is approved for noninvasive body circumference reduction and temporary improvement in the appearance of cellulite. Another noninvasive device based on the principle of manual lymph drainage is approved for body circumference reduction and improving the appearance of cellulite. This pilot study evaluated the effectiveness of combining these treatments for reducing body circumference. Healthy men and women (N = 27), 22 to 70 years of age with a body mass index of 25 to 40 kg/m2, inclusive, seeking to improve the appearance of their waist, hips, and upper abdomen, were enrolled. The laser device consists of 6 independent, variable frequency lasers emitting a 532-nm green light with a mean power output of 17 mW (Erchonia Verjú Laser System; Erchonia Corporation, Melbourne, Florida). The lymphatic drainage system is a pressure therapy intended for body contouring and cellulite reduction applications and for reducing edema (Green PRESS 8 Lymphatic Drainage System; Iskra Medical, Podnart, Slovenia). Participants received 12 treatments, one every 3 to 4 days over a 6-week period. Each session included a 30-minute nonthermal laser treatment (15 minutes each to front and back) followed by a 30-minute treatment with the lymphatic drainage system. To evaluate comparability of the combined devices treatment with the nonthermal laser treatment, individual study success for the nonthermal laser alone was a 3.0-inch (7.62 cm) decrease in combined baseline hips, waist, and upper abdomen circumference at the end of the study. A 50% increase in combined hips-waist-upper abdomen circumference measurement following combined treatments was considered a clinically meaningful improvement over the use of nonthermal laser alone. Individual study success was achieved by 17 participants (63.0%), exceeding the preestablished overall study success criteria of 60% in comparison with nonthermal laser treatment alone. The mean (SD) combined body circumference decreased from 112.3 (13.7) inches at baseline to 108.5 (13.8) inches at the end of the study, a mean decrease of 3.9 (2.7) inches (P < .0001). One-way analysis of variance tests for changes in total body circumference measures at weeks 4, 8, and 12 were significantly less than baseline (for each, P < .01); however, the study failed to achieve a 50% decrease in combined hips-waist-upper abdomen circumference measurement following application of combined treatments versus nonthermal laser alone. Additional treatment with a manual lymphatic drainage system does not improve the effectiveness of a nonthermal 532-nm green laser for reducing hips, waist, and upper abdomen circumference.

Erratum: Re: “Application of Low‐Level Laser Therapy for Noninvasive Body Contouring” Lasers in Surgery and Medicine, 2012;44(3):211–217

In the recent Clinical Report titled, ‘‘Application of Low-Level Laser Therapy for Noninvasive Body Contouring’’ Lasers Surg Med. 2012 Feb;44(3):211–17. DOI: 10.1002/lsm.22007.), the article should have included the following author conflict of interest disclosure statement: Jillian Maloney, MD, presently provides research guidance for Erchonia, the manufacturer of the device used in this study. However, she did not treat any patients or communicate with the participating physicians.