Laser-assisted lipolysis for cankle remodelling: a prospective study in 30 patients.

Cankles refer to the area where the calf and ankle meet. Unaesthetic fat cankles, where definition between the calf and ankle is impossible, are a frustrating aesthetic deformity, which are exacerbated by their genetic conditioning and special resistance to diet. This article reports our experience with laser-assisted lipolysis (LAL) in cankle remodelling. A total of 30 patients were treated for unaesthetic fat cankles with LAL. The 924/975-nm diode laser used in this study consisted of two lasers, one emitting at 924 nm, and the other at 975 nm. According to our mathematical models, we assumed that to destroy 1 ml of fat, 0.1 kJ was required in dual emission mode at 924/975 nm. Patients were asked to file a satisfaction questionnaire. Ultrasound was used to measure the fat thickness pre- and postoperatively. Oedema in both lateral sulcus of the Achilles tendon was seen in all patients. It subsided after 4 weeks in nine cases and 6 weeks in 21 cases. Only two patients developed mild hyperpigmentation that disappeared, respectively, after 4 and 10 weeks. Pain during the anaesthesia and discomfort after the procedure were low with this technique. Mean down time was 1.0 day. Of the 30 patients, 29 would recommend this treatment. Overall, high patient and investigator satisfaction was confirmed by the sonography used to measure decrease in fat thickness. LAL in cankle remodelling is a safe and reproducible technique that is particularly appreciated by the patient. The procedure allows homogenous reduction of fatty tissue together with skin tightening.

Long-term outcomes of laser assisted blepharoplasty for ptosis: about 104 procedures in 52 patients.

BACKGROUND: Eyelid ptosis or blepharoptosis is defined as an abnormal drooping of the upper eyelid when looking straight ahead. Laser-assisted blepharoplasty (LAB), first introduced by Baker in 1984, presents the following advantages: improved intraoperative haemostasis, decreased operating time and improved appearance in the immediate postoperative periods. This article reports our long-term experience with LAB in ptosis correction surgery and underlines the advantages of the technique. METHODS: A total of 52 patients were treated for ptosis with LAB between 2000 and 2011. The patients had an average age of 59.5 ± 9.6 years. Etiologies were senile ptosis in 34 cases, traumatic ptosis in 9 cases and congenital ptosis in 9 cases. The ptosis was classified as mild in 24 cases, moderate in 11 cases, and severe in 17 cases. The surgical technique was similar to the one described by Baker. The laser used in our studies was the CO2 Lumenis Active(™) with the following parameters for skin incision: ultrapulse mode, continuous emission, 3-W power (program 1). The laser was then reprogrammed (program 2) with the following parameters for resection of a skin-orbicular muscle flap: regular mode, continuous emission, 9-W power with the beam slightly defocused. RESULTS: Early complications included oedema in 8 patients. More than 1 mm of lid asymmetry was seen in 8 patients with 6 patients under corrected and two over corrected. Two of them chose secondary surgery. Mean down time was 5.5 ± 1.7 days (2-7 days). The mean late follow-up was performed after 2-10 years (mean 6.6 ± 1.7 years). Late complications included 4 recurrences 5, 6, 6, and 8 years, respectively, after the first procedure. All but one were successfully re-operated with the same technique. Overall patient satisfaction ranked high and all but one would recommend this treatment to others. CONCLUSION: LAB in ptosis surgery is a safe and reproducible technique particularly appreciated by patients. The procedure allows for improved intraoperative haemostasis, decreased operating time and improved appearance in the immediate postoperative periods.

980-nm laser lipolysis (LAL): About 674 procedures in 359 patients.

BACKGROUND: Since the first studies by Apfelberg in 1994, laser lipolysis (LAL) has been on the rise. Laser lipolysis leads to reduced operator fatigue, excellent patient tolerance, quick recovery time, as well as the additional benefit of dermal tightening. This article reports a 5-year experience of LAL and underlines the potential evolutions of the technique. METHODS: Between January 2006 and December 2010, 674 LAL procedures in 359 patients were performed at the Antoni De Gimbernat Foundation in collaboration with the French National Institute of Health and Medical Research (INSERM) U703. LAL was performed with a 980-nm diode laser after tumescent anaesthesia. The following laser settings were used: 600-µm optical fiber, continuous mode, power depending on individual body areas (18-40 W). The cumulative energy used for each area was recorded. Early and late complications were defined and reviewed for the whole series. Satisfaction was assessed by the patients using a visual analogue scale from 0 (unsatisfied) to 10 (highly satisfied). RESULTS: Mean cumulative energy ranged from 12 to 60 kJ. Ecchymoses were observed in all patients but resolved in less than 10 days. A touch up was needed in four patients to remove small cushions of fat missed. Mean patient satisfaction ranged from 6/10 to 9.5/10 depending on the treated area. Moreover, all patients reported they would be willing to undergo the procedure again, if needed. CONCLUSION: 980-nm LAL appears to be a safe, effective and reproducible alternative to conventional lipoplasty. However, refinements in dosimetry should be developed in order to optimise outcomes.

Prospective ex-vivo study on thermal effects in human skin phototypes II, IV and VI: a comparison between the 808, 1064, 1210 and 1320-nm diode laser.

BACKGROUND: Laser Assisted Skin Healing (LASH) was first introduced in 2001 by Capon and Mordon to prevent keloids and hypertrophic scars. LASH requires homogenous heating throughout the full thickness of the skin around the wound. However, LASH therapy with 808-nm diode laser is deemed to be only applicable for phototype I-IV due to melanin absorption. This prospective ex-vivo study aims to evaluate the thermal effects of different wavelengths (808, 1064, 1210 and 1320 nm) on human skin phototype II, IV and VI. MATERIAL AND METHODS: Laser shots were applied on skin explants phototypes II, IV and VI. The following laser settings were used: 808, 1064, 1210 and 1320-nm diode laser, Spot size 20 × 3.7 mm, Power 3 W, Irradiance 4 W/cm², 50 shots for each phototype and wavelength. The surface temperature at 2 and 4-mm depth respectively was evaluated by an infrared camera and a low inertia micro thermocouple. RESULTS: For the 1064, 1210 and 1320-nm wavelengths, the temperature gradient between the surface and 2-mm depth after an irradiation time of 15 s was less than 4.0°C for each phototype. For the 808 nm, the gradient was 0.8°C and 4.4°C in phototype II and IV respectively, but reached 17.2°C in phototype VI. Strong absorption by melanin of skin phototype VI induced unwanted temperature increases at the dermis-epidermis junction, making this wavelength unsuitable for LASH therapy for this phototype. Among the three other wavelengths, the discussion section indicates strong blood absorption at 1064 nm and presents both 1210 and 1320 nm as excellent compromises for LASH therapy across the whole range of phototypes. CONCLUSION: Being poorly absorbed by melanin, both 1210 and 1320-nm wavelengths ensure homogeneity of temperature throughout the full skin explant thickness. Their possible utilization for efficient LASH therapy should now be confirmed by prospective in vivo studies.

Laser-assisted lipolysis for knee remodelling: a prospective study in 30 patients.

BACKGROUND: Unsightly fat knees are a frustrating aesthetic deformity exacerbated by genetic predisposition and resistance to diet. This article reports our experience with laser-assisted lipolysis (LAL) in knee remodelling. METHODS: A total of 30 patients were treated for unsightly fat knees with LAL. The 924/975-nm diode laser used in this study consists of two lasers, one emitting at 924 nm and another at 975 nm. Previous mathematical modelling suggested that 0.1 kJ was required in order to destroy 1 ml of fat, in dual emission mode at 924/975 nm. Patients were asked to fill out a satisfaction questionnaire. Ultrasound was used to measure the fat thickness pre-and post-operatively. RESULTS: Other than one patient who developed mild hyperpigmentation that disappeared after 2 months, there were no complications in the series. Pain during the anaesthesia and discomfort after the procedure were minimal. Return to normal activities never took longer than 2 days and mean downtime was 0.92 days. Of the 30 patients, 29 would recommend this treatment. Overall satisfaction was high with both patients and investigators and was validated by ultrasound measurements demonstrating a systematic decrease in fat thickness. CONCLUSION: LAL in knee remodelling is a safe and reproducible technique, particularly appreciated by patients. The procedure allows for a reduction in the amount of adipose deposits while providing concurrent skin contraction.