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The Selective Laser-induced Melting Procedure – Advanced Laser Body Sculpting
male breast and back are particularly responsive to iUAL, unpleasant Figure 1: Absorption Spectrum of Human Fat Under
side effects such as seromas, skin loss and peripheral nerve injury have
Physiological Conditions and Super-hydrated Conditions
(with Tumescence)
precluded iUAL from being truly embraced by practitioners.
8–12
On the
other hand, XUAL is more widely used due to easier movement of
20
the cannula, reduced blood loss, reduced patient pain and discomfort
924 nm 975 nm 1,064 nm
18
and good skin retraction.
7,13–15
)
16
-1
14
Laser-assisted Liposuction
12
Laser-assisted liposuction (LAL) was developed around the same time
as ultrasound-assisted liposuction; however, early results were not
10
promising. Apfelberg’s 1996 progress report stated that no clear benefit
8
was observed with the neodymium: yttrium–aluminium–garnet
6
(Nd:YAG) laser following testing on 51 patients and the device was not
Absorption coefficient (m
4
approved by the US Food and Drug Administration (FDA).
16,17
Part of the
2
failure of this early device was attributed to the laser fibre being located
0
inside the aspiration cannula, which led to increased mechanical
900 920 940 960 980 1,000 1,020 1,040 1,060 1,080 1,100
Wavelength (nm)
damage and overheating of the device.
18
These technical difficulties
Regular fat Hydrated fat
were later rectified with the next generation of lasers that positioned
the laser fibre outside the aspiration cannula.
18
Despite these efficient heating of the hydrated adipose tissue after tumescence, as
modifications, preliminary studies have generated somewhat variable well as of the dermis. Both of these wavelengths are also absorbed by
results. In a randomised, double-blind study conducted by Prado et al., capillaries, leading to a combination of effects that translate into clinical
the authors compared the efficacy of the 1,064nm Nd:YAG laser benefits. As detailed below, these benefits include reduced post-
(SmartLipo™, Cynosure, Westford) with SAL in 25 patients. While less operative pain, bruising, bleeding and downtime for the patient.
pain and lower lipocrits were reported for the 1,064nm-treated side, Additionally, there is less fatigue and effort required by the physician
there were no major clinical differences between the two treatments.
19
performing the procedure.
Conversely, the Kim study treated 20 patients with the 1,064nm device
and observed excellent patient tolerance, quick recovery times and Optimal Wavelengths for Fat Thermolysis and Tissue Retraction
dermal tightening, although there was no control treatment.
20
The The choice of the optimal wavelength for laser thermolysis of fat is
Goldman study examined the ability of the 1,064nm laser to reduce fat critical to maximise penetration, to minimise tissue trauma and for the
and tighten skin in the submental area in 82 patients.
21
The authors success of the procedure. Palomar’s research team deciphered an
attributed the observed cosmetic benefits, such as skin retraction, to absorption profile for human fat that shows a clear peak in fat
collagen neoformation, which was revealed by histological samples absorption at the 924nm wavelength (see Figure 1).
24
This wavelength
collected from patients post-treatment.
21
While skin retraction was provides maximum selectivity for fat while simultaneously providing
previously observed with conventional liposuction, it is believed that sufficient optical penetration for maximal volume heating of adipose
LAL may offer even more dramatic benefits, especially for sites resilient tissue surrounding the tip. Evidence of this ‘lipid-liberation’ effect is seen
to skin retraction following liposuction, i.e. the face.
22
Preliminary results in the amount of translucent oily layer floating on the surface of the
in LAL studies thus far appear to validate this theory.
18,20,21,23
aspirate. This localised heating of adipose tissue also heats nearby
connective tissue, which contributes to the shrinkage of adipose tissue.
Unique Features of SlimLipo™ The second wavelength of 975nm was chosen for SlimLipo because it
A promising new LAL device is the SlimLipo™ system and handpiece corresponds to a peak in water absorption (see Figure 1). This
(Palomar Medical Technologies, Inc., Burlington), which was recently wavelength optimises the tip’s performance in hydrated adipose tissue
cleared by the FDA for laser-assisted lipolysis. The SlimLipo handpiece following tumescence and near the dermis to enable skin retraction.
was uniquely designed to release fat by photothermolytic heating with Tissue retraction with SlimLipo arises through a combination of effects.
its advanced tip design and optimal wavelength selection. The SlimLipo It is commonly believed that fat volume loss itself leads to skin retraction
tip is designed with rounded angles to minimise the mechanical damage due to the skin’s inherent elasticity (especially in younger patients).
that has been observed with other tips containing sharp angles. Unlike However, beyond this volume loss skin does not typically retract further,
the high-temperature spikes of standard laser fibres, the expelled leading to redundant skin. Clinical experience and previous studies have
energy from the SlimLipo tip is evenly distributed in the immediate shown that proper heating of the dermis provides additional skin
treatment area, allowing for smoother and more uniform heating of fat retraction. In principle, as the adipose connective tissue also contains
with easier extraction. While currently available laser tips can overheat collagen, heating of the septa together with reduced mechanical trauma
focal areas and generate bubbles or mechanical shock waves, the to the tissue helps to preserve and tighten the adipose connective
SlimLipo handpiece delivers smooth heating using continuous wattage tissue, leading to further skin retraction. Fairly immediate skin smoothing
or long pulses. This prevents overheating and enables effective and safe is observed. Over time, the skin retraction becomes even more
disruption of the adipocytes and coagulation of the surrounding cells. pronounced as the septa and meshwork separating adipocytes are
Other advantages of the SlimLipo system include a highly selective replaced with new connective tissue to remodel skin and body contours.
wavelength blend of 924 and 975nm that, respectively, allow for maximal
absorption by fat and by connective tissue with higher water content Clinical Data
such as dermis. The 924nm wavelength enables the device to glide Our less than optimal results with a number of devices on the market led
through adipocytes and liberate lipids with minimal effort compared us to investigate a better method of laser lipolysis or liposculpting. The
with non-fat-selective lasers. The 975nm wavelength results in more SlimLipo system of wavelengths and unique optical delivery compared
EUROPEAN DERMATOLOGY 55
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