and for debulking port-wine stains.

Laserlipolisi treatment, or laser lipolysis, involves the insertion of a 1.0 mm cannula, which is about half the size of a traditional liposuction cannula, under the dermis with an 18 gauge needle after tumescent anesthesia.

Dr. Yeo said, “The small caliber cannula is very beneficial when we’re treating tricky areas such as

the face.” The cannula protects two lasers: the treatment laser (1064 nm Nd:YAG) and a Helium-Neon (HeNe)

guide laser, both in a 300 micron fiber. “The aiming beam at the tip of the fiber lets you know exactly where you are at all times, which allows the user to be very precise,” Dr. Kim noted. As a result, SmartLipo is very useful in areas not suitable for standard techniques,

such as the face, neck, back and knees.  As the device is waved in a fan-like fashion within the subcutaneous fat and the laser is engaged, the

SmartLipo system disrupts the cell membranes of adipocytes and the collagen septa with photoacoustic and photothermal energy — basically melting the fat.

“Because the 1064 nm laser doesn’t have a specific chromophore in the skin,” Dr. Yeo elaborated, “it generates

heat rather nonspecifically. The 5,000 watt peak power is high enough to break the cell membrane. With proper

technique there is no carbonization at peak power.”

Tissue carbonization prolongs healing time and delays the onset of visible results.  The heat also promotes blood coagulation during

the procedure, which has been seen histologically, according to Dr. Kim. “The heat reduces post treatment

bruising. With the treatment itself you can get a little bit of bruising or a little bit of ecomosis that can last a

few days to a week, but patients are very pleased overall because there’s very little downtime associated with

this procedure.”

“The coagulation effect significantly reduces the chance for fat embolism,” said Dr. Yeo. “Worldwide,

there are no reported cases of mortality from tumescent liposuction.” Dr. Katz added that the almost non-existent

blood loss during treatment is also due to vasoconstriction as a side effect of the anesthesia.

Dr. Kim was also impressed by the lack of transient effects. “Preliminary studies have shown no elevation in blood cholesterol and

 things of that nature, which I think is very relevant given that we let the body remove the fat itself,” she remarked.

Triglyceride (TG) released from adipocytes enters the blood stream mainly through lymphatic channel

and enters dietary fat metabolism, according to Dr. Yeo. Deka reported that lysate may also be removed actively

with low-level suction (approximately 0.5 bar) or by syringe.  It takes a few weeks to see results as the body slowly

but surely eliminates the fat naturally. “Interestingly,  when patients come back five or six days later you can

hardly tell they’ve had anything done,” said Dr. Katz.  Because Laserlipolisi is minimally invasive, a small

bandage to protect the insertion wound is about the only post treatment care required. Some patients may

additionally wear compression garments or bandages, said Dr. Kim. Dr. Yeo recommends a three day course of

antibiotics as well.

According to Dr.Yeo, side effects are minimal, which contributes to the extremely low downtime. Common

side effects such as inflammation, tenderness, minor bruising, or temporary lumping subside within a week.

Mount Sinai School of Medicine, New York, N.Y., USA

“Even subcutaneous nodules, the manifestation of severe damage at the focus, subsided without further

management,” Dr. Yeo explained. “If it persists, I would consider triamcinolone intralesional injection.” Dr. Kim

reported two instances of mild hyperpigmentation which resolved within the first month.

Dr. Kim stressed that technique is very important, as it is for many procedures. “The learning curve is

quite steep. You don’t want to be overly aggressive because you’re heating up the subcutaneous fat. And

theoretically there is a risk of providing too much heat superficially to the skin. But as long as you’re well

trained and careful, I think the procedure itself has a lot of potential,” she said.

Other lasers treat fat deposits with a transdermal approach, using light through the skin from the outside.

“There’s no comparison,” said Dr. Kim. “With other lasers you’re not actually touching the area, so

you’ll see a definite reduction in potential efficacy. SmartLipo works under the skin, in contact with the

treatment area.”

The description of the ideal candidate for Laserlipolisi given by Dr. Katz echoed those of Drs. Kim

and Yeo, “I don’t think it’s much different than traditional Liposuction – someone who exercises regularly, is

not obese, or just has localized fat deposits that they can’t get rid of with exercise and diet. That’s really the

ideal patient.”

According to Dr. Yeo, “As with traditional liposuction, some patients mistakenly think that Smartlipo

can remove all their unwanted fat. It’s important that the patients have realistic expectations.”

Dr. Kim has had success combining Laserlipolisi treatment with the TriActive Laser Dermatology

(Cynosure, Westford, Mass., U.S. and Deka, Calenzano, Italy) system in a recent study. “Combining both the

fat reduction as well as the overlying skin tightening and contouring effect yielded higher, statistically significant

subjective improvement over Smartlipo alone,” she explained.

Laserlipolisi with Smartlipo may be extremely handy for revisiting areas of the body previously treated

with traditional liposuction. “With previously treated areas, if you wanted to further sculpt or

contour without going in again with liposuction, then the Smartlipo is a good idea,” she observed. “It’s also for

areas anywhere on the body that have overlying skin laxity, especially if you’re a relatively thin, fit, and

healthy person looking for additional toning and tightening.”

According to Dr. Katz, the main advantage of Smartlipo will be its two pronged attack. “Smartlipo tightens

the skin as it removes the fat, which typical liposuction doesn’t do,” he said. “We don’t have long-term experience

with it yet but we’ve done studies with pig skin and seen shrinkage of about 40%.” Dr. Katz is currently

involved in a study to investigate this potential in human patients.

As an additional application, Smartlipo may soon be added to the armamentarium for port-wine stains

(PWS) and other indications. “As the port-wine stain lesion progresses, there is soft tissue overgrowth under

the PWS lesion,” noted Dr. Yeo. “This is hard to remove with a conventional vascular laser. I inserted the

Smartlipo tip through the hypertrophic tissue under the stain. Surprisingly, that induced debulking for the

lesion. No other conventional laser can do this. I also used Smartlipo for venous malformations. and for

minor facial lifting on five patients. I did minor facial lifting, without fear of damaging facial motor nerves

because they are too deep to be effected by the technique.”

Before Tx After Smartlipo Tx

Photos courtesy of

Roy Geronemus, M.D.