"Basically," Douglas D. Dedo, M.D., says, "we combine vibro rolling and the effect of the low-level laser, which was introduced by Rodrigo Neira, M.D., of Columbia (Neira et al. Plast Reconstr Surg. 2002 Sep 1;110(3):912-922; discussion 923-925). He showed very eloquently that the 635 nm wavelength laser (Erchonia) causes a pore to develop in the fat cell" through which the cell's contents are extruded into the intracellular space, thereby facilitating fat removal. Dr. Dedo is a cosmetic surgeon in private practice in Palm Beach Gardens, Fla., at the Palm Beach Institute of Cosmetic Surgery and past president of the American Academy of Cosmetic Surgery (AACS).
Compared to ultrasound-assisted liposuction, Dr. Dedo says that with this low-level laser, the fat is more emulsified and less bloody. "This particular wavelength of light also has been shown experimentally to enhance wound healing by increasing epithelialization and blood vessel formation," he adds.The vibro roller, also made by Erchonia, measures about 5 inches long. "It's on a motorized handpiece that lets it vibrate up and down perpendicular to the skin, and one can adjust the frequency with which it vibrates," Dr. Dedo explains. When used in the immediate postoperative period, when patients are very sore, he says one must set the frequency very low to provide a very gentle motion as one rolls across the skin.
"I hold the laser in front of the roller and run it up and down in the areas that were treated with liposuction. It's my feeling that by using the laser, one enhances the wound healing while causing the fat cells to soften," Dr. Dedo says. When one follows behind the laser with the vibrating roller, he says it provides an effect essentially like leveling cement. "I believe it gives a much better, smoother result" than liposuction performed without laser vibro rolling, he adds.
Dr. Dedo says the theory behind this technology rests partly on the work of Claire Lieberman, M.D., of Costa Rica, who has shown that manual massage enhances liposuction results by improving fluid drainage. In his practice, he says he uses the 635 nm laser alone before applying dressings, and the day following liposuction. Usually on the second day post-procedure, he adds gentle vibro rolling to this regimen, increasing the frequency (up to several times a second) as the patient's tolerance grows. "If the patient is really tender," he adds, "one can simply use the roller without vibration."
Originally, Dr. Dedo says he received a roller that "sat in the box for a year." Finally, after one of his liposuction patients developed hardening of the treated areas, he says he tried the roller, achieving "such a spectacular result that I use it on all my liposuction patients."
In contrast to endermology, which Dr. Dedo says provides a temporary smoothing of skin irregularities following liposuction, he believes the combination of laser and vibro rolling achieves permanent results.
"The patient is in the process of healing after liposuction," he explains. Accordingly, the patient must pass through stages including inflammatory and vascular responses. With laser vibro rolling, he explains, "One is trying to enhance the patient's wound healing capability, so that when the patient has formed the collagen and scarring in the area where one has removed the fat, one can smooth out the 'highs' and add to the 'lows.' "
To date, Dr. Dedo has treated approximately 50 patients in this manner. As for potential complications, he says, "I can't think of any at the present time. One is basically massaging the patient. The laser is a low-level or cold laser, so one need not worry about burning."