Outcomes from 1,500 consecutive cases of office-based, laser-assisted liposuction using local anesthesia show it is a viable alternative to liposuction under traditional anesthesia for body contouring in appropriately selected patients, says Christopher T. Chia, M.D.
In collaboration with his partner, Spero J. Theodorou, M.D., Dr. Chia initially conducted a review of their experience with 1,000 consecutive cases of laser-assisted liposuction (Chia CT, Theodorou SP. Aesthetic Plast Surg. 2012;36(4):795-802; Epub ahead of print). In a presentation at the New York Plastic Surgery Foundation's 2011 Cutting Edge Aesthetic Surgery Symposium, they reported on an expanded cohort that included data for 812 patients (1,500 cases) who were treated at a variety of anatomic sites and had fat aspirate volumes ranging from 50 mL to 1,400 mL.
Results in both the original and updated series showed laser-assisted liposuction with local anesthesia provided reproducible results and was associated with minimal morbidity. Overall, 99 percent of patients resumed normal daily activities by postoperative day two, only about 7 percent of patients required a touch-up. Complications, of which none were major, occurred at a rate of less than 1 percent."The complication rate and enhancement rate in this series compare favorably with outcomes reported for traditional liposuction. However, with avoidance of intravenous sedation or general anesthesia, the recovery time is much quicker, and so laser-assisted liposuction with local anesthesia may appeal to patients who might otherwise not consider a body contouring procedure," says Dr. Chia, who is in private practice in New York and an attending surgeon, department of plastic surgery, Manhattan Eye, Ear & Throat Hospital.
STUDY DETAILS The 1,500 cases were performed over a 30-month period in an American Association for Accreditation of Ambulatory Surgery-accredited, office-based operating room and represented three sequential cohorts of 500 cases, each performed using different generations of an Nd:YAG laser lipolysis platform (Smartlipo, Cynosure). The first 500 cases were performed using the 1,064 nm single wavelength device (Smartlipo); the next 500 were done using the 1,064/1,320 nm dual wavelength system (Smartlipo MPX); and the last series was done using the 1,064/1,440 nm wavelength combination of the triple wavelength laser (Smartlipo TriPlex).
"The different wavelengths target different chromophores; 1,064 nm has high affinity for methemoglobin and hemoglobin, 1,320 nm is absorbed primarily by water, and 1,440 nm has relatively high affinity for fat," Dr. Chia says. "These wavelengths break fat apart by a photomechanical effect, and they also cause nonspecific thermal injury that leads to tissue contraction. In our practice, we find the combination of the 1,064 nm and 1,440 nm wavelengths to be quite effective, especially for fat emulsification."
Various fiberoptic cable sizes were used (300, 600 and 1,000 microns), although Dr. Chia says the 1,000 micron cable is now used exclusively. Applied energy ranged from 1,500 J to 65,000 J per site, depending on the wavelength(s) used, and power settings ranged from 7 watts to 38 watts.
Liposuction was performed using suction only in some cases, but mainly with power assistance, which the surgeons say they prefer because it is easier, faster and more efficient.