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lunes, 16 de noviembre de 2009

Laser lipolysis treatments

The authors submit in this article their experience with Smartlipo MPX laser from Cynosure, launched in November 2008. To date, more than 30 patients have been treated with this technique in different anatomical regions. The Smartlipo MPX system is equipped with 2 wavelengths (1,320 nm-1,064 nm) which can be used together or separately, optimizing the
advantages that can 1,320 nm is more lipolytic and 1,064 nm has a greater affinity for
oxyhemoglobin.

This technique has allowed us to perform liposuction via laser assisted lipolysis for in patients who would be ruled out as candidate for conventional liposuction due to residual skin excess, especially in brachial and crural regions, as excess residual skin would not yield a satisfactory aesthetic result.

CLINICAL CASE 1

A 40 years old patient presented curri grade II cellulite (cutaneous paleness and decrease in
skin elasticity) on the buttocks. Local anesthesia was utilized, employing klein solution (1 litre of normal saline solution, 1 adrenaline, 50 mg of 1% lidocaine, 1 ampoule of 8.4% sodium bicarbonate) infiltrating 400 cc into each bultock.

The goal of the treatment was to treat gluteal dimpling by means of skin tightening, so we only utilized a 1,064 nm wavelength at 20 W. 12,000 J was the energy delivered to each buttocks at, superficial level and we did not perform posterior liposuction, nor did we fill any region.

Analgesia and antibiotic a therapy were not required post-operatively and hematoma
formation was minimal. We diserved a significant improvement after 3 months.

CLINICAL CASE 2

A 68 years old patient presented a large brachial lipodystrophy. In this case, we suggested to her, as first option, to perform a conventional brachial lifting but the patient was not willing to accep any post-operative scarring.

We suggested her a laser lipolysis-assisted liposuction, andwe considered to perform it in two times if skin did not tighten how we expected. We suggested liposuction via laser-assisted lipolysis, emphasizing the possibility to perform this technique twice if the skin did not tighten as expected.

We used general anesthesia, so as the surgery could be performed comfortably, employing a wet infiltration of Klein solution (250 cc in each upper extremity). The laser protocol was as follows: We initiated the lipolytic phase using the two wavelengths offered by Smartlipo, beginning the surgery with the Blend 1 system to work in depth at 24 W (1,320 nm at 12 W and 1,064 nm at 12 W), delivering 8,000 J in each upper extremity (arm and forearm).

We continued surgery using conventional liposuction, aspirating 850 cc in the right upper extremity and 800 in the left upper extremity. We finished surgery with the tightening
phase with the 1064 nm wavelength at 20 W, delivering 12,000 J to each extremity.

The patient remained hospitalized for 24 hours in the clinic. The hematomas were discrete with minimal discomfort so analgesia was not needed to relieve the pain. We advised her to wear a contouring girdle for 5 weeks to assist in skin tightening.

CLINICAL CASE 3

A 35 years old patient presented a large crural and suprapubic lipodystrophy. After general anesthesia, we infiltrated the Klein solution (A total of 600 cc) on the area to be treated.
We began surgery with Blend 2 at 30 W (1,320 nm at 12 W and 1,064 nm at 18 W), delivering a total of 15,000 J between the suprapubic and umbilical area.

Next, we performed conventional liposuction, proceeding to aspirate 400 cc of fatty tissue.
Once we refined the flap of skin to the maximum, we started with dermolipectomy on residual skin, achieving the most minimal scarring possible.

We finished surgery with the tightening phase, in which we used the 1,064 nm wavelength at 16 W, especially in the suprapubic area, delivering 5,000 J. The crural area was treated in the same way, initiating the lipolytic phase in Blend 2 at 30 W (1,329 nm at 12 W and 1,064 nm at 18 W), delivering 6,000 J to each crural area. We aspirated 400 cc in the right crural area and 250 in the left crural region.

We finished surgery with the tightening phase with a 1,064 nm wavelength at 20 W, delivering 5,000 J in the right crural area and 4,000 J in the left crural area We recommended the patient wear a contouring girdle for 4 weeks and post-operative analgesia was minimal. We did not
observe any hematomas in the abdominal area, whereas the hematomas in the crural area were not significant.

CONCLUSIONS
The possibility of now having Smartlipo MPX technology among our systems allow us to treat a series of patients with skin excess after conventional liposuction, preventing residual scarring as much as possible.

On one hand, the lipolytic effect utilizing a 1,320 nm wavelength will allow us to remove fat gently and the tightening effect at 1,064 nm, will help skin to retract more effectively.

Laser-assisted liposuction enables more rapid postoperative recovery due to less bruising and reduced pain in this procedure.

Delivered energy on each patient was proportional to the treated area in question, dividing such areas in 5x5 sections, although the main parameter taken into consideration was the superficial skin temperature, which was never higher than 41 ºC, preventing any potential necrosis due to
an excess of energy delivered.

The Smartlipo technique can be performed individually or combined with other surgical techniques, which will help to yield better results in our treatments.

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