Laser lipolysis is really a new technique still under development. The primary objectives of the technique are faster recovery, less operator effort and skin tightening . Using the 1064 nm-Nd:YAG laser and also the 980-nm diode laser being an auxiliary tool has refined the standard lipoplasty technique. Under anaesthesia, a little puncture or cut is created within the skin and also the laser light is communicated with the insertion of the micro-cannula (having a diameter of just one mm) into which an optical fibre continues to be placed. Choices could see in which the finish from the cannula reaches all occasions as a result of visible sore point from the aiming beam that shines with the skin. Choices may then slowly move the cannula backwards and forwards and laterally to effectively and evenly liquefy body fat within the treatment area. Because of the small size cannulas used (1 mm) this liposculpture treatment is regarded as non-invasive in comparison with traditional liposuction techniques, and therefore delicate areas like the face, forearms, upper abdomen and knees may be treatable that way. Body fat will be discarded through the body’s natural processes.
The interaction from the laser using the tissue is achieved through the absorption from the laser energy through the receptive chromophores, thus producing sufficient heat to result in the preferred thermal damage. Heat functions around the fatty cell and, the extracellular matrix to create both reversible and irreversible cellular damage. Several research has shown that for low energy settings and both 980 nm and 1064 nm, a tumefaction from the adipocytes is noted resulting in a rise of the diameter as much as 100 μ m [4, 5]. Heat generated through the laser would affect the balance of sodium and potassium from the cellular membrane, allowing the disposable transport of extracellular liquid towards the intracellular atmosphere. For greater energy settings rupture of adipocytes, coagulation of bovine collagen fiber and small vessels are observed [3, 5]. Because of the rupture from the membrane, lipases liberated through the adipocyte have the effect of the liquefaction from the tissue, which further facilitates the following aspiration. With the liquefactive aftereffect of the laser, the backwards and forwards movement from the cannula is conducted a lot more easily than when conducting the traditional liposuction technique. The truth that heat induces also coagulation of small vessels within the fat tissue is essential because this phenomenon facilitates the liposuction through less trauma and bleeding. Liposuction removes quite a lot of fat, serum and bloodstream. In the event in which considerable amounts of fat should be removed, a physiologically significant lack of bloodstream can provoke metabolic alterations. In this manner, laser-aided liposuction offers the benefit of removing bigger volumes of fat without hemodynamic repercussions .
Up to now, mathematical modeling of laser lipolysis has not been suggested. This was performed to assistance with supplying a much better knowledge of the laser lipolysis process and perhaps to look for the optimal dosage like a purpose of the level of fat to become removed. Our model remains a mathematical model, implying that errors may seem because of the factors and simplifications needed to understand it. Generally, such errors appear due to inaccuracy from the optical, thermal, and damage qualities which are critical points within the model’s group of equations. Actually, these qualities play a vital role within the precision from the results achieved. Many methods happen to be given to calculate these qualities but nonetheless we have seen variations within the values presented through the different groups, which reflect the problem of calculating these qualities. The issue is elevated through the reliance from the qualities on several variables (temperature, damage) with time. This will make the deviation neither straight line nor regular . Furthermore, it’s very hard to standardize the surgeon’s technique during laser lypolysis. For, this reason and to be able to compare the outcomes in our calculations to clinical data already reported within the literature, only submental laser lipolysis was considered. Video tracks were utilised to achieve a much better knowledge of the backwards and forwards movement from the cannula during laser lipolysis (movie 01) to be able to consider them within our mathematical model. Infrared video tracks were also performed to be able to compare the particular surface temperatures to the calculations.
These video tracks have given helpful info on the positioning of cannula during laser lipolysis especially how this cannula is moved backwards and forwards within the fat layer. The parameters acquired from all of these video tracks are similar to individuals reported within the literature. For instance, Ichikawa et al placed the cannula in to the target layer from the fat under the skin roughly 1 cm under the skin layers . This cannula was moved backwards and forwards several occasions. The step consisted in irradiating body fat layer using the cannula having a different position while maintained on a single plane. Consequently, these video tracks make sure our mathematical simulations are transposable towards the surgical practice.
Before trying to compare the parameters employed for simulation to individuals usually reported within the literature, the next comments should be made: 1) to the very best of our understanding no previous publications have reported mathematical modeling of laser lipolysis 2) Several clinical papers were printed. In many of them, laser parameters particularly the entire energy of the given volume aren’t reported. Finally, if clinical pre and post photographs are presented, the decrease in fat volume is generally not reported, with the exception of one paper where magnetic Resonance Imaging before laser lipolysis and also at 3-month follow-up was utilized to evaluate this volume .
Aside from the fat volume reduction because of temperature elevation, the amount reduction because of the mechanical insertion and backwards and forwards motion within the fat layer should be considered. Histologic research has demonstrated that the funnel was created because of fiber insertion. Rupture of adipocytes and fragments of adipose cell membrane were observed inside this funnel [3, 5].
It’s interesting to check the parameters utilized in our mathematical simulations to individuals usually reported within the literature, for that submental zone. However merely a couple of studies were printed as well as in many of them important data are missing. Goldman, inside a clinical set of submental Nd:YAG laser lipolysis on 82 patients, observed on histology, the coagulation of small circulation system within the fat and also the rupture of adipocytes . Regrettably, no data receive around the total applied energy, and also the exact fat volume reduction. Prado et al used a Nd:YAG laser and applied 400 J for within the submental zone . Key performed submental laser lipolysis having a 1320 nm laser using 560 to 1040 Joules. However, of these two studies, the decrease in body fat volume continued to be unknown. To be able to evaluate the decrease in body fat volume, ten patients treated by Kim et al went through an MRI pre-procedure and three-several weeks after 1064 nm-laser lipolysis. Searching in the specific sites, the submentum having a baseline average amount of 20 cm3 were built with a greater reduction (25%) in contrast to other, bigger treatment sites, suggesting a serving-response relationship . Within the submental zone, roughly 3000 J was applied to obtain a mean volume decrease in 5.2 ± 2.8 cm3. This resembles the amount reduction noticed in our study: 10 cm3 ± 1 cm3 for any total energy of 6600 J.
Finally, the mechanical cannulation of excess fat tissues leads and to a fat volume reduction. Our calculations show it represents 1 / 3 from the total volume.
Consequently, the interaction between your laser and also the biological tissue create a decrease in the level of fat in addition to remodeling from the collagenous tissue, with clinically apparent skin retraction. The heating of deep reticular skin is confirmed through the infrared measurements by our calculations. These climate is similar to individuals already reported when laser irradiation was performed having a non-ablative laser [14, 15]. They induce an inflammatory reaction process within the much deeper skin. The wound repair that follows the laser facial treatment results in the development of new bovine collagen and elastin fibers and therefore tissue tightening. This phenomenon is confirmed by Badin et al who observed after histological analysis the bovine collagen denaturing performed within the deep reticular skin and also the conjunctive septum from the subcutaneous tissue constituted a proinflammatory stimulant adopted by vascular proliferation and bovine collagen neosynthesis . Finally, the resulting skin retraction observed around the patient confirms these claims and it is in compliance to previous studies [16, 6].