Vol. 28. No. 4


Can you believe that fat can be removed, predictably, without surgery? This fantastic development is the basis for this issue of Seminars in Cutaneous Medicine and Surgery. In today’s body-conscious society, it is difficult to find a person who would not desire to change their body shape in some manner. Patients often seek a physician’s opinion regarding fat removal options. It is important that all physicians, both those who perform fat removal and those who do not, be well versed in the body contouring options available so that they can properly counsel inquiring patients. Today, liposuction is the most common surgical cosmetic procedure performed in the United States.1 Liposuction has been performed regularly since the late 1970s,2 although over time, liposuction techniques have been refined. The advent of the “tumescent” technique in 1987 eliminated the need for general anesthesia, making liposuction easier and safer to perform.3 Despite the safety and efficacy of conventional liposuction, many patients seek a less invasive method for body contouring. A variety of devices have been developed in an attempt to reduce fat nonsurgically. Radiofrequency, ultrasound, lasers, and cryolipolysis are some of the new modalities employed to remove fat without liposuction. The mechanism of action, efficacy, and safety of each of these new devices will be presented in this issue of Seminars in Cutaneous Medicine and Surgery. Although all these new devices are exciting and offer great possibilities, it is important for the physician to also recognize their limitations so that the patient can be appropriately counseled. Some of the devices may not be a replacement to conventional suction liposuction, but rather an adjunct to liposuction. With this recent explosion of new body-contouring devices, it is hoped that the practice of body shaping can be further perfected. It is our hope that this journal edition will spark interest in people with regard to these devices, and further entice physicians and industry to perform additional clinical trials investigating these technologies.

The History of Liposuction

Ryan William Ahern, MD, MPH

This article aims to familiarize the reader with the history of liposuction. The author
documents the landmark events and characters in the development of this revolutionary
and widely known procedure. Included is a historical discussion of the obstacles and the
triumphs the practitioners and the procedure itself has seen, as well as a review of relevant
scientific data placed in its appropriate historical context up through modern day.
Semin Cutan Med Surg 28:208-211 © 2009 Elsevier Inc. All rights reserved


Laser Lipolysis Using a 1064/1319-nm Blended Wavelength Laser and Internal Temperature Monitoring

Marc J. Salzman, MD, FACS

Lasers, both in single and multiple wavelength designs, have recently been introduced to
enhance the results of liposuction. Safe parameters of fluence and temperature have not
yet been described. In this study, I describe a series of laser lipolysis patients treated with
a dual wavelength (1064/1319 nm) laser where internal and external temperatures have
been measured. From this series of 36 patients treated with a 1064/1319-nm wavelength
laser for laser lipolysis, we calculated the specific heat of the fat and tumescent fluid
combination to be 4.7 J/(g°C). The average increase in temperature measured in the
subcutaneous space was 16°C.
Semin Cutan Med Surg 28:220-225 © 2009 Elsevier Inc. All rights reserved.


Laser Lipolysis: Current Practices

Melanie D. Palm, MD | Mitchel P. Goldman, MD

Laser-assisted liposuction (LAL) is a recent innovation within the field of liposculpture. In
addition to body contouring, the indications of LAL are skin retraction in areas of flaccidity
and fat melting for challenging surgical cases including revisions, areas of dense
fibrosity, and large-volume cases. A photothermal effect explains the effects of LAL on
tissue, regardless of the wavelength used. Advantages of LAL include reduced bruising,
edema, pain, and recovery time. Disadvantages are most often related to thermal effects on
tissue, such as skin blistering. Currently, 3 wavelengths, 980, 1064, and 1320 nm, are Food
and Drug Administration-approved for LAL. Comparative studies examining the safety and
efficacy of LAL have appeared in the medical literature. Technical considerations, emerging
technology, and future indications are important to the success and continued development
of this procedure.
Semin Cutan Med Surg 28:212-219 © 2009 Elsevier Inc. All rights reserved.


Laser-Assisted Liposuction for Facial and Body Contouring and Tissue Tightening: A 2-Year Experience With 75 Consecutive Patients

Ana Tevez, RN | Gordon H. Sasaki, MD, FACS

Internal liposuction remains the standard and most reliable method to remove fat and
contour the face and body. The recent introduction (2006 FDA clearance) of a higher and
more controlled energized internal laser system is purported to increase tissue contraction
and damage unwanted fat deposits through dual 1064 nm/1320-nm wavelengths that are
initially used at a deep level of subcutaneous fat, and subsequently at a shallow level
beneath the dermis along with liposuction. Using classical principles of selective photothermolysis,
the sequential exposure of these wavelengths on target tissue chromophores
results in selective thermo-lipolysis and thermo-denaturation of collagen fibers (H2O)
within the septal architecture and lower reticular dermis for enhanced skin retraction
(accommodation) and contraction. This article reviews this innovative laser system, discusses
the latest clinical protocol changes, tabulates the measurements of time and energy
during each phase of treatment and temperature endpoints, and correlates the histologic
findings to energy deposition. The collected objective data are used to improve on the
safety and efficacy treatment profiles at 11 sites in 75 consecutive patients. Further clinical
studies and comparative trials are recommended to validate these outcomes.
Semin Cutan Med Surg 28:226-235 © 2009 Elsevier Inc. All rights reserved.


Radiofrequency Devices for Body Shaping: A Review and Study of 12 Patients

Anne M. Chapas, MD | Lori A. Brightman, MD | Robert Anolik, MD | Roy G Geronemus, MD

Radiofrequency (RF) devices such as ThermaCool TC (Solta Medical Inc., Hayward, CA)
offer a nonablative and noninvasive treatment option for unwanted skin concerns of the
head, neck, and body. Relatively fewer studies address RF treatment on the body when
compared with the head and neck. The purpose of this report is to investigate the use of the
ThermaCool TC system with the novel Thermage Multiplex Tip for the enhancement of body
shape. Additionally, this report will review the literature of RF technology with a concentration
on body shaping. Twelve subjects underwent ThermaCool TC treatments using the
Thermage Multiplex Tip. Waist circumference, standardized photographs, skin laxity score,
global aesthetic improvement score, and patient satisfaction surveys were assessed at
baseline and several follow-up visits after treatment. Average waist circumference and skin
laxity scores decreased after ThermaCool TC treatment, using the Thermage Multiplex Tip
at follow-up visits held at 1, 2, 4, and 6 months after treatment. Global aesthetic improvement
score and patient satisfaction surveys reflected these objective clinical improvements.
RF devices, such as the ThermaCool TC offer a nonablative and noninvasive
treatment option for unwanted skin findings of the head, neck, and body.
Semin Cutan Med Surg 28:236-243 © 2009 Elsevier Inc. All rights reserved.