Laser-Assisted Facial Contouring Using a Thermally Confined 1444-nm Nd-YAG Laser: A New Paradigm for Facial Sculpting and Rejuvenation

Abstract

The micropulsed 1444-nm neodymium-doped lipolysis laser exhibits favorable characteristics for novel application in facial contouring. The study described herein is the first clinical report of laser-assisted facial contouring (LAFC). We retrospectively reviewed records of 478 LAFC patients (mean age 52) who underwent contouring of 1278 individual mid- and lower facial treatment sites over 18 months. Along with clinical assessment, study parameters evaluated among “original” and “modified” (where protocol updates included deep dermal soft tissue coagulation as an optional step) protocol groups included laser power, pulse energy, and total energy delivery as well as lipoaspirate volume at each treatment site. Mean power and pulse energy were similar (within 5%) and total energy use was greater (70% higher for mid- and lower face) in the original protocol group. Lipoaspirate volume was similar for both groups for the midface (within 10%) but elevated in the modified protocol group for the lower face (40% higher). Treatment complications were observed in 47 of 363 treatment sites (13%) in the original and in 12 of 915 treatment sites (1%) in the modified protocol group with the majority (63%) of the complications comprising over- versus undercorrections of desired tissue contour. Clinical efficacy varied with improvements of mid- and/or lower facial contour ranging from marginal to subtle to very apparent. LAFC as detailed herein is a novel treatment modality that enables selective soft tissue removal for greater precision in three-dimensional contouring of the face. Protocol modifications based on laboratory and observed tissue photothermodynamics have improved LAFC safety.

Keywords

Laser lipolysis - facial contouring - midface - jawline - melolabial fold - jowl - three-dimensional

Disclosures

Lutronic Inc. Medical Advisory Board, Equipment Discount, Honoraria, Stock Options.

Publikationsverlauf

Artikel online veröffentlicht:
26. Juli 2011

• References

• 1 Pessa JE, Zadoo VP, Mutimer KL. et al. Relative maxillary retrusion as a natural consequence of aging: combining skeletal and soft-tissue changes into an integrated model of midfacial aging. Plast Reconstr Surg 1998; 102: 205-212
• 2 Shaw Jr RB, Kahn DM. Aging of the midface bony elements: a three-dimensional computed tomographic study. Plast Reconstr Surg 2007; 119: 675-681 ; discussion 682–683
• 3 Mendelson BC, Hartley W, Scott M, McNab A, Granzow JW. Age-related changes of the orbit and midcheek and the implications for facial rejuvenation. Aesthetic Plast Surg 2007; 31: 419-423
• 4 Romo T, Yalamanchili H, Sclafani AP. Chin and prejowl augmentation in the management of the aging jawline. Facial Plast Surg 2005; 21: 38-46
• 5 Mittelman H, Spencer JR, Chrzanowski DS. Chin region: management of grooves and mandibular hypoplasia with alloplastic implants. Facial Plast Surg Clin North Am 2007; 15: 445-460 , vi
• 6 Mendelson BC, Freeman ME, Wu W, Huggins RJ. Surgical anatomy of the lower face: the premasseter space, the jowl, and the labiomandibular fold. Aesthetic Plast Surg 2008; 32: 185-195
• 7 Reece EM, Pessa JE, Rohrich RJ. The mandibular septum: anatomical observations of the jowls in aging-implications for facial rejuvenation. Plast Reconstr Surg 2008; 121: 1414-1420
• 8 Reece EM, Rohrich RJ. The aesthetic jaw line: management of the aging jowl. Aesthet Surg J 2008; 28: 668-674
• 9 Donofrio LM, Coleman WP. Fat transplantation. In: Rigel DS, Weiss RA, Lim HW. et al, eds. Photoaging. New York: Informa Health Care; 2004: 265
• 10 Hamra ST. A study of the long-term effect of malar fat repositioning in face lift surgery: short-term success but long-term failure. Plast Reconstr Surg 2002; 110: 940-951 ; discussion 952–959
• 11 Calderon W, Andrades PR, Israel G, Cabello R, Leniz P. SMAS graft of the nasolabial area during deep plane rhytidectomy. Plast Reconstr Surg 2004; 114: 559-564 ; discussion 565–566
• 12 Rudkin G, Miller TA. Aging nasolabial fold and treatment by direct excision. Plast Reconstr Surg 1999; 104: 1502-1505 ; discussion 1506–1507
• 13 Little JW. Applications of the classic dermal fat graft in primary and secondary facial rejuvenation. Plast Reconstr Surg 2002; 109: 788-804
• 14 Noone RB. Suture suspension malarplasty with SMAS plication and modified SMASectomy: a simplified approach to midface lifting. Plast Reconstr Surg 2006; 117: 792-803
• 15 Goldstein SA, Goldstein SM. Anatomic and aesthetic considerations in midfacial rejuvenation. Facial Plast Surg 2006; 22: 105-111
• 16 Holcomb JD, Kent KJ, Rousso DE. Nitrogen plasma skin regeneration and aesthetic facial surgery: multicenter evaluation of concurrent treatment. Arch Facial Plast Surg 2009; 11: 184-193
• 17 Meier JD, Glasgold RA, Glasgold MJ. Autologous fat grafting: long-term evidence of its efficacy in midfacial rejuvenation. Arch Facial Plast Surg 2009; 11: 24-28
• 18 Coleman SR, Grover R. The anatomy of the aging face: volume loss and changes in 3-dimensional topography. Aesthet Surg J 2006; 26 (1S): S4-S9
• 19 Morrison W, Salisbury M, Beckham P, Schaeferle III M, Mladick R, Ersek RA. The minimal facelift: liposuction of the neck and jowls. Aesthetic Plast Surg 2001; 25: 94-99
• 20 McKinney P, Cook JQ. Liposuction and the treatment of nasolabial folds. Aesthetic Plast Surg 1989; 13: 167-171
• 21 Langdon RC. Liposuction of neck and jowls: five-incision method combining machine-assisted and syringe aspiration. Dermatol Surg 2000; 26: 388-391
• 22 Toselli F. Imaging Spectroscopy. Boston, MA: Kluwer Academic Publishers; 1992
• 23 Anderson RR, Farinelli W, Laubach H. et al. Selective photothermolysis of lipid-rich tissues: a free electron laser study. Lasers Surg Med 2006; 38: 913-919
• 24 Holcomb JD. Facelift adjunctive techniques: skin resurfacing and volumetric contouring. Facial Plast Surg Clin North Am 2009; 17: 505-514 , v
• 25 Youn JI. A wavelength dependence study of laser-assisted lipolysis effect (Abstract 24). Presented at: the American Society for Laser Medicine and Surgery Twenty-Ninth Annual Conference National Harbor, MD; April 1–5, 2009
• 26 Holcomb JD, Ko K. Evaluation of internal and skin surface thermal effects of 980 nm diode and 1064, 1320 and 1444 nm Nd YAG lipolysis lasers in an ex vivo porcine model (Abstract). Presented at: the Annual Meeting of the American Society for Laser Medicine and Surgery Phoenix, AZ; April 15–18, 2010
• 27 Holcomb JD, Baek SJ. 1444 nm Nd YAG lipolysis laser assisted facial contouring: a new paradigm for facial sculpting and rejuvenation (Abstract). Presented at: the Annual Meeting of the American Society for Laser Medicine and Surgery Phoenix, AZ; April 15–18, 2010
• 28 Sasaki GH. Quantification of human abdominal tissue tightening and contraction after component treatments with 1064-nm/1320-nm laser-assisted lipolysis: clinical implications. Aesthet Surg J 2010; 30: 246-248
• 29 Woodhall KE, Saluja R, Khoury J, Goldman MP. A comparison of three separate clinical studies evaluating the safety and efficacy of laser-assisted lipolysis using 1,064, 1,320 nm, and a combined 1,064/1,320 nm multiplex device. Lasers Surg Med 2009; 41: 774-778
• 30 DiBernardo BE, Reyes J, Chen B. Evaluation of tissue thermal effects from 1064/1320-nm laser-assisted lipolysis and its clinical implications. J Cosmet Laser Ther 2009; 11: 62-69
• 31 Avram MM, Harry RS. Cryolipolysis for subcutaneous fat layer reduction. Lasers Surg Med 2009; 41: 703-708
• 32 Alam M, White LE, Martin N, Witherspoon J, Yoo S, West DP. Ultrasound tightening of facial and neck skin: a rater-blinded prospective cohort study. J Am Acad Dermatol 2010; 62: 262-269