Medical fibers Clinical Experience:Laser Lipolysis of the Neck and Jowl Line

Keywords:laser, lipolysis, medical, fiber,  Time:25-12-2015
The Laser Lipolysis Clinical Experience

However, the first words out of her mouth are, “Anything but a facelift.” This trend began with the advent of fillers and Botox and was quickly followed by the popularity of minimally invasive surgery  
Our patients’ complaints most often are with their neck and jowl area. Younger patients with a reasonable amount of fat will do well with standard liposuction.

With age, however, the problem is more one of skin laxity, with some fullness over the jowl area. From our experience we knew that patients with a large degree of skin laxity will not respond to anything but a facelift.

Therefore, our practice spent a year experimenting with a variety of procedures, including noninvasive radiofrequency skin tightening, which achieved only minimal results and left patients unsatisfied. Then, two years ago, we began using the Cynosure Smartlipo™ laser lipolysis workstation on the neck and jowl area.
 The Smartlipo laser provides aesthetic surgeons with a less invasive technique than conventional liposuction for fat reduction and body toning.

Because the medical fibers is designed to achieve tissue tightening through tissue coagulation, it is ideal for treating localized fat deposits on the face and body, and can easily treat challenging areas of high vascularity and flaccidity.

A year ago we were one of the first practices to obtain the Medfibers™, which combines the benefits of the 1064 nm and 1320 nm wavelengths with MultiPlex technology. Medfibers also takes advantage of SmartSense, an intelligent handpiece delivery system that distributes energy for more uniform results.
After using this laser in conjunction with liposuction to treat some very difficult neck and jowl patients, we changed our suddenly, patients we would never consider for liposuction of the neck became very good candidates.

With the Medfibers laser, we are now able to address the challenge presented by skin laxity.  It has allowed us to extend the indications for “minimally invasive” surgery in the neck and jowl area and can be performed under local anesthesia, resulting in less operating time, less expense and quicker recovery.
Several patients who needed extensive lift operations, but refused open surgery, were willing to try the benefits of Medfibers laser-assisted lipolysis. The following patient histories and photographs are typical of the results we have achieved using Medfibers technology. In every case, the patients were willing to try this minimally invasive procedure because they would not have to undergo open surgery. Our patients have been extremely pleased with the substantial improvement they have experienced.
We often “package” minimal facial procedures for several of our patients. Such procedures as fat injection, chin augmentation, full-face TCA peel, CO2 laser resurfacing of the lower lids, along with the Medfibers laser-assisted lipolysis and traditional liposuction of the neck, resulted in dramatic overall improvement.
We have successfully treated a dozen face-and-neck patients who would have needed a facelift—or a very extensive facelift—but who came to us for help, as long as it was not a traditional invasive facelift procedure.

In each case, we discussed the options with the patient and offered them Medfibers laser-assisted lipolysis with or without traditional liposuction. We informed them of the limits of the results we might achieve compared to open surgery. We also emphasized that we would not recommend standard liposuction of the neck and jowl area alone, knowing from experience that the results would be poor.

Preliminary results of treating with the Medfibers laser were so dramatic that we have continued to extend treatment opportunities for this medical laser fibers.

The Medfibers laser produces a degree of tissue tightening through tissue coagulation that could not be obtained otherwise, even with a facelift. As indicated in several of the photographs and the angularity of the patients’ necks, accomplishing similar results with an open-lift would have been very difficult.
The following case studies will focus on patient selection, treatment technique and outcomes on the neck and jowls using the Medfibers laser.

Methods and Techniques

The treatment area was typically divided into 3 to 4 sections: the midline area below the chin to the neck line may be divided into 1 to 2 sections; while the left and right lateral areas are divided into individual segments. The central area was accessed through a midline incision just below the chin, and the two lateral areas were accessed via an incision just below the ear.  The marginal mandibular branch of the facial nerve was avoided to prevent adverse effects associated with heat or trauma to the region. As with other procedures, when traumatizing the nerve, weakness may occur at the corner of the mouth that can take weeks to months to resolve. Thus far however, we have observed no permanent damage.

Tumescence anesthesia was applied (see additional information within each case study). The laser beam was guided through the fat by a 600-micron optical fiber within a 1 mm diameter microcannula, which was attached to the SmartSense handpiece. The optic fiber was extended 2 mm to 3 mm beyond the microcannula tip, and energy from the laser was limited to this site. Transillumination of a red helium:neon (He:Ne) beam allowed the surgeon to identify the subcutaneous location of the laser tip. The laser was set at 24 watts (W), Blend 1. This allowed rapid delivery of laser energy and resulted in a quick temperature rise in the area. It is recommended that lower power be used (8 W-12 W in total) and gradually increased until more experience is obtained with the procedure. The laser was applied to each quadrant until the surgeon achieved the desired clinical endpoint. The surgeon’s endpoints were clinically determined and also guided by temperature rise, as measured on the surface of the skin. The clinical endpoints were the evaluation of the tissue and a safe target surface temperature of approximately 40°42°C. The surface skin temperature was measured using an external handheld temperature recording device.

Laser energy was applied by placing the microcannula directly under the dermis where the aiming beam could be visualized through the skin to achieve the best possible tissue tightening results through tissue coagulation. In difficult cases of extremely lax skin, a second pass was made, either after the liposuction or once the area had sufficiently cooled.

Postoperative care included the wearing of an ace bandage for 3 days, 24 hours per day; thereafter 11 days when sleeping and at home, in order to reduce edema and bruising.