One of the most popular and frequently requested procedures in the cosmetic field is liposuction and its related treatments. Since the introduction of liposuction in the early 1980s new methods have been developed to try and refine the technique and reduce the more common complications e.g. the evolution of aspiration by syringe to mechanical suction and later assistance by vibration or ultrasound.
In addition to modifying the treatment itself tumescent anaesthesia has also been introduced, using large volumes of dilute local anaesthetic with the addition of adrenaline to reduce bleeding and helping to minimise the adverse haemodynamic effects and speed recovery.
The latest development in this evolutionary process involves the use of laser lipolysis to achieve fat reduction, body contouring and skin tightening with much reduced risk and downtime for the patient.
The use of lasers to treat fat was first described by Apfelberg in 1992 when the term laser lipolysis was pioneered (1). The nature of interaction is principally photo-thermal with the absorption of laser energy by the fat cells generating heat, which damages the adipocyte cell membrane. There may also be a photomechanical element to the process generated by the very short pulse width of the low power Nd:YAG laser (2).
In 1996 Apfelberg carried out a study using an Nd:YAG laser delivered through a fibre optic within a cannula, which acted on the tissue as it was sucked into the cannula (3-4). Advantages demonstrated included less blood loss, quicker recovery and less swelling, bruising and discomfort in the recovery period.
In 2001 Schavelzon and Bluger have also studied the use of the Nd:YAG with or without suction and reported on the benefits in terms of reduced bruising and a better quality recovery (6-7).
The first laser lipolysis treatments in the United Kingdom were carried out in the late summer of 2006 at the author's clinic (the Snowberry Lane Clinic in Melksham, Wiltshire) following training in Italy under Dr Nicola Zerbianati. Dr Zerbianati then traveled to Wiltshire to complete the author's further instruction as 'national trainer' and helped set up the program of education for the UK.
In addition to the training program we have also established a users group, which had its inaugural meeting in February 2007, to give laser lipolysis practitioners the opportunity to network and share results and ideas and to optimise the treatments for our patients.
The laser lipolysis system SmartLipo (DEKA) is a low power, six watt Nd:YAG laser that delivers its energy via a 300 micron fibre-optic, which protrudes 2-3mm from the end of a 1mm laser lipolysis cannula. The small size of the cannula allows a very small incision to be used and is also very manoeuvrable in the tissues.
Dr Rupert Gabriel trained at the Middlesex Hospital in London and has been a full time principal in general practice in Wiltshire for more than 15 years. He has a special interest in surgery and has run the Bath Minor Surgery Course at Bath University for the last 10 years. He is a national trainer and international speaker in cosmetic laser surgery, radio frequency surgery, dermatological surgery and surgical technique. He is a member of the British Association of Cosmetic Doctors, General Medical Council, Royal College of General Practitioners and British Medical Association and is the UK's leading trainer in the SmartLipo technique.