Laser-Assisted Lipo May Lead to Future Tummy Tuck Complications

By S. Larry Schlesinger, MD, FACS

Laser-Assisted Lipo May Lead to Future Tummy Tuck Complications

Woman lifts shirt to look at stomach in mirror

While laser-assisted liposuction (LAL) is touted by many surgeons for its ease of use and high patient satisfaction rates, this liposuction technique may lead to future tummy tuck complications in patients who have previously received LAL to their midsection or during their tummy tuck procedure. In order for patients to understand the possible issues LAL may cause during and after tummy tuck surgery, I will explain the origins of liposuction, modern liposuction techniques, and how this technique may be problematic to tummy tuck patients.

The history of liposuction

The first attempt to reshape the body using liposuction dates back to 1921 when Charles Dujarrier sought to improve the contours of a dancer’s knees and ankles—which ultimately resulted in necrosis and amputation. Over the next several decades, liposuction techniques and tools were refined to achieve safer, more effective body contouring results.

In 1975, Arpad and Giorgio Fisher, father and son cosmetic surgeons, were the first to utilize a blunt hollow cannula and a criss-cross suctioning method to successfully reshape the outer thigh areas. Their method achieved improved aesthetic results and saw fewer complications, and thus became the modern technique for liposuction.

Just a few years later, in 1977, Parisian surgeon Dr. Yves Gerard Illouz incorporated 3 smaller blunt cannulas that reduced the disturbance of nerves and vessels and could be used on nearly every part of the body. Illouz also introduced the “wet technique” where saline and hyaluronidase was injected into the area prior to treatment to preserve neurovascular bundles and enlarge the adipose (fat) layer that would be removed.

Modern liposuction was brought to the United States after Lawrence Field, a California dermatological surgeon visited France to learn the newest, safest liposuction techniques in 1977. By 1984, liposuction training was offered in some surgery residency programs and was typically performed under general anesthesia.

In 1987, another California dermatologist, Jeffrey Klein, reported that using the “wet technique” with the addition of diluted anesthesia allowed large areas to be treated with liposuction without the need for sedation; the technique also reduced the risk of bleeding.

Today, liposuction is the most performed surgical procedure in the US—and when performed by an experienced board-certified plastic surgeon, achieves safe and beautiful body contouring results.

Types of liposuction

There are a few different liposuction techniques, each featuring its own advantages and possible disadvantages.

Traditional or power-assisted liposuction (PAL)

With the PAL technique, surgeons make a small incision and insert a cannula that is attached to a vacuum. Using side to side motions, the cannula is used to break up the fat cells which are then suctioned away from the body. This technique is labor-intensive for the surgeon and can have higher instances of surface skin irregularities and other complications, but PAL may still be indicated for high-volume fat removal.

Standard or tumescent liposuction

Currently the most common liposuction technique, tumescent liposuction uses a mixture of saline solution, lidocaine, and epinephrine which is injected to facilitate fat removal, numb the treatment area, and reduce bleeding. A cannula is then inserted under the skin and precisely guided to sculpt targeted areas by suctioning away unwanted fat.

Ultrasound-assisted liposuction (UAL)

This technique utilizes the addition of ultrasonic energy to rupture or “liquify” fat cells for easier suctioning. It is less labor-intensive for the surgeon and is effective for removing large quantities of fat. UAL may also help achieve greater skin contraction, thanks to the ultrasonic energy that is introduced. UAL carries a greater risk of scarring when compared to standard liposuction.

Laser-assisted liposuction (LAL)

The LAL technique introduces high-intensity laser light to emulsify fat cells. The broken-down fat cells are then easily removed via a cannula. LAL typically has higher patient satisfaction rates, achieves better skin contraction, and promotes greater fat reduction over standard or PAL techniques. However, LAL has future drawbacks which should concern both surgeons and patients.

A word of caution with laser-assisted liposuction

Though some studies have shown laser-assisted liposuction (LAL) to be preferred over other techniques, surgeons like myself, who’ve performed tummy tuck surgeries on patients with previous LAL, have a grim outlook on this technique.

Laser-assisted liposuction is favored by some surgeons for reducing the amount of time and effort expended in the operating room. Non-LAL liposuction requires substantial physical effort on the surgeon’s part and manufacturers were quick to capitalize on creating an easier method—winning over many surgeons who found themselves worn out after hours of using manual liposuction techniques in their operating suites. Manufacturers cleverly marketed LAL to patients as well, having noted the public’s fascination with any procedure including the term, “laser.” (As laser treatments are generally safe and highly-effective, the word laser has become a buzzword that is associated with the latest technology that provides optimal results.)

Unfortunately, there are growing concerns in the plastic surgery community that LAL may cause serious complications for patients who seek subsequent surgical procedures within the LAL treatment area.

Patients previously treated with laser-assisted liposuction in their midsection may not have the tissue flexibility or sufficient blood and oxygen supply in vital tissues to properly heal.

Laser-assisted liposuction’s effect on the superficial fascial system (SFS)

LAL works by dissolving fat cells and claims it does not burn the skin or deeper fascia. While more substantial structures beneath the skin like larger arteries and veins do remain intact, the superficial fascial system (SFS) is quite vulnerable to laser energy. The SFS is a network of connective tissues below the dermis and is considered a pivotal structure in excisional and non-invasive body contouring procedures. In an article published by the Aesthetic Surgery Journal, repairing the SFS layer significantly improved the strength of wound repair and increased long-term wound strength. The article went on to suggest that their data showed the SFS layer plays a key role in early and late stages of wound healing. Studies like this provide evidence that compromising the SFS layer may result in negative surgical outcomes.

Patients who have had previous LAL in their abdomen, or receive it during a tummy tuck, may not have the tissue flexibility or sufficient blood and oxygen supply to their SFS layer to heal properly and safely achieve optimal tummy tuck results. When laser energy comes in contact with the SFS layer, it is essentially “fried”—causing the SFS tissue to become rigid. It also reduces the number of venules and limits the blood supply to that area. The compromised SFS layer will no longer expand and stretch, one of the most significant factors in achieving a tighter midsection during a tummy tuck procedure.

Laser-assisted liposuction (LAL) complications and treatment options

Possible LAL complications in tummy tuck surgeries may include:

If you do plan on receiving LAL on any part of your body, verify the settings on the laser have been recently and properly calibrated. There is a strong likelihood that calibration has not been checked since the machine was purchased, potentially risking your tissue and aesthetic outcomes.

Hyperbaric oxygen therapy (HBOT)

Hyperbaric oxygen therapy (HBOT) can be used to treat gangrene and poorly healing wounds in patients who are experiencing poor oxygenation in laser-assisted liposuction (LAL) treated tissues. During HBOT, patients enter a special chamber to breathe pure oxygen in air pressure levels up to 3 times higher than average; this increases oxygen levels in the blood enough to help repair damaged tissues. Depending on the severity, 2-5 treatments may be necessary to save the tissue. HBOT should be used before any surgical intervention whenever possible.

Options for laser-assisted liposuction (LAL) patients seeking tummy tuck surgery

In my professional opinion, patients who have received LAL to their midsection should not undergo tummy tuck surgery; however, there are a few precautious you can take to help mitigate issues if you decide to move forward with surgery:

It is my sincere hope that raising awareness of the possible risks laser-assisted liposuction may have in tummy tuck surgeries will caution surgeons who use this liposuction technique and hopefully prevent negative outcomes for patients who have undergone LAL.

Patient safety is of the utmost importance and I am committed to educating my patients and sharing my knowledge and expertise with the plastic surgery community to achieve the safest, most aesthetically pleasing results possible.

Honolulu plastic surgeon Dr. Schlesinger

Dr. S Larry Schlesinger is a board certified plastic surgeon with over 30 years of experience, performing thousands of procedures over the course of his career. Dr. Schlesinger has published numerous articles on his techniques and procedures and is well-respected in the plastic surgery community for his commitment to patient safety and his surgical expertise. Dr. Schlesinger and his outstanding team of experts at the Breast Implant Center of Hawaii invite you to contact us online or call our office at 808.597.8835 to schedule a consultation.

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