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In the name of God. Laser Lipolysis Laser Body Contouring Laser Liposuction Laser- Assisted Lipolysis Laser Lipo Suction Laser- Assisted Body Contouring. Dr anahita vali Dermatologist www.drvali.ir 03116632834-5.

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In the name of God


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    1. In the name of God

    2. Laser Lipolysis Laser BodyContouring Laser Liposuction Laser-AssistedLipolysis Laser LipoSuction Laser-AssistedBodyContouring Dr anahitavaliDermatologistwww.drvali.ir 03116632834-5

    3. Careful discussions regarding your reasons for wanting treatment are very important before you undertake any procedure.

    4. 1-Diet2-Exercise3-????4-Laser Lipolysis

    5. The rounded fat cells (pink) are called adipocytes. Connective tissue fibres (yellow) have a supporting function for the fat cells. Almost the entire volume of each adipocyte is occupied by a single lipid droplet formed from triglycerides. Fat not used up in metabolic processes is housed in these cells. Adipose connective tissue forms a thick layer under the skin, around the buttocks, thighs and kidneys. It functions as an insulating layer and energy store. Magnification: x115 at 6x7cm size. The average human body hasup to 40 billion fat cells.

    6. The rounded fat cells (pink) are called adipocytes. Connective tissue fibres (yellow) have a supporting function for the fat cells. Almost the entire volume of each adipocyte is occupied by a single lipid droplet formed from triglycerides. Fat not used up in metabolic processes is housed in these cells. Adipose connective tissue forms a thick layer under the skin, around the buttocks, thighs and kidneys. It functions as an insulating layer and energy store.

    7. In biology, adipose tissue is loose connective tissue • composed of adipocytes. • It is technically composed of roughly only 80% fat; fat in its solitary state exists in the liver and muscles. • Adipose tissue is derived from lipoblasts. • Its main role is to store energy in the form of lipids, • cushions and insulates the body. • adipose tissue as a major endocrine organ, hormones such as leptin, estrogen, resistin, and the cytokineTNFα.

    8. Adipose tissue is the greatest peripheral source of aromatase in both males and females, contributing to the production of estradiol. Adipose derived hormones include: Adiponectin Resistin Plasminogen activator inhibitor-1 (PAI-1) TNFα IL-6 Leptin Estradiol (E2) Adipose tissues also secrete a type of cytokines (cell-to-cell signalling proteins) called adipokines (adipocytokines), which play a role in obesity-associated complications.

    9. only when insulin is low can FFA leave adipose tissue.

    10. Leptin is produced in the white adipose tissue and signals to the hypothalamus. • When leptin levels drop, the body interprets this as loss of energy, and hunger increases. Mice lacking this protein eat until they are four times their normal size. • Leptin, plays a different role in diet-induced obesity in rodents and humans. Because adipocytes produce leptin, leptin levels are elevated in the obese. However, hunger remains, and, when leptin levels drop due to weight loss, hunger increases. The drop of leptin is better viewed as a starvation signal than the rise of leptin as a satiety signal.[However, elevated leptin in obesity is known as leptin resistance. The changes that occur in the hypothalamus to result in leptin resistance in obesity are currently the focus of obesity research.[

    11. "Dying to be thin:A dinitrophenol related fatality". • McFee, RB; Caraccio, TR; McGuigan, MA; Reynolds, SA; Bellanger, P (2004). "Dying to be thin: A dinitrophenol related fatality". Veterinary and human toxicology 46 (5): 251–4. PMID15487646.  • ^ Miranda, EJ; McIntyre, IM; Parker, DR; Gary, RD; Logan, BK (2006). "Two deaths attributed to the use of 2,4-dinitrophenol". Journal of analytical toxicology 30 (3): 219–22. PMID16803658. 

    12. The best and healthiest way to lose weight is with a combination of diet and exercise.

    13. Adipose tissue as an endocrine organ regulating growth, puberty, and other physiological functions.

    14. Being overweight is a contributing cause of manypreventable illnesses. Perhaps more important than weight is the percentage of fat in the body. For healthy women, fat can account for as much as 25 % of body weight, 17 % is a healthy percentage for men. Most of the extra calories we eat that we do not need for immediate energy is stored as fat. Obesity – even moderate overweight – puts undue stress on the back, legs and internal organs an this can eventually exacerbate many physical problems and compromise health.

    15. Obesity increases the body’s resistance to insulin susceptibility to infection higher risk for developing coronary artery disease diabetes, stroke, and other serious health problems premature death. Complications of pregnancy liver damage suffer psychologically as well as physically. • , providinginsulation from heat and cold. • Around organs, it provides protective padding. • its main function is to be a reserve of lipids, which can be burned to meet the energy needs of the body and to protect us from excess glucose by storing triglycerides produced by the liver from sugars. • Adipose depots in different parts of the body have different biochemical profiles. Under normal conditions, it provides feedback for hunger and diet to the brain. • Biotechnology • human embryonic stem cells. induced pluripotent stem cells without the need for feeder cells.

    16. Excess fat Without fat • susceptibility to infection • higher risk for developing coronary artery disease • diabetes, stroke, and other serious health problems • premature death. • Complications of pregnancy • liver damage • suffer psychologically as well as physically. • you would freeze to death in weather that was anything less than warm, have no energy stores, and have to eat constantly. If you did anything at all that expended energy, your body would have to start burning muscle tissue to create that energy. Without body fat, you would be uncomfortable sitting or laying down because your bones would have no padding.

    17. International research hasshown that the common causes of obesity are: • Poor diet/eating habits • Hormonal Imbalances • Lack of exercise • Glandular Malfunctions • Diabetes • Hypoglycaemia • Hyperinsulinemia • Emotional Tension • Boredom • And many, many others.

    18. Science Behind the Treatment Fat tissue (anatomy,physiology,histology) Adipocytes(Cellular characteristics,subcellularorganells,metabolism) Nutrition & Diet Exercise programms Tumescent aesthesia Laser –fat interaction &Technical information

    19. نردبام اين جهان مال و مني استعاقبت اين نردبان بشكستني است لاجرم هركس كه بالا تر نشست استخوانش سخت تر خواهد شكست

    20. BODY SLIMMING Decrease in Adipocytessize Lypomed &LLLT Decrease in number of adipocytes Laser lipolysis &liposuction • No invasion • Less expensive • More sessions • If weight gain occurs no risk • More invasive • Risk of abnormal fat deposition if weight gain • More expensive • Limited session

    21. Fat Location and Distribution: Subcutaneous and Visceral Fat The superficial and deep subcutaneous layers are separated by a membrane called fascia. subcutaneous fat (the superficial layer) subcutaneous fat (the deep layer • is less commonly removed, suctioned out in liposuction. (Hyper hidrosis) • is denser than the deep layer and is tightly packed with nerves and blood vessels. This fat layer is the location of the dreaded cellulite, which is caused by tight bands of connective tissue that squeeze portions of the fat cells and cause the bumpy irregularities on the skin. • Liposuction in the superficial layer must be done carefully so as not to damage the functional components of the skin. • This damage can result in visible permanent irregularities, discolorations, and possible death to that section of skin (skin necrosis). • The deep subcutaneous fat layer is the one that is commonly removed in liposuction.

    22. Definition • Laser Lipolysis is a minimally invasive way of removing small localised fat deposits. It is a newer laser assisted liposculpture procedure first used around 2004 for the removal of 'saddlebags', 'love handles', and 'double chins' etc. It can effectively reduce areas of fat resistant to diet or exercise whilst reducing the risks associated with traditional procedures such as liposuction.

    23. Indications Body sclpturing & Beauty Metabolic correction e.g.DM Axillaryhyperhidrosis & Bromhydrosis Hydradenitissuppurative(apocrinehydradenitis ) Gynecomastia

    24. Devices • It is currently available in the UK using mainly the Smartlipo® laser, although more and more clinics are now offering a variety of other devices including the OSYRIS PharaonLaser Lipolysis System and the CoolTouch • CoolLipo™. Private costs for Laser Lipolysis treatment depends on the size and number of area(s) being treated and can range from £1,500 – £4,500. • 1064nm/1320/1444/Diode

    25. Smartlipo MPX system. Smartlipo MPX affects adipocytesthrough • photo-mechanical • Thermal interactions. • The energy was delivered until the tissue was pliable.

    26. The procedure • is performed by introducing a fine fibre-optic probe under the skin which delivers low-level laser energy - this selectively breaks up fat cells transforming them into an oily substance that is absorbed and eliminated by the body over the following weeks, or sucked out at the time of the procedure.

    27. The Smartlipo MPX, offering two distinct wavelengths, isa safe and effective procedure for laser lipolysis and skintightening. The combination of wavelengths appears to increase the speed and efficiency of disrupting the adipocytes. The laser tissue interaction supporting the addition of the 1320 nm wavelength to the current 1064 nm Nd:YAG system is based on the strong absorption and minimal scattering characteristics of the 1320 nm wavelength in fat tissue allowing the majority of the energy to be deposited in a localized region near the laser fiber tip in the subcutaneous layer. This results in efficient heating of the subcutaneous layer and effective lipolysis.

    28. The 1064 nm laser has less absorption and larger scattering than the 1320 nm counterpart allowing for disruption of a broader region of fat tissue. The 1064 nm wavelength heats tissue more evenly while generating broader heating zones than the 1320 nm wavelength. Sequential lasering with both wavelengths in the MultiPlex mode, not only generates higher temperature rise at the front of the laser tip but also heats peripheral tissue. It allows for more efficient lipolysis, and safer and more efficient heating of collagen bundles in the dermis resulting in tissue tightening.

    29. Two different types of adipose tissue Brown adipose tissue White adipose tissue

    30. Difference between Liposuction & Laser Lipolysis Liposuction Laser Lipolysis • uses an invasivemechanical technique to tear the fat cells and suck them out of the body. • usaes a thermal process to gently heat up and destroy the fat cells, leaving it in a liquefied state which makes it easier for the Specialist to remove, or for the body to naturally metabolize the fat. • The heat stimulates the fibroblast resulting in a skin-tightening effect. This also happens to be an extremely beneficial post-pregnancy treatment.

    31. Tumescent anesthesia

    32. Marking in different positions

    33. Marking &positioning both before and during surgery

    34. Today’s tumescent anesthesia Tumescent LiposuctionBody sculpture by liposuction is literally a dream come true. • you can improve upon your appearance without incurring the cost and risk associated with “going to sleep” under general anesthesia. Skilled cosmetic surgeon gives women the option of in-office cosmetic surgery with tumescent anesthesia. • advantages of tumescent anesthesia with breast augmentation, liposuction, lipoabdominoplasty and other cosmetic procedures. • 1975/Georgia &Arpad fischer/Rome • 1987/Klein/california/Dermatologist &pharmacologist • Max dose 35mg/kg lidocaine or 50mg/kg for prilocaine up to 6 liters

    35. Tumescent anesthesia (lidocaine has antibacterial properties)

    36. Anytime you can avoid general anesthesia, you should. • The anesthetic solution containing approximately either 0.05% or 0.1% with epinephrine 1:1,000,000 is prepared by adding either 500 mg or 1000 mg lidocaine (50 or 100 ml of 1% lidocaine), 1 mg epinephrine (1 ml of 1:1000), and 12.5 meq of sodium bicarbonate (1 meq/ml) to 1000 ml of normal saline (0.9% NaC1). • Recipe for Tumescent Technique Anesthetic Solutions for Liposuction • (Lidocaine 0.05%, Epinephrine 1:1,000,000) • Lidocaine                                   500 mg (50 ml of 1% lidocaine solution) • Epinephrine                                1 mg (1 mg of 1:1,000,000 solution of epinephrine • Sodium bicarbonate                     12.5 meq (12.5 ml of an 8.4% NaH2CO3 solution) • Normal saline                             1000 ml of 0.9% NaC1 solution • The resultant solution is lidocaine (0.047%), epinephrine (1:1063,500), and sodium bicarbonate 11.8 meq/L in 1063.5 ml of saline 0.84%

    37. The addition of sodium bicarbonate to the anesthetic solution minimizes the pain of infiltration.  Using a local anesthetic solution without sodium bicarbonate often necessitates the use of IV sedation and narcotic anesthesia. With the tumescent technique, IV sedation and narcotic analgesia are virtually unnecessary.

    38. Tumescent Technique for Regional Anesthesia Permits Lidocaine Doses of 35 mg/kg for LiposuctionJeffrey A. Klein, M.D. • Abstract.The tumescent technique for local anesthesia permits regional local anesthesia of the skin and subcutaneous tissues by direct infiltration. The tumescent technique uses large columns of a dilute anesthetic solution to produce swelling and firmness of targeted areas. This investigation examines the absorption pharmacokinetics of dilute solutions of lidocaine (0.1% or 0.05%) and epinephrine (1:1,000,000) in physiologic saline following infiltration into subcutaneous fat of liposuction surgery patients. Plasma lidocaine concentrations were measured repeatedly over more than 24 hours following the infiltration. Peak plasma lidocaine levels occurred 12-14 hours after beginning the infiltration. Clinical local anesthesia is apparent for up to 18 hours, obviating the need for postoperative analgesia. Dilution of lidocaine diminishes and delays the peak plasma lidocaine concentrations, thereby reducing potential toxicity. Liposuction reduces the total amount of lidocaine absorbed systemically, but does not dramatically reduce peak plasma lidocaine levels. A safe upper limit for lidocaine dosage using the tumescent technique is estimated to be 35 mg/kg. Infiltrating a large volume of dilute epinephrine assures diffusion throughout the entire targeted area while avoiding tachycardia and hypertension. The associated vasoconstriction is so complete that there is virtually no blood loss with liposuction. The tumescent technique can be used with general anesthesia or IV sedation. However, with appropriate instrumentation and surgical method, the tumescent technique permits liposuction of large volumes of fat totally by local anesthesia, without IV sedation or narcotic analgesia. J DermatolSurgOncol 1990; 16:248-263.

    39. How much is sufficient ? The word tumescent means swollen &firm Watermelon • Distension • Sound • 40-50ml/palm area

    40. Peauds orange apearance Means • The volume of tumescense is sufficient in the upper part of SQ tissue and dermis

    41. Why is tumescent anesthesia a safer option? • Anytime you can avoid general anesthesia, you should. Well-publicized risks include respiratory problems, stroke, heart attack and even death. • The vasoconstrictor element (adrenaline) of tumescent anesthesia helps prevent blood loss during surgery because it constricts the blood vessels. Lidocaine acts both as a pain reliever and a bacteriostatinso you’re better protected from infection. Tumescent anesthesia also offers the advantages of diminished bruising, faster recovery and less pain after surgery.

    42. Lidocaine Toxicity with Tumescent LiposuctionA Case Report of Probable Drug Interactionsby Jeffrey A. Klein MD and Norma Kassarjdian, MD • We report a case of mild lidocaine toxicity. A reduced rate of lidocaine metabolism following tumescent liposuction may result from an inhibition of cytochrome P450 3A4 (CYP3A4) by sertraline (Zoloft) and flurazepam (Dalmane).

    43. Awake but pain-free, patients can comfortably interact with Dr. during cosmetic surgery to provide input on size and body contouring General local anesthesia Tumescent local anesthesia • FDA based its official 7mg/kg maximum recommended dosage for lidocaine with epinephrine for infiltration • 35mg/kg

    44. High-intensity exercise is one way to effectively reduce total abdominal fatat least 10 MET-hours per week of aerobic exercise is required for visceral fat visceral fat Abdominal obesity • An excess of visceral fat is known as central obesity, or "belly fat", in which the abdomen protrudes excessively. • The correlation between central obesity and cardiovascular disease is strong. Excess visceral fat is also linked to type 2 diabetes, insulin resistance, inflammatory diseases,and other obesity-related diseases.

    45. Subcutaneous fat is not related to many of the classic obesity-related pathologies, such as heart disease, cancer, and stroke, and some evidence even suggests it might be protective. The typically female (or gynecoid) pattern of body fat distribution around the hips, thighs, and buttocks, is subcutaneous fat, and therefore poses less of a health risk compared to visceral fat.[ Like all other fat organs, subcutaneous fat is an active part of the endocrine system, secreting the hormones leptin and resistin.