Section 4 Plastic and Reconstructive Problems

Fiber Laser in Aging Face and Neck

maximal subcutaneous tissue thickness, however, generally requires guiding the cannula into these areas at a deeper level. Although contrary to what has been an accepted tenet for traditional cold liposuction techniques, it is permissible and often helpful to remove some of the immediately subcutaneous fatty tissue adherent to the under- surface of the skin by using the lipoaspiration can- nula with the ports directed upward toward the undersurface of the dermis. It is the author’s belief that failure to do so may limit the facial contour, related skin contraction, and the ultimate result obtained. Immediately after treatment, a compression dressing is applied that consists of 1 or 2 layers of 1-inch–thick roll cotton and a compression garment (eg, Universal Facial Band, Design Vero- nique, Richmond, CA, USA). The wound is evalu- ated the next day and the cotton is removed but patients are encouraged to wear the compression garment as much as possible for at least 1 week after treatment. Patient expectations must be carefully managed during the recovery and extended post-treatment period (as described previously). Fig. 3 depicts before and long-term (>2 years) clinical photography following LAFC of the mid- and lower face as well as laser-assisted neck contouring.

detached and irrigated until clear and then reat- tached to the same syringe and the procedure continued. If the syringe becomes filled with air, the seal at the syringe hub may need to be tight- ened or the percutaneous entry point may be too close to the treatment area. If the latter is the case, the procedure can usually continue with gentle manual occlusive pressure placed over the entry point area. Any air in the syringe can be gently expelled but with care to not also expel any fat already aspirated at this point. At the end of the lipoaspiration, the fat aspirate volume (less 1.0 mL from sterile saline prefilling) from each side is recorded in the treatment record. Mean vol- umes removed during unilateral lower face LAFC treatment approximate 2.5 mL in 2 studies, with ranges extending from 0.5 mL to more than 5.0 mL. 1,7 Table 3 outlines major LAFC treatment steps and typical treatment parameters. Initially, the aspiration cannula should be more superficial (immediately subcutaneous), with ports directed down. Effective debulking in areas of Fig. 2. LAFC instrumentation. ( Top ) 21-Gauge multi- hole infiltration cannula attached to 6-mL syringe containing 3-mL local anesthetic solution. ( Middle ) 600- m m Bare laser fiber with red diode aiming beam visible ( left ) and 18-gauge needle ( right ). ( Bottom ) 19-Gauge dual port aspiration cannula attached to 6-mL syringe prefilled with 1.0-mL sterile saline.

INTERSTITIAL ND:YAG FIBER LASER– ASSISTED NECK CONTOURING

Interstitial Nd:YAG fiber LANC may be performed as a stand-alone percutaneous neck contouring procedure. Appropriate patient selection should include those with mild to moderate fullness in the submentum and neck with accumulated sub- cutaneous fatty tissue in these areas but without excessive skin laxity. Patients with skin laxity but

Table 3 Major LAFC treatment steps and typical treatment parameters

LAFC Treatment Step

Detailed Information

Field block a

Include percutaneous access point and target tissue

Infiltrate target tissue a

3 mL each LAFC treatment area (21-gauge multihole infiltration cannula)

Apply laser energy

Up to 200 J midface; up to 400 J for jawline Typical laser treatment parameters 5.4 W, 180 mJ, 30 Hz

Postcooling (thermal quenching)

Infiltrate 3-mL room temperature sterile saline (21-gauge multihole infiltration cannula) Mean 2.5 mL (19-gauge dual port aspiration cannula attached to 6-mL syringe prefilled with 1.0-mL saline)

Aspiration

Compression

Roll cotton and elastic compression garment

a Local anesthetic mixture contains 0.5% lidocaine, 0.25% Bupivacaine hydrochloride, 1:200,000 epinephrine, and 2 IU hyaluronidase per mL.