Section 4 Plastic and Reconstructive Problems

Holcomb

Fig. 3. Before ( A , C , E ) and 25 months after ( B , D , F ) photos in a 49-year-old woman after LAFC of the mid- and lower face and LANC (percutaneous). Treatment parameters for the mid- and lower face included 3.0 mL local/ tumescent anesthetic, laser power 5.4 W, treatment speed 30 Hz, pulse energy 180 mJ, total energy delivered 400 J and 1.0- to 1.5-mL lipoaspirate. Treatment parameters for the submentum included 12.0-mL local/tumescent anesthetic, laser power 8.0 W, treatment speed 40 Hz, pulse energy 200 mJ, total energy delivered 1000 J and 5.0-mL lipoaspirate.

contracts. Early on (eg, weeks 2 through 6), weekly lymphatic massage sessions for the LANC treat- ment area may help reduce PIE and improve sub- mentum/neck contour. Significant PIE may be treated with staged escalating-dose intralesional triamcinolone (eg, 10 mg/mL initially, gradually moving to 40 mg/mL) beginning at post- treatment month 1 or 2 and continuing monthly as needed until final desired contour is achieved or until no further tissue response is seen. Although this approach is successful in a majority

no significant subcutaneous fat are not appro- priate candidates for the LANC procedure. Patient age is not a major determining factor with regard to successful outcomes—very good LANC results have been obtained with patients into their late 60s. Mild to moderate PIE is expected. Early on PIE seems to have blunted or limited the submental/ neck tissue contouring response; however, the tis- sue contour and cervicomental angle improve over time as PIE gradually resolves and the skin