材料和方法：2008年6月和2011年6月之間，在景升聯合診所接受臉部雷射溶脂的患者中，排除手術前曾經接受過臉部填充物〈玻尿酸、微晶磁或自體脂肪〉注射的患者，總共有126位納入本研究。術前皆取得同意書的簽名，患者的平均年齡是31歲〈16至64歲〉，男女比例是104比22。手術使用1064nm, 6W或8W的能量，100μs 脈衝，40Hz頻率的Nd-YAG雷射〈Smartlipo, DEKA〉。所有患者於術前術後皆告知不須特別控制飲食或更改生活習慣，手術後2個月、4個月和一年回診。每次回診皆量測體重、體脂、BMI和手術部位照相，臨床改善程度和副作用皆須紀錄。臉部外觀和臉部皮膚的變化在術前和術後追蹤當中也給予評估，評估方式為5分：非常明顯，4分：很好，3分：普通，2分：沒效，1分：變差。最後並記錄患者的滿意程度，評估方式同前。此外，由一位不知情的臨床工作人員進行客觀評估，將術後和術前的照片加以比較，以VAS分數〈0-10分〉評估其變化情形，0分：沒變化，10分：非常明顯的變化。
Laser Lipolysis with Pulsed 1064 nm Nd: YAG Laser for the Treatment of Unwanted Fat in the Face
Cheng-Hung Chiu, M.D. 邱正宏醫師
Aesthetic Department, Genesis Clinic 景升聯合診所醫學美容部
Taipei, Taiwan 台北台灣
Lasers are currently being used for body fat contouring through laser-assisted liposuction and laser lipolysis. Nd-YAG laser has been adopted for the treatment of lipodystrophy in the body and submentum. This study was conducted to evaluate the efficacy and safety of the use of the 1064 nm Nd-YAG laser for the treatment of unwanted fat in the face.
Materials and Methods
Between June 2008 and June 2011, 126 subjects with unwanted fat in the face were enrolled in this study. Informed consents were achieved from all of the subjects. Their mean age was 31 (from 16 to 64) years old. The female to male ratio was 104 to 22. A 100-microsecond-pulsed, 40 Hz-frequency, and 6W-power 1064 nm Nd:YAG laser system (Smartlipo, Deka) was used for lipolysis in this study (fig.1). All the patients were asked not to control their diets and exercises during the study period. They were visited before the treatment, and at 2 months, 4 months and 1 year after the treatment. At every visit, photographs of the face in different views were taken. The clinical improvement and side effects were recorded. Body weight, body composition and body mass index (BMI) were also obtained at every visit. Clinical assessment of facial size changes and skin texture changes was evaluated before the operation and at the end of follow up according to a 5 point scale (1:worse, 2: no effect, 3: mild improvement, 4: good, 5: excellent) and the level of patient satisfaction was determined by grading the final results as “excellent”, “good”, “fair”, “no change”, “worse”). Objective evaluations of the face were performed by one blinded clinician by comparing the face with their previous pictures. The clinician’s estimations were determined by employing a ten-point scale ranging from 0 to 10 with 0 as no change or worse and 10 as excellent.
Fig.1 After local anesthesia with tumescent solution, a 100-microsecond-pulsed, 40 Hz-frequency, and 6W-power 1064 nm Nd:YAG laser system (Smartlipo, Deka) was used to treat facial cellulite.
For the change of facial size, the clinical outcomes of the patients’ treatment at the end of follow up were excellent in 27 patients (21 %), good in 80 patients (63%), fair in 14 patients (11%), and no effect in 5 patients (4%). No patients reported their results as ‘worse’. For the change of skin texture in the face, the results were excellent 28(22%), good 74(58%), fair 21(17%) and no effect 3(2%). No patient reported as ‘worse’. Clinician’s evaluation scores were 7.73 for change of face size and 7.69 for change of skin texture. Two patients developed blisters on their faces 3 days after the procedure. One patient received chemical peel on the face 2 weeks before the operation. The other patient received 9000 J laser irradiation to her face which energy was considered too much for a single operation of facial laser lipolysis. Almost all patients developed swelling soon after the operation lasted only briefly and disappeared within 2 weeks after they first manifested. The body weight, body fat ratio and BMI before and after the operation had no significant change. Finally 110(87%) patients reported their results as very satisfied and satisfied. (fig.2-4)
Fig.2 Results 2 months after one therapy of laserlipolysis. Total laser dose for this patient was 6029J ( 3016J for right side and 3019J for left side).
Fig.3 Results 4 months after one therapy of laserlipolysis. Total laser dose for this patient was 7000J (3500J for right side and 3500J for left side)
Fig 4. Results 9 months after one therapy of laserlipolysis. Total laser dose for this patient was 7028J (3518J for right side and 3510J for left side). Note the flattening of nasolabial folds after treatment.
Laser lipolysis is cosmetically safte and favorable because it causes less trauma, swelling, bruising and postoperative discomfort than classic liposuction does. In this study, laser lipolysis also showed good tolerance to the patients. Its only side effects were pain, swelling and ecchymosis, all of which did not last long and disappeared soon after they first manifested. Our study demonstrated that Nd: YAG laser lipolysis reduced facial unwanted fat and improve facial skin texture without serious complications.
face, laser lipolysis, fat
Dr. Cheng-Hung Chiu
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