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 Dr. Holcomb |
Dr. Holcomb, a facial plastic and cosmetic laser surgeon in private practice in Sarasota, Fla., presented the first clinical results from LAFC with the 1,444 nm Nd:YAG for rejuvenating the mid- and lower face. Eligible patients were either younger adults (early 20s and older) with a round face from accumulated fat in the mid- or lower regions, or older adults with descended fat from facial aging that resulted in melolabial fold and/or jowl ptosis.
According to Dr. Holcomb, there was an initial learning curve, and the treatment protocol was adjusted after the first six months based on findings from simultaneously performed laboratory and clinical studies in an effort to minimize prolonged inflammatory edema, which occurred in a few patients.
 A 52-year-old female before (left) and eight months after laser-assisted facial contouring of jawline, with 2.0 cc removed from each jawline for correction of jowling and restoration of a youthful jawline. (Photos credit: J. David Holcomb, M.D.) |
"LAFC using this particular wavelength holds promise for creating a new paradigm for facial sculpting and rejuvenation. The treatment allows for selective tissue removal to afford greater precision in three-dimensional facial contouring, while simultaneously enabling substantial skin tightening via a novel, direct subdermal approach to energy delivery," Dr. Holcomb says.
Dr. Holcomb says the 1,444 nm laser offers several characteristics that make it attractive for use in facial contouring and sculpting. These include the high selectivity of the 1,444 nm wavelength for both fat and water, as both of these chromophores have an absorption peak in the mid-1,400 range. In addition, the laser features a short pulse duration (less than 100 microseconds) and high peak power, so there is rapid tissue response time and excellent thermal confinement.
CURRENT PROTOCOL The current protocol for LAFC with the 1,444 nm laser consists of five steps, beginning with a field block and infiltration of small volumes of anesthetic solution (2 cc in the midface and 3 cc in the jawline) using a 1.6 mm multiport infiltration cannula.
"Only small amounts of anesthetic solution are delivered, since introducing too much water might negate the fat absorption advantage of this wavelength," Dr. Holcomb says.
The next step is laser-induced lipolysis using a bare fiber introduced 2 mm to 4 mm below the skin surface. After the fat liquefaction is completed, about 3 cc of room-temperature normal saline is injected to flush the tissue.
"The normal saline provides both a cooling effect and optimizes the results achieved with the following microlipoaspiration step," Dr. Holcomb says.
Microlipoaspiration is performed using a 19 g cannula with three ports that are offset to minimize any possibility of tissue grooving. Typically, total volumes removed range from 0.5 cc to 3 cc in the midface and 1 cc to 4 cc in the lower face and jawline, although larger volumes are aspirated in select patients with heavier features.
