Sciton BBL assisted Pro-Lipo Nd Yag Liposuction of the sub-mental area

1. Laser Liposuction: A 2 Year ExperienceLaser Liposuction: A 2 Year Experience
Rex Moulton-Barrett, MD
Plastic & Reconstructive Surgery
Alameda and Brentwood, Ca

2. Paradoxes of ProgressParadoxes of Progress
SirSir
Peter MedawarPeter Medawar
““technology and science advance in a sinusoidal patterntechnology and science advance in a sinusoidal pattern ””
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• Discoveries arise through necessity & create need for newDiscoveries arise through necessity & create need for new
technologytechnology
• When technology advances without a scientific basisWhen technology advances without a scientific basis be cautiousbe cautious

3. Current Techniques of LipolysisCurrent Techniques of Lipolysis
• Topical anti-cellulite creamsTopical anti-cellulite creams
• Oral anti-cellulite medicationOral anti-cellulite medication
• Trans-cutaneous laser lipolysisTrans-cutaneous laser lipolysis
• ultrasonic lipolysisultrasonic lipolysis
• Sub-cutaneous injection lipolysisSub-cutaneous injection lipolysis
• Subcutaneous ‘mechanical’ lipolysis aka liposuctionSubcutaneous ‘mechanical’ lipolysis aka liposuction
• Subcutaneous Liposuction with:Subcutaneous Liposuction with: UltrasonicUltrasonic lipolysislipolysis
VibrationVibration lipolysislipolysis
HydroHydro lipolysislipolysis
RadiofrequencyRadiofrequency lipolysislipolysis
LaserLaser lipolysislipolysis

4. Topical Anti-CelluliteTopical Anti-Cellulite
CreamsCreams
• > 30 products commercially available> 30 products commercially available
• Only 1 study with blinding: 8 pts onlyOnly 1 study with blinding: 8 pts only
• Not effectiveNot effective in double blind placebo studyin double blind placebo study
• Top product :Top product : RevitolRevitol
• 3 most common agents:3 most common agents: retinol, caffeine, aminophyllineretinol, caffeine, aminophylline
• ‘‘Ms. Sixty Jeans’:Ms. Sixty Jeans’: retinol capsules rupture with wear!retinol capsules rupture with wear!
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5. Oral anti-cellulite MedicationOral anti-cellulite Medication
• Cellasene: Fucus vesiculolus or bladderwrack & clover
extract, gingko, grapeseed, 240mig iodine, primerose
oil and fish oil, lecithin
• Published studies, New York 1998 and London 1999:
placebo and double blinded found no difference

6. Cutaneous Injection LipolysisCutaneous Injection Lipolysis
• Self administered 10 week kits ($540) ‘Lipodissolve’Self administered 10 week kits ($540) ‘Lipodissolve’
• AKA:AKA: LipostabilLipostabil
• Each kit contains:Each kit contains:
– 5mls: 1250 mg5mls: 1250 mg Phosphatidylcholine+deoxycholatePhosphatidylcholine+deoxycholate
– 10mls: 14 mgs Tiratricol: Triiodothyroacetic acid10mls: 14 mgs Tiratricol: Triiodothyroacetic acid
– 10mls: 2% Procaine HCL10mls: 2% Procaine HCL
– 10 x 5 ml syringes10 x 5 ml syringes
– EMLA creamEMLA cream
– 10 x 30 g needles10 x 30 g needles
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7. Injectional Lipolysis for LipomasInjectional Lipolysis for Lipomas
• 30 lipomas in 10 patients: Germany 200730 lipomas in 10 patients: Germany 2007
• 4 Phospatidylcholine injections/lipoma/6-8 wk intervals4 Phospatidylcholine injections/lipoma/6-8 wk intervals
• 46% reduction in sonographic size46% reduction in sonographic size
• 27% hematoma complication27% hematoma complication
• 40% complained of pain over injection site40% complained of pain over injection site
Bachara, etal, 2007. J Cut Surg 10(4), 155-9.Bachara, etal, 2007. J Cut Surg 10(4), 155-9.

8. Sub-cutaneousSub-cutaneous Laser & Liposuction:Laser & Liposuction: 88 companiescompanies
From 2006-2009
Name Wavelength
(nm)
Pulse Freq Pulse
Power
Max power
output
Fiber
size
Pulse
width/duration
Simultaneous
or staged lipo
Date FDA
cleared
Osyris
‘LipoControl’
980nm
diode laser
staged 2009 pending
CoolTouch
‘Cool-Lipo’
1320
Nd:YAG
20-50 Hz 15 Watts .32-2mm 100 micsec simultaneous January 2008
Eleme
‘SmoothLipo’
980nm continuous
Cynosure
‘Smart-Lipo’
1064 &1320
Nd:YAG
40 Hz (aiming
beam-
3mW)
6, 12, 18
watt
.35mm
.4 mm,
.6mm
150,200, 250
mic sec
staged November
2006
Palomar
‘SlimLipo’
924 & 975
diode laser
continuous N/A 15-25 Watt
& 40 watt.
1.5 mm continuous staged April 2008
Sciton
‘ProLipo’
1064 &
1319
Nd:YAG
1-50Hz 5-10
watts
5-25 Watts 0.6 and
1 mm
10-100
microsec
staged July 2007
Lutronic
‘AccuSculpt’
1444nm
Nd:Yag
40 Hz 175 mJ 7 W 0.6mm 100-150 micsec staged November
2008
Syneron
‘LipoLite’
1064
Nd:YAG
50Hz 800mJ
2 pulsed
energy
levels
12 Watts .550 mm 100-800 micsec staged May 2008

9. Lutronic AccuSculpt 1444nm Laser Assisted LiposuctionLutronic AccuSculpt 1444nm Laser Assisted Liposuction
• Purported to be the greatest fat absorption coefficient of laser assistedPurported to be the greatest fat absorption coefficient of laser assisted
devices: “ > 8 x absorption 1064 and 1320nm”devices: “ > 8 x absorption 1064 and 1320nm”
• Relies on photo-acoustic properties & less photo-thermic action for lipolysisRelies on photo-acoustic properties & less photo-thermic action for lipolysis
• Because of this requires less power and therefore less thermal damageBecause of this requires less power and therefore less thermal damage
• Theoretically, should have high photo-thermic injuryTheoretically, should have high photo-thermic injury, purported opposite, purported opposite
• Competing chromophores: ieCompeting chromophores: ie dermal waterdermal water should limit power usedshould limit power used

10. ‘‘Slimlipo’:Palomar Aspire 924 & 975 nmSlimlipo’:Palomar Aspire 924 & 975 nm
YAG Laser Assisted LiposuctionYAG Laser Assisted Liposuction
• Approved for laser lipolysis April, 2008Approved for laser lipolysis April, 2008
• Dual Diode laserDual Diode laser
• 924nm high preference for fat absorption924nm high preference for fat absorption
• 975nm high preference for dermis975nm high preference for dermis
• Purported continuous wave delivery withPurported continuous wave delivery with
20 times greater area of thermolytic20 times greater area of thermolytic
lipolysis over other laser lipolysislipolysis over other laser lipolysis
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Slimlipo 1064nm
Histological zone of thermal effect

11. Cooltouch CoolLipo 1320nm Nd:YAGCooltouch CoolLipo 1320nm Nd:YAG
Laser Assisted LiposuctionLaser Assisted Liposuction
• Delivery fiber diameter 320-Delivery fiber diameter 320-2000 microns2000 microns
• Designed for small area: neck and chinDesigned for small area: neck and chin
• New CoolBlue Duet HandpieceNew CoolBlue Duet Handpiece :: ablates and simultaneousablates and simultaneous
aspirationaspiration with 2.5 mm cannulae ( June 2008 )with 2.5 mm cannulae ( June 2008 )

12. SmartLipo 1064nm Nd:YagSmartLipo 1064nm Nd:Yag
SmartLipo MPX: 1064+1320nmSmartLipo MPX: 1064+1320nm
SmartLipo Triplex:1064+1320+1444SmartLipo Triplex:1064+1320+1444
Laser Assisted LiposuctionLaser Assisted Liposuction
• Originally Italian ‘Deka’ company: termed ‘lipolysis’, designed for up toOriginally Italian ‘Deka’ company: termed ‘lipolysis’, designed for up to
500cc500cc
• FDA approved 2006 CynosureFDA approved 2006 Cynosure
• 1, 734 pts Brazil: 1 burn, 1 seroma, all < 500 mls, 300micron fiber,1, 734 pts Brazil: 1 burn, 1 seroma, all < 500 mls, 300micron fiber,
1mm metal cannulae, tumescent technique ( Goldman, 2002)1mm metal cannulae, tumescent technique ( Goldman, 2002)
• Commonest complaintCommonest complaint undercorrectionundercorrection especially larger treatmentespecially larger treatment
areasareas
• 82 pts Brazil: submental area:82 pts Brazil: submental area: similar overall results with traditionalsimilar overall results with traditional
liposuction except he noted less postoperative bleedingliposuction except he noted less postoperative bleeding ( Goldman,( Goldman,
2006)2006)
• New 1mm fiber and hand-piece measures tip temperature andNew 1mm fiber and hand-piece measures tip temperature and
regulates energy provided to avoid overheating and skin injuryregulates energy provided to avoid overheating and skin injury
• Maximum power MPX up to 30 Watts 1064nm, 16 Watts 1320nmMaximum power MPX up to 30 Watts 1064nm, 16 Watts 1320nm

13. Syneron Lipolyte 1064nm with Nd:YagSyneron Lipolyte 1064nm with Nd:Yag
Laser Assisted LiposuctionLaser Assisted Liposuction
• Up to 12W, 100-800 mcsecsUp to 12W, 100-800 mcsecs
• Uses 2 pulses:Uses 2 pulses:
– <150 mcsec + < 250 mJ:photo-mechanical<150 mcsec + < 250 mJ:photo-mechanical
ie high frequency and low energy:mechanicalie high frequency and low energy:mechanical
– > 700mcsec+>1J: photo-thermal> 700mcsec+>1J: photo-thermal
ie low frequency and high energy: thermalie low frequency and high energy: thermal
• 0.55 mm diameter fiber0.55 mm diameter fiber
• Disposable handpiece/cannulaeDisposable handpiece/cannulae
• Recommended for < = 15x20cm zonesRecommended for < = 15x20cm zones

14. Sciton: ‘ProLipo’ 1064+1319nm Nd:YagSciton: ‘ProLipo’ 1064+1319nm Nd:Yag
Laser Assisted LiposuctionLaser Assisted Liposuction
• Subcutaneous laser lipolysis followed by liposuctionSubcutaneous laser lipolysis followed by liposuction
• 600 -1000 micron fiber, inside a 14 or 18g cannulae600 -1000 micron fiber, inside a 14 or 18g cannulae
• Choice of 2 wavelengths:Choice of 2 wavelengths: 10641064 & 1319 nm or blending both& 1319 nm or blending both
• Maximum power 1064nm & 1319nm 40 W, RR up 50 HzMaximum power 1064nm & 1319nm 40 W, RR up 50 Hz
• Pulse duration 10-100 microsecondsPulse duration 10-100 microseconds
• MayMay combine with transcutaneous intense pulse light:combine with transcutaneous intense pulse light:
• ‘‘Skin -Tyte’Skin -Tyte’ 800-1400nm800-1400nm BBL: Broad Band LightBBL: Broad Band Light

15. Trans-cutaneousTrans-cutaneous Laser & Non-Laser Assisted Lipolysis:Laser & Non-Laser Assisted Lipolysis: >13>13 companiescompanies
From 2002-2011
Company and
product name
Type of
product
Action FDA clearance
Erchonia
‘Niera’
635nm
Dual Diode
laser
Staged
lipolysis
before
liposuction
2004
Erchonia
‘Zerona’ 650nm Diode
Laser
Lipolysis
alone
April 2008
Eleme
‘SmoothShapes’
650 nm laser
and 915nm IPL
Cellulite
reduction
January 2008
Cutera
‘Titan’: V, XL,S
Infrared 1100-
1800 nm
Skin
tightening
2004
Palomar
‘LuxDeepIR’
Infrared Skin
tightening
Feb 2007
Sciton
‘BBL’
IPL: 800-
1400nm
Skin
tightening
2006
Solta Medical
‘Thermage’
IPL Skin
tightening
2002
Syneron
‘VelaShape II’
RF Cellulite
reduction
August 2007
Alma Lasers
‘Accent XL’
RF: Uni / Bi -
polar
Skin
tightening
April 2007
BTL
‘Exilis’
RF ans U/S Skin
tightening
FDA pending
General Project
‘Slim Project,
Med Sculpt, Med
Contour’
External 2
wave U/S and
massage
Cellulite
Reduction
& lipolysis
November
2006
Medicis
‘Liposonix’
High intensity
focused U/S
Lipolysis
alone
Pending 2011 ?
MedixSysteme
‘Ultracontour’
High intensity
focused U/S
and U/S
vasodilation
Lipolysis
Alone
Pending 2009
Zeltiq Aesthetics Cryolipolysis Lipolysis
alone
Pending 2009
LASER
IPL
RF
U/S
CRYO

16. Science Behind Specific Wavelength Choice forScience Behind Specific Wavelength Choice for
Laser Assisted LiposuctionLaser Assisted Liposuction
• Little information to support a given wavelength: either photoacousticLittle information to support a given wavelength: either photoacoustic
or photothermolytic, comparing histological or clinical dataor photothermolytic, comparing histological or clinical data ::
900-930, 1190-1220, 1700-1730, or 2280-2350 nm900-930, 1190-1220, 1700-1730, or 2280-2350 nm
• Fresh ex-vivo cadaveric abdominoplasty pannus lasered with 1064, 1320,Fresh ex-vivo cadaveric abdominoplasty pannus lasered with 1064, 1320,
2100 nm using a 0.320mm fiber2100 nm using a 0.320mm fiber
– Control: mechanical fiber trauma aloneControl: mechanical fiber trauma alone
– Fiber withdrawn at 1mm per second, single passFiber withdrawn at 1mm per second, single pass
– No clear fat liquefaction seen histologicallyNo clear fat liquefaction seen histologically
– Difficult to capture photoacoustic effect histologicallyDifficult to capture photoacoustic effect histologically
– Thermal damage dependent on power for each wavelengthThermal damage dependent on power for each wavelength
– Diameter of damage 1-5mm proportionate to power/pulseDiameter of damage 1-5mm proportionate to power/pulse
Koury et al, 2008; Laser Surg Med 40(6):402-6Koury et al, 2008; Laser Surg Med 40(6):402-6

17. Liposuction alone vrs 1064nm subcutaneousLiposuction alone vrs 1064nm subcutaneous
laser assisted liposuctionlaser assisted liposuction
• Few comparative clinical studiesFew comparative clinical studies
• Laser assisted Liposuction describedLaser assisted Liposuction described 1994: (Affelberg)1994: (Affelberg):: inconclusive benefitinconclusive benefit
using 1064nm over traditional liposuctionusing 1064nm over traditional liposuction
• Liposuction vrs Laser1064nm /liposuction randomised, controlled study inLiposuction vrs Laser1064nm /liposuction randomised, controlled study in
Chile, the latter causes:Chile, the latter causes:
less painless pain (p > 0.0001 t test),(p > 0.0001 t test),
less bloodless blood within the aspirate,within the aspirate,
averageaverage duration of surgery 25% longerduration of surgery 25% longer (p>0.0005):(p>0.0005):
otherwise all other parameters are equal:otherwise all other parameters are equal:
swelling, bruising, skin tightening, contour improvementswelling, bruising, skin tightening, contour improvement (Prado, et al, 2006)(Prado, et al, 2006)
• 82 pts Brazil: submental area:82 pts Brazil: submental area: similar overall resultssimilar overall results with traditional liposuctionwith traditional liposuction exceptexcept
he noted less postoperative bleedinghe noted less postoperative bleeding (Goldman, 2006)(Goldman, 2006)

18. 1064nm Laser lipolysis with1064nm Laser lipolysis with
liposuctionliposuction versusversus no liposuctionno liposuction
• No clinical studies sitedNo clinical studies sited
• No reports comparing liposuction with vrs no liposuctionNo reports comparing liposuction with vrs no liposuction
• Lysed fat is locally inflammatoryLysed fat is locally inflammatory
• Does leaving lysed fat cause more swelling ?Does leaving lysed fat cause more swelling ?

19. Trans-cutaneous Laser Assisted Liposuction VersusTrans-cutaneous Laser Assisted Liposuction Versus
Liposuction AloneLiposuction Alone
• Few comparative studiesFew comparative studies
• Erchonia Niera 635nm Dual Diode, 14 mWattErchonia Niera 635nm Dual Diode, 14 mWatt
– Reduces swelling & bruisingReduces swelling & bruising (Neira, et al, 2002)(Neira, et al, 2002)
– Speeds up rate of extraction by liposuction:Speeds up rate of extraction by liposuction:
40% faster, after 6 minute of application40% faster, after 6 minute of application
(Jackson, et al, 2004)(Jackson, et al, 2004)
– 50% greater volume of lipolysis when tumescent solution50% greater volume of lipolysis when tumescent solution
usedused

20. BBL & Prolipo Clinical ChoicesBBL & Prolipo Clinical Choices
• BBL: before or after laser liposuction ?BBL: before or after laser liposuction ?
• Laser lipolysis with and without liposuction ?Laser lipolysis with and without liposuction ?
• End-point of laser lipolysis ?End-point of laser lipolysis ?

21. Variables In Technique of BBL &Variables In Technique of BBL &
Laser Lipolysis and LiposuctionLaser Lipolysis and Liposuction
• BBL settingsBBL settings and application method:and application method: passespasses
• Tumescent InjectionTumescent Injection: concentration & volume: concentration & volume
• Laser FiberLaser Fiber: size, settings, technique: depth/passes: size, settings, technique: depth/passes
• LiposuctionLiposuction: cannulae size, volume, end point: cannulae size, volume, end point
• Post procedure carePost procedure care: compression duration: compression duration

22. BBL Interchangeable FiltersBBL Interchangeable Filters
• Filters (nm)Filters (nm)
– 420 -420 - Blue lightBlue light
– 515 -515 - PigmentPigment
– 560 -560 - VascularVascular && PigmentPigment
– 590 -590 - VascularVascular && HairHair
– 640 -640 - VascularVascular && HairHair
– 695 -695 - HairHair
– 800 - 1400800 - 1400 - ST applicator *- ST applicator *
Applications
*

23. BBL: ControlledBBL: Controlled
CoolingCooling
• Sapphire crystal contact coolingSapphire crystal contact cooling
• Provides timed before, during and after contact coolingProvides timed before, during and after contact cooling
• System sets skin temperature accurately from 0ºC to 30ºCSystem sets skin temperature accurately from 0ºC to 30ºC
• Includes 15 x 45, 15 x 15 or round 10 mm treatment areaIncludes 15 x 45, 15 x 15 or round 10 mm treatment area

24. Epidermis
Dermis
SkinTyte elevates subsurface temperature
A subsurface layer is briefly heated
The epidermis remains 12 C and
dermis heats to 55 C
Sciton SkinTyteSciton SkinTyte
Chilled Sapphire Plate
12°C
55°C

25. Epidermis
Dermis
• Denatured collagen causing immediate contraction
• Activated fibroblasts leads to long-term remodeling
Sciton SkinTyteSciton SkinTyte

26. BBL Settings

27. ProLipo EquipmentProLipo Equipment
• liposuction cannulaeliposuction cannulae
• fiber and handlefiber and handle

28. Settings

29. Clinical Case Series: Case 1Clinical Case Series: Case 1
• Patient information: age 39Patient information: age 39
• Hispanic with Fitzpatrick III-IVHispanic with Fitzpatrick III-IV
• Unhappy with submental pannusUnhappy with submental pannus

30. Clinical series:Clinical series: Case 1 ( cont.)Case 1 ( cont.)
BBL: submental
40J/cm2
3 second pulse
3 second post-cooling
12C cooling temp
3 passes
one week laterProLipo:
•20 ml 1% Lidocaine
• with 1:100,000 Epinephrine
• 0.6mm fiber
• 0.4 J/pulse
• 3000 Joules
• Repitition rate (RR) 30
• No liposuction performed

31. Clinical Case Series: Case 1 (cont.)Clinical Case Series: Case 1 (cont.)
• Continued improvementContinued improvement 4-54-5 monthsmonths
• More swelling without liposuctionMore swelling without liposuctionBefore 6 months after

32. Clinical Series: CaseClinical Series: Case
22
• Patient Information: age 45Patient Information: age 45
– 1 yr after facelift1 yr after facelift
– Unhappy with separation of submental platysmaUnhappy with separation of submental platysma
– & fat collections& fat collections
• ProLipo: 20ml 1% lido with 1:100,000 epiProLipo: 20ml 1% lido with 1:100,000 epi
– 3400 J3400 J total, RR 30, 2.5mm cannula,total, RR 30, 2.5mm cannula,
– 10ml liposuction10ml liposuction
• Followed by BBL ST:Followed by BBL ST:
– Unable to determine end -pointUnable to determine end -point
– 40 J/Cm240 J/Cm2
– RR 30 HzRR 30 Hz
– 12C cooling, 3 seconds,12C cooling, 3 seconds,3 passes3 passes
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Before 3 Months after

33. Clinical Series: Case 3Clinical Series: Case 3
• Pt. Information: 63 FPt. Information: 63 F
– Fitzpatrick IIFitzpatrick II
– unhappy with submental faty playtsma bandsunhappy with submental faty playtsma bands
– previous facelift with playtsma corseting 1 yr beforeprevious facelift with playtsma corseting 1 yr before
• BBL: ST:BBL: ST:
– 35 J/cm235 J/cm2, 30 Hz, 3 second cooling,, 30 Hz, 3 second cooling,
– 3 passes3 passes
• ProLipo:ProLipo:
– 15ml 1%lido with 1:100,00 epi15ml 1%lido with 1:100,00 epi
– 0.4 J/ pulse, 35 Hz,0.4 J/ pulse, 35 Hz, 3600 Joules3600 Joules
– LiposuctionLiposuction aspiration 10mlaspiration 10ml 2.5mm cannula2.5mm cannula
• ComplicationComplication::
– small skin burn at cervico-mental anglesmall skin burn at cervico-mental angle
– just right of midline at platysma bandjust right of midline at platysma band
Before 5 Months after

34. Clinical series: CaseClinical series: Case
44
• Pt Information: age 48Pt Information: age 48
– Fitzpatrick II-IIIFitzpatrick II-III
– Unhappy with submental & jowl fat andUnhappy with submental & jowl fat and
– platysma bandsplatysma bands
• BBL ST:BBL ST: 40 J/cm240 J/cm2
– 2 second post cooling2 second post cooling
– Cooling at 12 CCooling at 12 C
– Pulse width 5 secondsPulse width 5 seconds
– 3 passes3 passes
• ProLipo: 0.4J/pulseProLipo: 0.4J/pulse
– Freq 30 HzFreq 30 Hz
– 2000 Joules2000 Joules
• Liposuction:Liposuction: 14ml lidocaine & 1:100,000 epi14ml lidocaine & 1:100,000 epi
– 2mm liposuction cannulae2mm liposuction cannulae
– Aspiration volume 10mlAspiration volume 10ml
Before 3 Months after

35. Clinical Series: Case 5Clinical Series: Case 5
• Pt. information:Pt. information:
– 42F42F
– Unhappy with submental pannusUnhappy with submental pannus
• BBL:BBL:35J/cm235J/cm2
– 3 second passes3 second passes
– 3 second cooling: 12C3 second cooling: 12C
– 3 passes3 passes
• PropLipo: 20ml 1% lido with epiPropLipo: 20ml 1% lido with epi
1:100,0001:100,000
– 6mm cannulae .35J/cm26mm cannulae .35J/cm2
– RR 30RR 30
– 2000J2000J
– Liposuction 2mm cannula 15mlsLiposuction 2mm cannula 15mls
Before 7 Months after

36. • Pt Information: 17 MPt Information: 17 M
– Unhappy with submentalUnhappy with submental
pannuspannus
• BBL: ST:BBL: ST: 40J/cm240J/cm2
– 3.5 second pulse width3.5 second pulse width
– 12 C cooling12 C cooling
– 2 second cooling2 second cooling
– 3 passes3 passes
• ProlipoProlipo
– 0.35 J/pulse0.35 J/pulse
– RR 30RR 30
– 2400 J2400 J
• Liposuction: infusion 20mlLiposuction: infusion 20ml
– 1% lidocaine &1% lidocaine &
– 1:100,000 epi1:100,000 epi
– Aspiration 20mlAspiration 20ml
Clinical Series: CaseClinical Series: Case
66
Before 3 Months after

37. Clinical Series: CaseClinical Series: Case
77
• Patient Information: age 51Patient Information: age 51
– Fitzpatrick IIFitzpatrick II
– Requesting reduction ofRequesting reduction of
– Submental fat pannusSubmental fat pannus
• BBL: 3 passesBBL: 3 passes 40J/cm240J/cm2
– 12C cooling temp12C cooling temp
– 5 second pulse width5 second pulse width
– 2 second post cooling2 second post cooling
• ProLipo: 13 ml 1% lido with epiProLipo: 13 ml 1% lido with epi
– 6mm fiber6mm fiber
– rate 40rate 40
– 12 watt12 watt
– 3 Jewels3 Jewels
– pulse energy 30pulse energy 30
– 234 seconds234 seconds
– total 2000 Jtotal 2000 J
• LiposuctionLiposuction
– 2mm cannulae lposuction2mm cannulae lposuction
– 10ml liposuction aspiration10ml liposuction aspiration
Before 9 Months after

38. Clinical Series: Case 8Clinical Series: Case 8
• Pt. information: 36 FPt. information: 36 F
– Unhappy with submentalUnhappy with submental
laxity and fatlaxity and fat
• BBL ST:BBL ST: 45 J/cm245 J/cm2
– 3 second post cooling3 second post cooling
– Cooling at 12 CCooling at 12 C
– Pulse width 5 secondsPulse width 5 seconds
– 3 passes3 passes
• ProLipo:ProLipo:
– 30 ml infiltration30 ml infiltration
– 1064nm1064nm
– 6mm fiber6mm fiber
– 0.7J/pulse0.7J/pulse
– Freq 30 HzFreq 30 Hz
– 3,300 Joules3,300 Joules
– 25ml liposuction aspiration25ml liposuction aspiration
Before 3 Months after

39. • Pt Information 35 FPt Information 35 F
– c/o familial submentalc/o familial submental
laxity and pannuslaxity and pannus
• BBL:BBL: 40J/cm240J/cm2
– 3 second exposure3 second exposure
– 2 seconds cooling2 seconds cooling
– Temp 15CTemp 15C
– 3 passes3 passes
• Prolipo: 0.4J/pulseProlipo: 0.4J/pulse
– RR 30,RR 30, 2412 J total2412 J total
• LiposuctionLiposuction
– 18 ml tumescent solution18 ml tumescent solution
– 2.5mm cannula2.5mm cannula
– 20ml aspiration20ml aspiration
Clinical Series: Case 9Clinical Series: Case 9
Before 3 weeks after

40. Case 10Case 10
Before 11 Months after2 Months after

41. Results: Submental ST andResults: Submental ST and
ProLipoProLipo
Demographics and ClinicalDemographics and Clinical
• 10 pts aged from 17-6310 pts aged from 17-63
• Between 2008-2009Between 2008-2009
• longest follow-up 12 monthslongest follow-up 12 months
• 7/10 women7/10 women
• All unhappy with submental fat collection & laxityAll unhappy with submental fat collection & laxity
• 2/10 previous face lifts & developed laxity within 1 yr2/10 previous face lifts & developed laxity within 1 yr

42. Results: Submental ST and ProlipoResults: Submental ST and Prolipo
( cont. )( cont. )
• 9/10 pts underwent BBL: ST prior to ProLipo9/10 pts underwent BBL: ST prior to ProLipo
• End-point: patient ‘heat and or dyscomfort’ from STEnd-point: patient ‘heat and or dyscomfort’ from ST
• Unable to tolerate more than 3 passesUnable to tolerate more than 3 passes
• Most common settings: 35-40J/cm2, 3.5 second pulseMost common settings: 35-40J/cm2, 3.5 second pulse
width, 12-15 C cooling temp, 2-3 second post coolingwidth, 12-15 C cooling temp, 2-3 second post cooling
• 1/10 injected with local anesthetic before ST: patient1/10 injected with local anesthetic before ST: patient
unable to help us with endpoint determination,unable to help us with endpoint determination, felt unsafe
to use anesthetic prior to ST thereafter

43. Results: Submental ST and Prolipo ( cont. )Results: Submental ST and Prolipo ( cont. )
• 0.6mm fiber passed through a single submental incision0.6mm fiber passed through a single submental incision
• No pre-tunneling & no cross-hatchingNo pre-tunneling & no cross-hatching
• Settings:Settings:
• 2000J total energy used in submental area2000J total energy used in submental area
• between 0.35-0.4 J/pulsebetween 0.35-0.4 J/pulse
• RR 30RR 30
• End - point: Ease of fiber passageEnd - point: Ease of fiber passage
Surface temperature measured by handSurface temperature measured by hand
Total energy count 2000 JTotal energy count 2000 J

44. Results: Submental ST and Prolipo ( cont. )Results: Submental ST and Prolipo ( cont. )
• 1/10 underwent laser without liposuction1/10 underwent laser without liposuction
• This patient developed significant local tissueThis patient developed significant local tissue
reaction presumed secondary to not removingreaction presumed secondary to not removing
the lysed fatthe lysed fat
• I felt it is better to remove the lysed fat cells
• 1/10 technical complication of skin injury1/10 technical complication of skin injury
• Complication was entirely preventable, surgeonComplication was entirely preventable, surgeon
was attempting to divide a platysma band whichwas attempting to divide a platysma band which
was adherent to the skin s/p faceliftwas adherent to the skin s/p facelift
• All 10 patientsAll 10 patients very satisfiedvery satisfied with resultswith results

45. Results: Submental ST and Prolipo ( cont.)Results: Submental ST and Prolipo ( cont.)
• No patients reported significant pain and did not require painNo patients reported significant pain and did not require pain
medication, all patients were given prophylactic antibiotics inmedication, all patients were given prophylactic antibiotics in
view of the procedure being performed in an office settingview of the procedure being performed in an office setting
• 7/10 patients requested oral sedation with a combination of7/10 patients requested oral sedation with a combination of
diazepam and vicodin immediately prior to the procedurediazepam and vicodin immediately prior to the procedure

46. Conclusions: Submental ST & ProlipoConclusions: Submental ST & Prolipo
• Combination BBL:ST and ProLipo with laser followed by immediateCombination BBL:ST and ProLipo with laser followed by immediate
liposuction isliposuction is safe and operator dependentsafe and operator dependent technique for improvingtechnique for improving
submental contoursubmental contour
• BBL:BBL:ST should be performed prior toST should be performed prior to local-injectionlocal-injection anesthesiaanesthesia
• Laser without liposuction leads to unacceptable swellingLaser without liposuction leads to unacceptable swelling due to thedue to the
inflammatory effect of lysed fat cell products in the intercellularinflammatory effect of lysed fat cell products in the intercellular
space. However, it can achieve significant contour improvementspace. However, it can achieve significant contour improvement
• A further study comparing BBL alone with, liposuction alone, versusA further study comparing BBL alone with, liposuction alone, versus
combined BBL, laser and liposuction alone is warrantedcombined BBL, laser and liposuction alone is warranted..

47. “Be joyful while we are young”
Gaudeamus igitur juvenes