Tumescent liposuction versus internal ultrasonic-assisted tumescent liposuction. A side-to-side comparison.

BACKGROUND: Tumescent liposuction (TL) performed according to accepted guidelines has proven to be a safe and effective outpatient procedure. The recent introduction of internal ultrasonic assistance may be a beneficial adjunct to the proven technique of tumescent liposuction at no additional risk to the patient. OBJECTIVE: To determine whether there are differences in the intra- and postoperative course and the final cosmetic result between TL and internal ultrasonic-assisted tumescent liposuction (I-UATL) with a device using a double-lumen, saline-cooled cannula. METHODS: Twenty-eight patients were enrolled in a randomized, prospective, side-to-side comparative study of TL with and without internal ultrasonic assistance. Intraoperative data including patient and physician observations are reported. A blinded evaluation was performed by the nonoperating surgeon of postoperative bruising, swelling, nodularity, skin retraction, decrease in cellulite, and symmetry at regular intervals after the procedure. Patients assessed variables concurrently. RESULTS: In most cases, the surgeon sensed a greater ease of cannula motion on the I-UATL side, associated with less physician exertion and fatigue. Patients tended to note a more pleasant intraoperative experience on the I-UATL side. We found no significant difference in the degree of postoperative bruising, nodularity, skin retraction, or decreased cellulite as evaluated by the observing physician, although swelling at 1 week was greater on the I-UATL side. The degree of bruising, swelling, soreness, numbness, skin retraction, or decrease in cellulite as reported by the patient did not differ significantly. There were no major complications attributable to either technique. CONCLUSION: This study suggests that the addition of internal ultrasonic assistance to the tumescent liposuction procedure may be advantageous regarding less physician effort and increased patient comfort during the procedure. We have not shown a significant difference in the postoperative course or the final cosmetic result when comparing TL with I-UATL.

Pulsed carbon dioxide laser resurfacing of photo-aged facial skin.

BACKGROUND AND DESIGN: public demand for procedures to rejuvenate photoaged skin have stimulated the use of high-energy short-pulsed carbon dioxide lasers as a precise and predictable treatment modality. The purpose of this study was to determine the degree of clinical improvement achieved in treating perioral and periorbital wrinkles with a high-energy, microsecond-domain pulsed CO2 laser. Photodamaged skin in the perioral (n=73) and periorbital (n=38) regions was treated with multiple passes of confluent single pulses of CO2 laser energy (10 600 nm, 3-mm collimated beam, <1- millisecond pulse, 450 mJ per pulse, 2 to 5 W), with the tissue being cleansed and débrided with normal saline between passes. A nine-point clinical scoring system was devised for evaluation of the degree of wrinkling and photodamage present. Preoperative and postoperative photographs were independently scored by four ¿blinded¿ reviewers. The patients were observed postoperatively for 1 to 12 months for the course of healing, and adverse events were recorded. RESULTS: All three classes (mild, moderate, and severe) of photoaging of the skin responded equally well, showing an average wrinkling score reduction of 2.25 for the periorbital region and 2.34 for the perioral region, the most superficial wrinkles and photodamage being eliminated and the more severe being markedly improved. An unexpected finding was tightening of loose and folded skin. Side effects included transient erythemia and postinflammatory hyperpigmentation, and one instance of an isolated hypertrophic scar. CONCLUSIONS: Resurfacing of photoaged skin by means of a high-energy, microsecond-domain pulsed CO2 laser with a specific clinical treatment protocol results in predictable improvement in perioral and periorbital wrinkling and photodamage with minimal risks. Heat-induced collagen shrinkage appears to contribute to these results by tightening loose skin and folds.