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17 Laser Assisted Body Contouring
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a
e
b
f
c
g
d
h
Fig. 17.11 (a) Before. (b) After 7days (c) Before. (d) After 7days. (e) Before. (f) After 7days. (g) Before. (h) After 7days
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a
e
b
f
c
d
Fig. 17.12 (a) Before. (b) After 6weeks. (c) Before. (d) After 6weeks. (e) Before. (f) After 6weeks
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Fig. 17.13 (a) Before. (b)
After 3weeks
a
a
b
c
b
d
Fig. 17.14 (a) Before (b) After 7days. (c) Before. (d) After 7days
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Z. Žgaljardić and I. Žgaljardić
a
e
b
f
c
d
Fig. 17.15 (a) Before. (b) After 2weeks. (c) Before. (d) After 2weeks. (e) Before. (f) After 2weeks
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Fig. 17.16 (a) Before. (b)
After 3weeks
Fig. 17.17 (a) Before. (b)
After 3weeks
a
a
b
b
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Z. Žgaljardić and I. Žgaljardić
of some patients. The photographs are chosen from among
different age group of males and females addressing the various body parts with outstanding results.
Case 1.
Case 2.
Case 3.
Case 4.
Case 5.
Case 6.
Case 7.
Case 8.
Case 9.
Case 10.
Case 11.
17.13 Conclusion
Inclusion of laser energy in liposuction procedures has been
a big step forward in body contouring. Although there is still
no consensus on the best wavelength used during the procedure, all reports conrm the benets of the laser usage and
subsequent favorable energy–tissue interaction.
1. Skin tightening.
2. Vessel coagulation.
3. Diminished postoperative recovery.
4. Enables treatment of delicate area.
5. Less strain for the surgeon.
6. Ideal treatment for large or multiple lipomas.
The right balance has to be found in order to achieve a
better nal result but at the same time not to apply too much
energy that can lead to a thermal injury. Moreover, one
should always bear in mind the possibility of complications
and remember that any technology is only a “tool in a surgeon’s hand.”
References
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2. Khanna A, Filobbos G. Avoiding unfavourable outcomes in liposuction. Indian J Plast Surg. 2013;46(2):393–400. https://doi.
org/10.4103/0970- 0358.118618.
3. Bellini E, Grieco MP, Raposio E. A journey through liposuction
and liposculture: Review. Ann Med Surg (Lond). 2017;24:53–60.
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Hills, Calif: Medical Aesthetics; 1985.
5. Klein JA. The tumescent technique for liposuction surgery. Am J
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6. Goldman L.Pathology of the effect of the laser beam on the skin.
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7. Hukki J, Krogerus L, Castren M, Schroder T.Effects of different
contact laser scalpels on skin and subcutaneous fat. Lasers Surg
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8. Dressel T. Laser lipoplasty: the preliminary report. Lipoplasty
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9. Apfelberg DB, Rosenthal S, Hunstad JP, etal. Progress report on
multicenter study of laser-assisted liposuction. Aesthet Plast Surg.
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12. Goldman AG, Schavelzon D, Blugerman G. Liposuction using
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L. Laser lipolysis: accidity under control. Aesthet Plast Surg.
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effects from 1064/1320-nm laser-assisted lipolysis and its clinical
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skinny. Semin Cutan Med Surg. 2008;27(4):259–63. https://doi.
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18. Lukac M, Vizintin Z, Zabkar J, Pirnat S. QCW pulsed Nd:YAG
1064nm laser lipolysis. J.Laser Health Acad. 2009;4/1:5–17.
19. Mordon SR, Wassmer B, Reynaud JP, etal. Mathematical modeling of laser lipolysis. Biomed Eng Online. 2008;7:10. https://doi.
org/10.1186/1475- 925X- 7- 10.
20. Dudelzak J, Hussain M, Goldberg DJ.Laser lipolysis of the arm,
with and without suction aspiration: clinical and histologic changes.
J Cosmet Laser Ther. 2009 Jun;11(2):70–3.
21. Nachabé R, Hendriks BH, van der Voort M, Desjardins AE,
Sterenborg HJ.Estimation of biological chromophores using diffuse optical spectroscopy: benet of extending the UV-VIS wavelength range to include 1000 to 1600 nm. Biomed Opt Express.
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PMID: 21258560; PMCID: PMC3018130.
22. Ichikawa K, Miyasaka M, Tanaka R, Tanino R, Mizukami K,
Wakaki M. Histologic evaluation of the pulsed Nd:YAG laser for
laser lipolysis. Lasers Surg Med. 2005;36(1):43–6.
23. Goldman A, Wollina U, de Mundstock EC.Evaluation of tissue tightening by the subdermal Nd: YAG laser-assisted
liposuction versus liposuction alone. J Cutan Aesthet Surg.
2011;4(2):122–8.
24. Goldman A, Gotkin RH.Laser-assisted liposuction. Clin Plast Surg.
2009;36(2):241–60. https://doi.org/10.1016/j.cps.2008.11.005.
25. McBean JC, Katz BE.A pilot study of the efcacy of a 1,064 and
1,320nm sequentially ring Nd:YAG laser device for lipolysis and
skin tightening. Lasers Surg Med. 2009;41(10):779–84.
26. DiBernardo BE, Reyes J.Evaluation of skin tightening after laserassisted liposuction. Aesthet Surg J. 2009;29(5):400–7.
27. Badin AZ, Gondek LB, Garcia MJ, Valle LC, Flizikowski FB, de
Noronha L.Analysis of laser lipolysis effects on human tissue samples obtained from liposuction. Aesthet Plast Surg. 2005;29(4):281–
6. https://doi.org/10.1007/s00266- 004- 0102- 9.
28. Goldman MP, Bacci PA, Leibaschoff G, etal. Cellulite: pathophysiology and treatment. NewYork, NY: Taylor & Francis; 2006.
29. Proebstle TM.Cellulite. Hautarzt. 2010;61(10):864–72.
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30. Goldman A, Gotkin RH, Sarnoff DS, Prati C, Rossato F.Cellulite:
a new treatment approach combining subdermal Nd: YAG laser
lipolysis and autologous fat transplantation. Aesthet Surg J.
2008;28(6):656–62.
31. Petti C, Stoneburner J, McLaughlin L. Laser cellulite treatment
and laser-assisted lipoplasty of the thighs and buttocks: combined
modalities for single stage contouring of the lower body. Lasers
Surg Med. 2016;48(1):14–22.
32. Forman Taub A, Friedman A.Laser lipolysis with a 980nm diode
laser. J Drugs Dermatol. 2010;9(5 Suppl ODAC Conf Pt 1):s58–61.
33. Palm MD, Goldman MP.Laser lipolysis: current practices. Semin
Cutan Med Surg. 2009;28(4):212–9. https://doi.org/10.1016/j.
sder.2009.10.002.
34. Dudelzak J, Hussain M, Goldberg DJ.Laser lipolysis of the arm,
with and without suction aspiration: clinical and histologic changes.
J Cosmet Laser Ther. 2009;11(2):70–3.
35. Gentileschi S, Servillo M, D’Ettorre M, Salgarello M.Abdominal
subcutaneous mass after laser-assisted lipolysis and immediate
multiple treatments with a dual-wavelength laser, vacuum and
massage device. Aesthet Surg J. 2016;36(4):NP144–9. https://doi.
org/10.1093/asj/sjv248.
36. Hostiuc S, Francisc A, Ceauşu M, Negoi I, Carantino A.Lethal
complications of laser assisted liposuction. Case report.
Rom J Leg Med. 2014;22(3):173–6. https://doi.org/10.4323/
rjlm.2014.173.
37. Shin JY, Chang H.Rhabdomyolysis after cosmetic laser-assisted
liposuction. Aesthet Plast Surg. 2015;39(4):635–8. https://doi.
org/10.1007/s00266- 015- 0511- y.
38. Reynaud JP, Skibinski M, Wassmer B, Rochon P, Mordon
S.Lipolysis using a 980-nm diode laser: a retrospective analysis of
534 procedures. Aesthet Plast Surg. 2009;33(1):28–36.
39. Ali YH. Laser-assisted lipolysis burn safety: proposed detailed
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algorithm. Breast J. 2011;17:246–55.
Use of J Plasma in Body Contouring
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EhabAkkary
18
18.1 Introduction
Skin tightening has been one of the most sought procedures
in the eld of cosmetic surgery. As we continue to improve
and develop different techniques needed to optimize our cosmetic results, advancement in technology has been repeatedly introduced to the eld to achieve skin tightening. Aging,
pregnancy, massive weight loss, and other factors cause skin
laxity that presents a very common indication for cosmetic
surgery. Skin tightening can be surgical, nonsurgical, or
combined. Different modalities of energy-based skin tightening include laser, ultrasound energy, and radiofrequency.
These modalities can be used externally or subdermally. The
optimal skin tightening modality should achieve reproducible acceptable cosmetic results, be time efcient, cost effective, and relatively easy to learn and implement into the
surgeon’s practice. So, have we nally found the Holy Grail
of skin tightening?
18.2 Historical Background ofRenuvion
Renuvion® is a medical device used to deliver radiofrequency
energy via helium gas plasma ow. It can be used for cutting,
coagulation, or ablation of soft tissue. The device is manufactured by Apyx Medical (Clearwater, FL, USA). Renuvion®
evolved from the J plasma technology that was commonly used
in treating endometriosis, adhesions, and chronic pelvic pain.
Initially, J plasma was introduced into the eld of cos-
metic surgery over the past few years and then developed
Supplementary Information The online version contains supplementary
material available at [https://doi.org/10.1007/978- 981- 19- 4997- 5_18].
E. Akkary (*)
Akkary Surgery Center, Morgantown, WV, USA
Akkary Surgery Center, Bridgeport, WV, USA
e-mail: eakkary@yourdreambody.com
®
into the current Renuvion® device that was cleared by the US
Food and Drug Administration (FDA) in October 2019 [1].
The device is relatively new in the eld of cosmetic surgery
and has been showing very promising results in skin tightening. It is important to understand that the FDA clearance is a
general clearance for medical use in soft tissue cutting, coag-
ulation, and ablation and is not specic for skin tightening of
a certain body part.
18.3 The Renuvion® System Structure
Renuvion® system consists of the following:
1. Renuvion® generator.
2. Helium tank.
3. Hand piece.
4. Split grounding pad.
5. Foot controls.
18.3.1 Renuvion® Generator
This is a dual generator that comprises the regular bovie
electrocautery (cutting and coagulation generator) as well as
radiofrequency generator with helium plasma ow
(Fig.18.1). The two main settings of the generator are power
and ow.
Setting up the generator:
1. Conrm the generator is connected to the helium tank.
2. Open the helium tank and read the tank gauge conrming
that it is not empty.
3. When the tank is open, the green light tank indicator will
turn on (Fig.18.2).
4. Setting up the power and helium ow of the generator:
(a) Power of the generator reects the heat delivered to
the tissue.
(b) The thinner the tissue is, the lower the power setting
should be.
© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2022
M. Thomas, J. D’silva (eds.), Manual of Cosmetic Surgery and Medicine, https://doi.org/10.1007/978-981-19-4997-5_18
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E. Akkary
(c) Generally, I use 80% power for tissue below the clav-
icle and 60% power for tissue above the clavicle.
(d) Generally, I use helium ow at 2L/min. It is impor-
tant to avoid setting the ow to less than 1.5L/min to
avoid decreasing efcacy (some cases are performed
with ow of 1 L/min as discussed later in this
chapter).
5. The generator also shows the amount of energy delivered.
This is particularly useful if working on bilateral areas to
match the energy on both sides (Fig.18.3).
18.3.2 Helium Tank
Fig. 18.1 Renuvion® generator
Fig. 18.2 Green light turned on indicating successful connection to the
Helium tank
GENERATOR SETTINGS
Set yellow and blue
1
buttons to zero.
Set power 60%-80% (power=heat)
2
For thinner/crepey areas use 60%.
*Power settings above 80% have not been
evaluated safety.
(a) The helium tank is routinely connected to the generator
on the rst assembly of the device by the company.
(b) The tank is connected to a gauge to reect the volume of
the tank based on pressure. Commonly, the gauge reads
between 0 and 2000psi (lb per square inch) (Fig.18.4).
(c) Open the helium tank and read the tank gauge conrm-
ing that it is not empty.
(d) When the tank is open, the green light tank indicator will
be activated on the generator (Fig.18.2).
(e) The tank needs to be kept in an upright position at all
times.
(f) After completion of the treatment, conrm the tank is
shut off.
The flow rate should be 1.5
3
liters to 3 liters.
Lower flow rates are for smaller more confined
spaces such as: necks, knees and arms.
Fig. 18.3 Joule setting on the generator. (Courtesy of Apyx Medical Corporation (Apyx Medical Corporation owns the copyright of this image))
PEARL: Do not use < 1.5 L or > 3.0
for safety precautions.
% of power
Liters of helium gas flow
Joule Settings
Orange buttons indicate Joule use
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18.3.3 Handpiece
(a) There are two different types of handpieces, short
(15cm) and long (27cm) (Fig.18.5).
(b) There is no difference in the energy delivery between
both types.
(c) The handpiece is connected to the generator.
(d) On initial activation of the handpiece, the blade is
deployed, and the handpiece is activated against a metal
object, for example, Adson forceps (Fig.18.6).
(e) The blade is then retracted back into the handpiece.
18.3.4 Split Grounding Pad
(a) The pad is connected to a smooth area of the body
achieving skin contact with the full surface area of the
pad.
(b) Metal objects within the circuit should be avoided.
(c) The pad is connected to the generator.
Fig. 18.4 Helium tank
18.3.5 Foot Controls
(a) The foot controls are optional.
(b) The handpiece has built in controls.
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