Comprehensive histologic analysis of interstitial lipolysis with the 1444 nm wavelength during a 3-month follow-up

Multi-modal treatment strategy for achieving an aesthetic lower face

BACKGROUND

Most women consider an oval-shaped face to be youthful and beautiful. In recent years, demand has grown for surgical procedures with a shorter downtime and fewer complications. These minimally invasive procedures include botulinum toxin type A (BoNTA) injection, filler injection, suction-assisted liposuction (SAL), laser-assisted lipolysis (LAL), thread lifting, and fat grafting. This study aims to introduce an effective method for creating an aesthetically pleasing lower face using a combination of minimally invasive procedures.

METHODS

From March 2017 to March 2019, 94 patients simultaneously underwent LAL, SAL, and thread lifting. Ancillary procedures such as BoNTA injections, hyaluronic acid filler injections, and removal of the buccal fat pad (BFP) were selectively performed according to the patient's condition.

RESULTS

Patients rated their postoperative satisfaction as very satisfied, satisfied, dissatisfied, or very dissatisfied. Approximately 83% of all respondents were satisfied with the results, whereas the remaining respondents had complaints regarding the outcomes. The most common reasons for dissatisfaction were a longer-than-expected recovery time and undercorrection, and the most severe complaint was skin depression as a result of overcorrection.

CONCLUSIONS

Our method of simultaneously performing LAL, SAL, and thread lifting, while adding BoNTA, filler injections, and BFP removal as needed, was capable of producing consistent and reliable aesthetic outcomes for the lower face.

Ultrastructural assessment of cellulite morphology: clues to a therapeutic strategy?

INTRODUCTION AND AIMS

Cellulite is a problematic condition affecting mostly women, characterized by a bumpy or nodular skin surface. Recent approaches with laser treatment have offered some promise. The present study sought to identify possible targets for laser treatment or light therapy through an ultrastructural investigation of the condition.

SUBJECTS AND METHODS

Study subjects comprised 7 healthy Japanese female volunteers (Age range 37-46 yr, average 38.4) with cellulite, graded on the 4-point Nurnberger-Muller cellulite severity scale. Four patients were at grade 2 and 3 at grade 3. Three millimeter punch biopsies were obtained and routinely processed for light and transmission electron microscopy.

RESULTS

Microphotography of specimens from cellulite patients demonstrated the presence of fibrotic septa which divided up larger clusters of adipose tissue into smaller packets, with the septa acting as a tethering system, thus producing the typical dimpling pattern. Ultrastructural findings showed proliferation of collagen and elastic fibers down into the cellulite tissue with compression of capillaries and congestion of arterioles, resulting in poor blood flow.

CONCLUSIONS

The histological and ultrastructural findings of cellulite clearly distinguish the condition from simple fat deposition. The remodeling of the fat layer into lobulated packets of lipocytes sequestered by fibrotic septa with a high proportion of elastic fibers would suggest the use of a fiber-based interstitial laser-assisted lipolysis system at an appropriate wavelength which might offer benefits through disruption of the septae through a photomechanical effect and lipolysis of the sequestered lipocytes. This could be followed by a course of near-infrared phototherapy to accelerate clearance of freed lipid and debris and reestablish the vascular system.

Ultrastructural assessment of cellulite morphology: clues to a therapeutic strategy?

INTRODUCTION AND AIMS

Cellulite is a problematic condition affecting mostly women, characterized by a bumpy or nodular skin surface. Recent approaches with laser treatment have offered some promise. The present study sought to identify possible targets for laser treatment or light therapy through an ultrastructural investigation of the condition.

SUBJECTS AND METHODS

Study subjects comprised 7 healthy Japanese female volunteers (Age range 37-46 yr, average 38.4) with cellulite, graded on the 4-point Nurnberger-Muller cellulite severity scale. Four patients were at grade 2 and 3 at grade 3. Three millimeter punch biopsies were obtained and routinely processed for light and transmission electron microscopy.

RESULTS

Microphotography of specimens from cellulite patients demonstrated the presence of fibrotic septa which divided up larger clusters of adipose tissue into smaller packets, with the septa acting as a tethering system, thus producing the typical dimpling pattern. Ultrastructural findings showed proliferation of collagen and elastic fibers down into the cellulite tissue with compression of capillaries and congestion of arterioles, resulting in poor blood flow.

CONCLUSIONS

The histological and ultrastructural findings of cellulite clearly distinguish the condition from simple fat deposition. The remodeling of the fat layer into lobulated packets of lipocytes sequestered by fibrotic septa with a high proportion of elastic fibers would suggest the use of a fiber-based interstitial laser-assisted lipolysis system at an appropriate wavelength which might offer benefits through disruption of the septae through a photomechanical effect and lipolysis of the sequestered lipocytes. This could be followed by a course of near-infrared phototherapy to accelerate clearance of freed lipid and debris and reestablish the vascular system.