Standard photographic technique in plastic surgery is an important topic that has been stressed in the discipline over the past several years. Clinical photographs should always be taken with the same camera lens, lens setting, lighting, film, and patient position to ensure reproducibility and to enable valid pre- and postoperative comparisons. A 35-mm single lens reflex camera is highly recommended for this type of photography. Two lenses are suggested, one with a focal length range of 50 to 60 mm and one with a focal length range of 90 to 105 mm. Both should have macro capability. Two or more flash units are recommended, either camera-mounted or a studio system set-up in the office. Using the patient preparation method and technique outlined in the text, the Standards in Clinical Photography achieve consistency from patient to patient and also in the same patient in pre- and postoperative photographs. Henceforth, the information discussed in the article forms the basis for standard views, regardless of the image-capture medium.

Liposuction is a standard for removing fat. Recently developed, laser lipolysis can be used to simultaneously remove unwanted fat and tighten skin. Laser lipolysis is accomplished with single or multiple sequential wavelengths. Development of an optimal method requires detailed understanding of tissue heating for the wavelengths employed. This study systematically evaluates tissue heating for superficial and deep laser lipolysis using three approaches, and correlates temperature rise with histology changes, defining appropriate system parameters. Two individuals scheduled for abdominoplasty had laser testing on healthy abdominal skin scheduled for excision. Each treatment was applied to 3 x 3 cm squares with various laser parameters. Treatment was conducted in the fatty layer for lipolysis and subdermally for skin tightening. Individual squares were treated with SmartLipo (Cynosure, Inc. Westford, MA, USA) using 1064 nm, 1320 nm, or MultiPlex (1064 nm/1320 nm) with laser doses of 8.3 to 333 J/cm2. Exposures were applied at 3-5 mm or approximately 20 mm depth below the skin surface. Skin temperatures at the surface and at depths of 5 mm to 37 mm were recorded immediately post-treatment for each exposure. Treated tissue was excised and evaluated for thermal injury using H&E and transmission polarization microscopy. Histology was correlated to tissue temperature to determine appropriate treatment limits. Superficial treatment with surface temperatures exceeding 47 degrees C (50 degrees C and 55 degrees C at 5 mm depth) typically caused epidermal and dermal injury, with blistering above 58 degrees C. Below this threshold, focal collagen change and dermal inflammatory response were found in many samples without epidermal injury. These acute thermal effects may link to skin tightening during the healing process. Deep treatments, at up to 133 J/cm2, exhibited minimal temperature rise and induced thermal effects in vessels and ligaments. Higher laser doses were associated with a significant temperature increase. In conclusion, superficial subdermal heating (within approximately 5 mm of the surface) during laser lipolysis should limit skin surface temperature to 42 degrees C. The laser dose per surface temperature rise in treatments are 4.5 J/cm2/degrees C for 1320 nm, 6 J/cm2/degrees C for MultiPlex and 7.5 J/cm2/degrees C for 1064 nm. Clinical studies should be performed to validate these results.

Our findings represent the first documentation of quantifiable evidence of positive skin changes resulting from the addition of laser treatment to liposuction.

Laser-assisted liposuction has a statistically significant effect on skin shrinkage and tightening of the skin in the abdominal area when compared to liposuction alone.

No abstract

In this study, a single treatment with the 1440-nm pulsed laser improved the appearance of cellulite, an improvement that persisted through at least one year of follow-up with minimal adverse effects.

Treatment options correlate with the presence and severity of conditions. Categories 1 and 2 have only a fat excess condition. Laser application alone, without skin intervention, is utilized. The amount of fat with subsequent aspiration follows guidelines of categories 2 through 5. The 1440-nm laser helps in all treatments. The surgeon may elect to address skin tightening with surgical tightening in categories 6 and 7. Modalities such as toxins and focused ultrasound can be used to address muscle laxity.

Cellulite is characterized by dimpled contour alterations of the skin and is present in approximately 85% to 90% of postpubertal females. Although the pathophysiology of cellulite remains to be fully elucidated, experimental evidence indicates a multifactorial process involving the number and types of fibrous septae, microvascular dysfunction, subcutaneous inflammation, decreased dermal thickness with age, and fat deposition. Cellulite is a major cosmetic concern for many women, and a number of both noninvasive (eg, massage, cosmeceuticals, laser therapy) and minimally invasive techniques (eg, subcision, collagenase injection) have been evaluated to improve the appearance of the affected skin. However, evidence for many of these treatments is limited, largely due to the lack of a validated, convenient tool for the standardized evaluation of cellulite severity. Various imaging modalities have been used to characterize cellulite severity and the impact of treatment, but only 2-dimensional and 3-dimensional digital photography have been adequately validated. However, in many cases, imaging findings do not correlate with subjective measures of cellulite severity. A number of cellulite rating scales have been developed; some provide only a qualitative measure, while others do not fully capture all clinically relevant aspects of cellulite, including the perspective of the patient. There remains an unmet need for global adoption of a validated scale that can be used easily by clinicians and patients in clinical and research settings. We propose features that should be included in an ideal rating scale for assessment of cellulite severity.