896- Endolaser soft-lift (Scrimali,Lomeo,Dell'Avanzato,Crippa)_31aW

1EJAMeDwww.ejamed.comThe european Journal of Aesthetic Medicine and DermatologyThe European Journal ofAesthetic Medicine and DermatologyVolume 3, Issue 3, 2013 ISSN 2240-5046

The European Journal of Aesthetic Medicine and Dermatology86Original ArticleEndolaser soft-lift: a new approach on bodycontouring. Perspective and suggestionsLuca Scrimali MD 1 , Giuseppe Lomeo MD, Roberto Dell’Avanzato MD,Angelo Crippa MD1University of Catania, Plastic Surgery, Catania, ItalyABSTRACTRecently lifting and body remodeling techniques have gone through a great development, looking for less invasiveand traumatic methods, due to the considerable number of people that have fear to undergo surgery.In this regard, very encouraging results have been obtained with the use of lasers, which seems to rapresentthe future of cosmetic surgery in body contouring. What we would like to point out in this study is the effectof laser on skin thightening and retraction; Thiago is possible for its photothermal action on subdermal tissuesand allows similar outcomes compared to classic thread lift, with greater comfort for the patient, less painand scars, less complications and shorter recovery time. We used a 1470 nm diode laser, which is a nonablativelaser that goes deep in the tissues due to its high affinity for fat and water.KEYWORDS: laser, laserlift, endolift, skin tighteningEur. J. Aesth. Medicine and Dermatology. 2013;3(3):86-90INTRODUCTIONIn the last years, patients request of liftingand body remodeling procedures,due to bad lifestyle's habits, have grow;an increasing number of new methods, lessinvasive and less traumatic have been proposed;despite the widespread distributionof cosmetic surgery, a considerable numberof people have fear to undergo surgery. Inthis regard, very encouraging results havebeen obtained with the use of laser, whichseems to rapresent the future of the cosmeticsurgery in body contouring.What we would like to point out in thisstudy is the effect of laser on skin thighteningand retraction due to its photothermalaction on the subdermal tissues, allowingto achieve similar outcomes compared toclassic thread lift, with greater comfort forCORRESPONDENCELuca Scrimali MDUniversity of Catania, Plastic Surgery Unit, Catania, Italyluca.scrimali@gmail.comDISCLOSURESAuthor disclose any commercial associations or financialdisclosures that might pose or create a conflict of interestwith information presented in the manuscript.

The European Journal of Aesthetic Medicine and Dermatology87Scrimali L. et al.the patient, less pain and scaring, minorrisk of complications and a shorter recoverytime.We used a 1470 nm diode laser, which is anonablative laser able to penetrate deeplyin tissues due to its high affinity for fat andwater.M AT E R I A L S A N D M E T H O D SThe laser we tested is a Diode laser for Endolifttechnique, emitting at 1470 nm (EufotonLasemar 1500, Via Flavia 23/1, 34148Trieste, Italy). The light is delivered to theskin by an optic fiber of 100, 200, 300, 400,600, 800 and 1000 nm. The laser is equipedwith a fractional scanner which can beused both with 200 or 400 microns powercables.To obtain several vectors of traction, theEndolift tecnique, can be performed with acannula, inserted trough a tab incision intothe skin, reaching the junction betweendeep dermis and superficial layer of subdermicfat.We cheked the right position of the cannulawith ultrasonographic examination whileperforming the treatment; 3 weeks after,the same examination was performed todemonstrate the fibrosis obtained by laserand cannula.The result in tightening few weeks after,continues for the next three months approximatively,according to wound healingprocess, achieving better results monthafter month.The cannula should go forward and backward3 times each tunnel, emitting laserlight while moving back. The number oftunnels depends on the treated area andcould vary from a minimum of 3 to a maximumof 10. Thus tunnels must be orientedaccording to antigravitational lines to obtainthe right traction.Alternatively (but only in expert hands) thistecnique can be performed with a free fiber,especially in areas where the skin is verythin, like cheek and neck, or in small areaslike the peri umbelical area or the medialaspect of thigh and knees.At the end of the treatment, that must berepeated three times in a month, the patientwill have a compressive dressing to keep inplace 24h a day for the first 4days post-opand only during the night for 4 more days..The treatment can be performed in localanesthesia, there is no pain after treatmentdespite a burning sensation for at least 4-5h, that can be controlled with oral painkiller.An antibiotic therapy is suggested in thenext 3-5 days after treatment.An aedema can occur in treated areas, for

The European Journal of Aesthetic Medicine and Dermatology88Scrimali L. et al.about 5/6 days; it twill resolve spontaneously,whitout any drugs; a mild massagecould help resolving it more fast. Aecchimosiscan occur in the treated areas, and itwill resolve spontaneously whitin 7/10days.The follow up is at least 8 moths, becausethis is the time the subcutaneous scarsneeds to reshape the treated area to obtainthe best result.D I S C U S S I O NThe gold standard technique widely approvedfor body remodeling and skin rejuvenationis lifting.As it is well-known, it is possible to performmany different kind of lifting, such as subcutaneousface lift ( like the first face liftever performed in the early twentieth century)deep subcutaneous lift, subcutaneousface lift with suture manipulation of superficialfat and SMAS, subcutaneous face liftwith SMASectomy, the Skoog procedure,subperiosteal approach and so on. 1Thread lift surely represent a less invasiveapproach compared to the above mentionedtechniques and consist in lifting saggingskin using surgical sutures, with smallskin incisions. 1, 2, 3 But this is still a surgicalapproach, with all its side effects implicationssuch as ecchymosis, erythema,hematoma, swelling, discomfort, and somespecific complications like thread exposurewhich leads or asymmetries(3).Several studies report the comparison betweenthe different techniques of lifting butin literature still doesn't exist a report aboutan endo-laser soft lift, using a diode laser,which is comparable in cosmetic outcomesto a standard thread lift (mini lifting) but impliesa considerable minor risk and discomfortfor the patient. 3, 4, 5, 6, 7, 8, 9, 10, 11The use of cannula and laser allowed us totake advantage not only of the mechanicalaction of the cannula used to obtain severaltunnels through the subdermal tissues (12),but also of the controlled photothermal injuryobtained with laser, that gives skinthightening, retraction and than lifting (13).Diode laser interacts both with water andfat and the most a tissue is rich in waterand fat, the better will be laser transmission,with lower dispersion. Moreover fat isparticularly rich in glycerol which further facilitateslaser effectiveness.An interesting peculiarity of laser action isthe preservation of the interstice, especiallyconcerning vessels; this means less ecchymosisand hematoma.The most interesting aspect that we havefound with Endolaser soft-lift is the inductionof a controlled skin retraction, that al-

The European Journal of Aesthetic Medicine and Dermatology89Scrimali L. et al.lows the surgeon to perform, with a safeprocedure, a soft endo-lift, with a cosmeticoutcomes similar to surgical procedures,but with less trauma and scars. Laser photothermalinjury, within the subdermal adiposetissue, induces an increasing incollagen production, thus implying a graterskin elasticity and tightening. The amountof thick septae in the superficial fat layerseems to predict the degree of skin retraction(13).This procedure should be performed in thesame areas that could be treated with astandard thread lift (face and neck, arms,abdomen and legs).This technique is not indicated for all kindof patients. When a severe skin ptosis ispresent, the endo-laser soft lift risks to failpatient expectation, not achieving the desiredoutcomes. The best target is amedium degree of skin excess.Using the scanner action, we can alsocombine endo-laser soft lift and fractionalskin rejuvenation; this will give us the bestresults in skin tightening.Due to its action on skin remodelling andnew collagen fibers production, results arevisible three or four months after the lasttreatment reaching the top in the next sixmonths (14).C O N C L U S I O N SIn this preliminary stage of the study we arefollowing up about 20 patients, to be surethe technique is really safe and effectivness.We believe that many patients treateduntil now with a standard thread lift techniquecould have benefits from this newprocedure of endo-laser soft lift, achievingFIGURE 1. Pre-operative view FIGURE 2. 4 moths after 1 pass of endolift