| Backgroud"God has given you one face, and you make yourselves another"-----Shakespeare writed in《Hamlett.》the third chapter,writing the pursuit of beauty from ancient times to today:People have never stopped on the ideal of shaping their own another face diligently. In the Warring States period, Song Yu described the beauty in the "Dengtuzi Lust Fu":the master, by one of the points was too long, by one of the points was too short; powder was white, taking blusher was red; eyebrow was like the kingfisher, skin was white as snow; waist such as beam elements, white and even teeth. From the looks of the martial arts novels to the modern plastic surgery, facial beauty is the eternal pursuit of mankind!A beauty in her old age, the neck is a woman’s second face! With the aging of the human body, will bone absorption occurred, muscle atrophy and hypertrophy, absorption, translocation and redistribution of fat tissue, skin light damage and solar elastosis, soft tissue from the surface of bone sag, the accumulation in the lower part, neck, upper limbs and abdomen, deformation bagged appear site and "double chin". Aesthetic parameters with the age changing, reduces the sense of three-dimensional face, make the face and neck contour fuzzy, old bi. Human skeletal morphology has been fixed in the adult stage, muscle tissue has formed a little change. Fat soft coverage on the bones and muscles, forming a contour line of the typical human and undulating lines, texture and aesthetic sense of the amount produced. Fat is the biggest change in adult human tissues, number of little change in fat cells, changes of pregnancy and ovarian endocrine level, make fat cell size and distribution of the human body have undergone tremendous changes, body concave and convex curve of S Meizhi, ups and downs smooth will deformation of shape, size, bloated obesity and imbalance will be completely destroyed the body contour shape. Body contour is mainly shaped by fat and muscle fat, which is the dominant, body shaping is mainly fat shaping. At present the world popular "lunch" beauty, minimally invasive cosmetic demand for the creation of the United States has put forward higher requirements, but also put forward new call for the traditional plastic method, the new method allows us to seek a body contouring a minimally invasive, safe and effective for the rapid.Fat and skin in shallow face, shaped body shape. With the aging, of light damage and solar elastosis will result in the loss of collagen and elastin, makes the body (especially the face and neck skin aging). Facial plastic surgery including chemical peeling, dermabrasion, laser, microwave, electric therapy, cryotherapy, injection therapy, all kinds of plastic surgery face lift. The skin is the target tissue of hormone, estrogen and androgen receptors with,the subcutaneous fat cells contain aromatase, the conversion of androgens to estrogens, thighs, abdomen and buttocks aromatase activity. There are sites and different period of estrogen regulation on it. Fat contains linoleic acid and linolenic acid and other unsaturated fatty acids on the skin nourishing effect, can increase the skin smooth and delicate texture, adjust the facial activity, shaping the curvaceous female facial characteristic. Fat is one of the target tissue contours of the face and neck. Facial fat, thin and dense, fibrous septum fat cells are wrapped into fat lobule, deformation ability than other cells, the volume can be expanded by10-1000times, not proliferation, with the same volume of striated muscle compared with more abundant blood supply, each fat cells is connected with at least a capillary, which is beneficial to the absorption or release of lipid. In the ischemia and inadequate nutrition condition can release intracellular lipid, inversion of fat cells. This structure makes the face and neck fat soluble form than other parts require higher carved to create ideal facial contour. We tried to find a new minimally invasive method can also solve the aging skin and fat can mediate the body contour integral shaping.Laser skin resurfacing began in the70’s of the last century, the first use of carbon dioxide laser equipment of continuous wavelength. From the early90’s of last century, in the United States under the support of FDA Apfelberg and other5doctors began to dissolve fat role focuses on the research of laser, such as Goldman, Badin found that laser is fat soluble firming, less bleeding, less postoperative ecchymosis, the theoretical system of laser lipolysis slowly mature. But because the laser equipment limitations, not suitable for laser lipolysis, fat dissolving once made little progress laser makes no importance, plastic surgeon. At present, with the development of laser equipment, laser lipolysis is becoming mature, in Europe and Latin America laser lipolysis technology has been widely applied.924/975,980,1064,1064/1320,1440,1470nm wavelength is at present the most fat dissolving equipment laser. The wavelength of visible light in the range of400～770nm wavelength of electromagnetic waves, different, cause sensation of human eyes of different colors,662～770nm of human feeling into the red light. The laser wavelength dissolved fat fat equipment as infrared wavelength, the wavelength is1470nm in the infrared wavelength, due to highly selective absorption of fat and water, the laser absorption coefficient of well over980, and10641320nm wavelength, the hemoglobin absorb less melanin, and no absorption, so it has a unique advantage safety and effectiveness of fat soluble firming. Laser is a kind of electromagnetic wave, with parallel resistance, high strength, good monochromaticity and coherence characteristics, is an important technology in the early nineteen sixties, is regarded as one of the four great inventions of twentieth Century (laser, semiconductor, atomic energy and computer). The biological effect of laser on human tissues:photothermal effect, mechanical effect of light, light pressure effect, photoelectric magnetic effect, photochemical effect, biological effect, cavitation phenomena and jet-Reflection flow phenomenon, Raman scattering and Brillouin scattering, pressure and shock wave effect. In the aspect of laser lipolysis, photothermal effect plays the main role, followed by the stimulation effect of light mechanical effect and biological. In the aspect of plasma laser lipolysis, in addition to the above mechanisms, pressure and the effects of shock wave, cavitation phenomena and jet-flow phenomenon is the dominant mechanism of reflection. Water and biological pigment particles of fat, melanin, melanin in biological tissue, and hemoglobin, myoglobin and carotene absorption effects of different wavelength laser. Laser irradiation on the biological tissue, because of its wavelength, intensity, working mode, the exposure time of the different parameters, can exhibit different biological effects; but the biological tissue, due to absorption and heat transfer characteristics of irradiated parts of the laser reflection, different, different parameters in laser action can have different biological effects the. The main biological effect of infrared laser wavelength is:1、Selective photothermal effect:laser is the essence of the electromagnetic wave, if the vibration frequency is equal to the frequency and the organization of molecules or similar, will enhance the vibration and rotation of organization of molecules, the molecular vibration which produce heat mechanism, so called thermal vibration, manifested on the local temperature increase. The visible and infrared spectral region (1470nm for mid-infrared) long pulse (pulse width is in milliseconds) and continuous wave laser effects on biological tissue, the main mechanism of biological material change is caused by heat production. Tissue absorption of laser radiation, light energy into heat energy, make the local temperature, when the tissue temperature exceeds45℃, and lasted for more than1minutes, will cause cell protein denaturation, cell damage. Thermal effect of potassium sodium electrolyte balance changes both within and outside the cell, the extracellular fluid can be free to transfer into cells; high energy make fat cells produce irreversible damage, cells undergoing coagulative and liquefactive necrosis, rupture of membranes, esterase by intracellular overflow; at the same time, gasification, dissolved organizations, collagen fibers and solidification vascular. Close relationship between thermal effect and the scope and duration of exposure. Short, high temperature and long time, low temperature can cause tissue damage, exposure duration is shorter than the second, even when the temperature rose to70℃, still can be tolerated; exposure lasted for more than10seconds, the temperature rise to58℃, the organization will be destroyed. Because the laser pulse duration is short, the thermal conductivity of biological tissue is poor, instantaneous heat could spread to the irradiated sites outside of the reason, the laser damage and normal tissue of the worlds edge is clear. After irradiation, the secondary changes, such as inflammation, bleeding, regeneration, will make the original clear damage boundary edge gradually become blurred. Concrete can be divided into the following categories:A, overheating reaction:cell irreversible death changed without changing the whole structure for organ. B, solidification:organization not burn, only showed necrosis. C, evaporation: intracellular water absorption after being heated, turns into steam, thousands of times larger cell size, cell wall rupture, steam escape. D:when a local water evaporation finished, component temperatures continue to rise to300-500℃, tissue charring occurs dry necrosis, the formation of black charcoal. E, combustion:local temperature rises to500℃began burning. F, gasification:local temperature up to573℃, all components can be gas from the gasification of solid, high-speed emitted from the skin leaving sag. Adult facial and neck99%white fat, lipid components60-80%,90-99%is three TQ water5-30%, protein2-3%. Lipids with myristic acid, palmitic acid, stearic acid, palmitic acid, oleic acid, linoleic acid, containing more unsaturated fatty acids, low melting point, fluidity big, the temperature drops and liquid. Thermal effect of tissue is usually a combination of several complex superposition effect, can be treated can cause thermal damage, so in different tissues and parts of the treatment needs we choose different wavelength of laser to achieve the desired therapeutic effect, and the side of the surrounding tissue with reduced to a minimum. The wavelength of1470nm has the superiority in the fat soluble firming properties, thermal effect of target is the first fat (subcutaneous fat), followed by water (subcutaneous fat, fascia and skin), biological effects of accumulated in the first three stages, only cell death, evaporation, no organization carbonization, is fat soluble firming wavelength is very ideal.2.Light mechanical action:four target tissues of human action of laser is:water, fat, hemoglobin (red), melanoma, in which water and fat is fat soluble and favorable factors, hemoglobin and melanin is a competitive disadvantage fat melting. Melanin and hemoglobin as the wavelength increases the absorption of light by gradually reduced, the wavelength is1470nm in infrared wavelengths, the absorption of fat and water absorption of high selectivity, hemoglobin and melanin is less, basically not absorption. Theory of the wavelength of the absorption coefficient between adipose tissue and surrounding tissue is different, so the damage range is small, the operation accuracy is high, coagulation, or multiple pulse can produce high in the local energy density, direct destruction of adipose tissue, plays of light mechanical action. In fact, a high degree of aggregation selective photothermal effect determines the optical mechanical effect of it, according to the laser power density, the mechanical effect of1470nm laser in the operation area is cutting and tissue water vaporization resulting in volume expansion pressure increases, and organize the inherent tension was separated and the formation of incision; B, gasification technique-tissues in an instant evaporation, drying, collagen tissue also occurred partially cross-linked solidification. In the laser soluble tissue lipid moulding process of water vaporization resulting in volume expansion pressure increased, fat cells after absorbing the laser instantaneous volume increases, deformation until the burst, cell content leakage between cells apoptosis and potentially irreversible, and the inherent tension tissue and separated and the formation of incision. The laser like this is a sophisticated operation knife, while fat fragments can suck or metabolism, and fat dissolving temperature has no obvious change. Laser1470nm laser melting fat body shaping is mainly confined to the cutting range; because the fat cells containing unsaturated fatty acid, less water, fat melting point below the water, so the gasification phenomena weak, no carbonization technique, so as to avoid the adverse effects, increase the safety of operation.3. Pressure and shock wave effects:focused laser beam at the focal point of the energy in a short period of time can be converted into heat energy, then with irradiated tissue material evaporation, heat expansion and tissue fluid from liquid to gas phase transition known as the two pressure, this effect by shock waves generated in the organization to supersonic speed of movement, causing cavitation in tissue, causing tissue damage, is one of the causes of laser tissue interaction. 4. The photochemical effect:when the photon energy to biological macromolecules, disconnect the weak bond is greater than the required energy, a chemical reaction occurs. The condition is:A, low light power density (low intensity); B, a longer exposure time. The clinical typical application in photodynamic therapy (PDT), intravascular low intensity laser irradiation and laser irradiation.5. Biological effect:after injury fiber repair reaction--photothermal effect produce collagen, elastin instant self shrinkage and bonded with each other cross-linking reach3D tightening fibrous septum (fascia, ligament) and skin. The skin is I and III collagen, normal ratio is about4:1. The repair reaction occurred after laser stimulation, the body to produce a variety of inflammatory factor, stimulates the formation and remodeling of local collagen, the skin elastic tightening fascia:stimulation of synthesis and covalent cross-linking of collagen, fibrosis after3weeks treatment area, collagen synthesis and degradation of collagen has leveled off, number of little change, structure adjustment become the theme similarly, artificial ligaments, resulting in long-term three-dimensional tightening effect. This process of different length up to2years, gene, age, location and aseptic inflammation reaction time and patient duration.In Europe and Latin America laser soluble lipid technology has been widely used, in vitro, will happen with Nd:YAG laser of1064nm wavelength in human fat tissue specimens:1, cell membrane rupture, cell gasification and liquefaction;2, collagen tissue carbonization and small vascular occlusion;3, with tissue repair, can obviously observed collagen and skin shrinkage. Compared with the traditional liposuction, laser lipolysis of edema after light, less bleeding, rapid recovery, skin collagen, make skin tightening makes operation smooth and soft, the effect is better than the traditional liposuction operation 6, Raman scattering and Brillouin scattering:refers to the weak strength under light, a molecular absorption of photons by stimulation, part of light energy into heat energy, small part of phosphorescent or fluorescent radiation form again, for accelerating the chemical reaction. Brillouin scattering is inelastic scattering, is due to the refraction of light through a medium when the rate of nonuniform generation, will cause the photon frequency increases or decreases, only produced in the shock wave is obvious.7. Cavitation phenomenon, jet and inverse jet phenomenon:refers to the physical phenomenon with the liquid laser at breakdown. Laser and soft tissue containing more water and liquid met, liquid material after a series of expansion, contraction and rebound, solid wall and body surface is met, vacuoles in the collapse phase will produce high-speed jet and inverse jet phenomenon, thereby increasing the peripheral tissue injury.Research status at home and abroadAt present, with the development of laser equipment, laser lipolysis is becoming mature, in Europe and Latin America laser lipolysis technology has been widely applied.924/975,980,1064,1440,1444,1064/1320,1470nm wavelength is at present the most fat dissolving equipment laser. The wavelength of visible light in the range of400～770nm,662～770nm of human feeling into the red light. The laser wavelength dissolved fat fat equipment as infrared wavelength, the wavelength of the infrared wavelength near1450, relative to other wavelength due to highly selective absorption of fat and water, laser absorption coefficient is far more than980and1064,1320nm wavelength, the hemoglobin absorb less melanin, and no absorption, so it has the unique advantages of safety and effectiveness of fat soluble firming. In Europe and Latin America laser soluble lipid technology has been widely used, in vitro, will happen with Nd:YAG laser of1064nm wavelength in human fat tissue specimens:1, cell membrane rupture, cell gasification and liquefaction;2, collagen tissue carbonization and small vascular occlusion;3, with tissue repair, can obviously observed collagen and skin shrinkage of. Compared with the traditional liposuction, laser lipolysis of edema after light, less bleeding, rapid recovery of, skin collagen, make skin tightening makes operation smooth and soft, the effect is better than the traditional liposuction operation.Serge Mordon histological study showed:980nm wavelength treatment area of body fat in laser display fracture micrograph:fat cell membrane, collagen fibers and blood coagulation, can tighten the skin, reduce intraoperative hemorrhage.In the2010domestic study with Italy DEKA1064nmNd:YAG laser for laser melting on lipid of pig animal model:fat:laser caused the degeneration and necrosis of immediate and long-term effective destruction of pig fat cell, light irradiation after the formation of pits and voids, the surrounding tissue with black carbon phenomenon. After1weeks of inflammatory cells with morphological integrity, number of fat cells less residue, fibroblast hyperplasia; in January after the fat lobules irregularly, collagen fiber hyperplasia, hyperplasia of fibroblasts. The small blood vessels and collagen fibers:the fat melting process, at the same time, solidification of the small blood vessels, reduce bleeding, reduce the damage to the body, may reduce the incidence of complications. The laser to collagen fiber shrinkage, condensation, in long-term promote collagen regeneration and reorganization, to tighten the loose organization, improves skin elasticity. Nerve:in6W power irradiation length of a neural2S LCM, diameter of about1.5mm case, cause local epineurium and perineurium rupture, melting, solidification, so that part of the nerve fiber degeneration, axonal and myelin breakdown. Most of the nerve membrane integrity, a part of the nerve fiber degeneration. Most of the nerve fiber not damaged obviously, influence on the whole of the nerve conduction function is limited.Conclusion:1064nmNd:YAG laser liposuction compared with the traditional negative pressure liposuction, laser melting fat has the following advantages:the amount of bleeding is reduced; the effect of uniform, postoperative skin without obvious uneven; formation, can stimulate the local collagen, increase skin elasticity; the operation is labor-saving; the nerve damage is not obvious; the trauma small, fast postoperative recovery, and low complication rate. Treatment of the method is suitable for small range or dense parts, but also suitable for common liposuction after local uneven improvement.Now there is no1470nm wavelength laser lipolysis in basic and clinical experiments reported.Objectives1. Animal experiment with Italy Eufoton company to provide980nm,1470nm semiconductor laser and observe its biological effects of an isolated pork fat, fascia, skin, blood vessels and muscle, to observe the change of gross changes and microscopic, comparison of two kinds of wavelength fat dissolving efficiency and safety.2. Clinical trials, with Italy Eufoton company to provide1470nm semiconductor laser:holistic neck, on surface of upper limbs and abdominal striae of pregnancy were fat, skin and fascia, aims to observe human biological reaction, the effectiveness of the equipment and safety, and explore the equipment operation, clinical effect of body fat soluble firming contouring operation the operation skills, indications, matters needing attention and the end of therapy. Materials and methods1,Animal experiment:the death of fresh4hours structure and uniform distribution of in vitro porcine specimens, comprising skin, fat and muscle tissue. Provided by the Italy Eufoton980,1470nm semiconductor laser device using0.6mm intrusive, ordinary optical fiber test, microscopic observation of changes in the set parameters after laser irradiation and gross changes of radiation of pork samples and parts.2、Clinical trials from June2012to december2012:collected in December30cases, age distribution below, all female, the148face and neck treatment area (cheek, nasolabial folds pouch, bilateral each meter into1treatment zone), cheek30cases,25cases and25cases of chin, stretch marks, decree pattern20cases,15cases of forehead wrinkles, bags under the eyes of18cases,15cases of butterfly sleeve. To dissolve fat, enhance and wrinkles with Italy Eufoton1470nm semiconductor intrusive laser under the set parameters, observation the changing after the reaction and the facial contour. Treatment parameters and follow-up parameters through the test of normality, with P>0.1for statistical significance.Results1、The fat efficiency solution of980nm continuous wavelength under different power:6W,12W power can not dissolve fat, by20W fat dissolving without carbonization, skin was hot, the temperature was over42℃, fat dissolving efficiency:4.717×10-5cm3/S.2、The fat efficiency solution of1470nm continuous wavelength:6W can efficiently dissolve fat, no carbonization, skin was warm, temperature was38.6℃, fat dissolving efficiency:6.663×10-3cm3/S. 3、Effect of980,1470nm wavelength on the skin, muscle:1.5,1.8W power,200J,250J laser energy were applied to excised fresh pig skin treatment area, skin slightly thickened, color white, the skin was warm. Muscle tissue surface hoar, no traces of carbonation.4、Microscopic changes:in the high-power electron microscope observation of laser action before and after the fat, fascia, skin, blood vessels and muscle.Fat:980nm wavelength of6W can only make the cell degeneration;12W can only make the cell necrosis, reducing the little number of cell;20W can dissolve fat, reducing the number of fat cells.1470nm wavelength of6W fat cells:the number cells decreased significantly.Fascia:two wavelengths were fat cell fibrous septa between the fascia was crosslinked thickening, hyalinization.Skin:two wavelengths were observed before and after laser irradiation dermis collagen cross-linking immediately obvious thickening and hyalinization, no skin structure damage. Compared with250J energy and200J energy, collagen cross-linking thickening, hyaline degeneration is more significant, no skin structure damage.Vascular:two wavelengths were observed before and after laser irradiation in adipose tissue of small vascular hyalinization and tube wall thickening, stenosis, occlusion (irreversible).Muscle:muscle fiber structure without damage, muscle fascia tightening, fiber distance.5、The clinical experiment:laser lipolysis firming rhytidectomy surgery only minimal bleeding or no bleeding, preoperative and postoperative effect contrast, shaping beautiful, patient satisfaction in the148treatment. Satisfaction degree was 83.3～96%, complication was reversible chronic granulomatous swelling, there was no any long-dated complication.Conclusion1470nm laser because of its optical characteristics, determines the efficiency of dissolving fat is higher than980nm wavelength, while reducing the risk of heat injury.1470nm semiconductor laser can effectively fine intrusive dissolved and emulsified fat, hemostatic, fatty shaping, lifting the lifting effect, safe, accurate, uniform treatment, minimally invasive, easy; hemostasis, enhance wrinkle fill and improve the shortcomings of traditional methods, in body contouring, restore the body of young of open up fast, minimally invasive the effectiveness and safety of clinical application of the new method. |
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