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					Agnieszka Protasewicz MD,
  PhD, Poznan, Poland


 Laser lipolisis – new method of
        body contouring
Dubai Congress on Anti-Aging & Aesthetic Medicine
         7-9 November 2008 Dubai, UAE
Overweight and obesity
      definition
                                   •Overweight and obesity are defined as
                                   abnormal or excessive fat accumulation
                                   that presents a risk to health.
                                   •WHO’s latest projections indicate that
                                   globally in 2005:
                                   •approximately 1.6 billion adults (age
                                   15+) were overweight;
                                   • at least 400 million adults were obese.
                                   •WHO further projects that by 2015,
                                   approximately 2.3 billion adults will be
                                   overweight
                                   • more than 700 million will be obese.

                                        Dubai Congress on Anti-Aging & Aesthetic Medicine, 7-9 November 2008 Dubai, UAE



Agnieszka Protasewicz - Laser lipolisis – new method of body contouring
Overweight and obesity
      definition
                        BMI is defined as a weight in kg
                         divided by the square of the heigh
                         in meters(kg/m2)

                        BMI>25=overweight
                        BMI>30 obese




                                        Dubai Congress on Anti-Aging & Aesthetic Medicine, 7-9 November 2008 Dubai, UAE



Agnieszka Protasewicz - Laser lipolisis – new method of body contouring
                 Overweight and obesity
                                                                       •Aesthetic trends about body
                                                                       shapes may change, but one fact
                                                                       is immutable: obesity is a health
                                                                       risk.
                                                                       •Overweight and obesity are
                                                                       major risk factors for a number
                                                                       of chronic diseases, including
                                                                       diabetes, cardiovascular diseases
                                                                       and cancer.

Venus de Milo Leonardo da Vinci Museum Louvre
                                                                          Dubai Congress on Anti-Aging & Aesthetic Medicine, 7-9 November 2008 Dubai, UAE
Venus of Willendorf, from Austria. c. 25,000 - 20,000 BCE Limestone,

                            Agnieszka Protasewicz - Laser lipolisis – new method of body contouring
                   Liposuction
Lipoplasty
Fat modeling
Liposculpture
Fat modeling
Suction lipectomy
Suction assisted fat removal

                                               Dubai Congress on Anti-Aging & Aesthetic Medicine, 7-9 November 2008 Dubai, UAE



      Agnieszka Protasewicz - Laser lipolisis – new method of body contouring
             Liposuction
                                         1926-Charles Dujarier.A tragic case that
                                         resulted in gangrene in the leg of the patient
                                         a procedure performed
                                          late 1960s - United States Leon Forrester
                                         Tcheupdjian using primitive curetage
                                         techniques which were largely ignored, as
                                         they achieved irregular results with
                                         significant morbidity and bleeding.
                                         1982-Dr Yves-Gerard Illouz in a
                                         presentation by the The "Illouz Method"
                                         featured a technique of suction-assisted
                                         lipolysis after infusing fluid into tissues
                                         using blunt cannulas and high-vacuum
                                         suction and demonstrated both reproducible
                                         good results and low morbidity.
                                  Rubens, Pieter Paul (1577-1640)
                                  Bachus 1638-1640
                                           Dubai Congress on Anti-Aging & Aesthetic Medicine, 7-9 November 2008 Dubai, UAE



Agnieszka Protasewicz - Laser lipolisis – new method of body contouring
             Liposuction
                                         1985, Klein and Lillis - "tumescent
                                         technique", which added high volumes of
                                         fluid containing a local anesthetic allowing
                                         the procedure to be done in an office setting
                                         under intravenous sedation rather than
                                         general anesthesia. Concerns over the high
                                         volume of fluid and potential toxicity of
                                         lidocaine with tumescent techniques
                                         eventually led to the concept of lower
                                         volume "super wet" tumescence.
                                         In the late 1990s, ultrasound was introduced
                                         to facilitate the fat removal by first
                                         liquefying it using ultrasonic energy



                                  Rubens, Pieter Paul (1577-1640)
                                  Three graces 1639
                                           Dubai Congress on Anti-Aging & Aesthetic Medicine, 7-9 November 2008 Dubai, UAE



Agnieszka Protasewicz - Laser lipolisis – new method of body contouring
             Liposuction
                                          According to the American Society
                                          of Aesthetic Plastic Surgeons
                                          (ASPS,) the number of liposuction
                                          procedures performed in the United
                                          States was 4
                                          56,828 during 2007, the most current
                                          year for which statistics exist.
                                          This figure represents 4 percent of
                                          the 11.7 million plastic surgery
                                          procedures done in 2007 and an
                                          increase of 13.2 percent over
                                          liposuction cases performed in 2006.

                                  Rubens, Pieter Paul (1577-1640)
                                  The Union of Earth and Water. 1618
                                            Dubai Congress on Anti-Aging & Aesthetic Medicine, 7-9 November 2008 Dubai, UAE



Agnieszka Protasewicz - Laser lipolisis – new method of body contouring
         Laser lipolisis
                                        Laser-assisted lipolysis ( Laser lipoplasty,
                                        lipolaser) with a medium-pulsed 1064-
                                        nanometer neodymium-doped yttrium
                                        aluminum garnet (Nd:YAG) system is a new
                                        FDA-approved method (2006) of removing
                                        localised areas of fat with the added benefit
                                        of skin tightening.
                                        This method was widely used in Europe and
                                        Latin America, has recently been introduced
                                        in Poland.
                                         Photo mechanical action by heating and
                                        rupturing cell membranes of adipocytes
                                        disrupts the fat which one can be easily
                                        aspired.



                                         Dubai Congress on Anti-Aging & Aesthetic Medicine, 7-9 November 2008 Dubai, UAE



Agnieszka Protasewicz - Laser lipolisis – new method of body contouring
       Laser lipolisis -
indications/contraindications




                                             Dubai Congress on Anti-Aging & Aesthetic Medicine, 7-9 November 2008 Dubai, UAE



    Agnieszka Protasewicz - Laser lipolisis – new method of body contouring
       Laser lipolisis -
indications/contraindications




                                    Bernini, Gianlorenzo
                                    Truth (La Verita)1646-52, White marble
                                               Dubai Congress on Anti-Aging & Aesthetic Medicine, 7-9 November 2008 Dubai, UAE



    Agnieszka Protasewicz - Laser lipolisis – new method of body contouring
 Laser lipolisis – before the
          procedure
Examination
Preparations
Aproaches




                                               Dubai Congress on Anti-Aging & Aesthetic Medicine, 7-9 November 2008 Dubai, UAE



      Agnieszka Protasewicz - Laser lipolisis – new method of body contouring
Laser lipolisis – the procedure
 Tumescent anaesthesia
 Technique of laser lipolisis




                                                Dubai Congress on Anti-Aging & Aesthetic Medicine, 7-9 November 2008 Dubai, UAE



       Agnieszka Protasewicz - Laser lipolisis – new method of body contouring
Laser lipolisis- safety
                                         Burk RW,Guzman-Stein G,Vasconez, LO Lidocaine and
                                         epinephrine levels in tumescent technique liposuction. Plast and
                                         Reconstr. Surg 1996;97:1379-1384

                                         Butterwick KJ, Goldman MP, Sriprachya-Anunt S. Lidocaine
                                         levels during the first two hours of infiltration of dilute anesthetic
                                         solution for tumescent liposuction:rapid versus slow delivery.
                                         Dermatological Surg. 1999;25:681-685

                                         Hanke CW, Bullock Berntein G.Current status of tumecent
                                         liposuction in the United States: National Survey Results.
                                         Dermatological Surg. 1996;22;595-598

                                         Klein Tumescent technique for regional anesthesia permits
                                         lidocaine doses of 35mg/kg for liposuction. Journal of
                                         Dermatological Surg in Oncology 1990;16;248-263

                                         Ostad A,Kageyama N,Moy RL. Tumescent anesthesia with
                                         lidocaine dose of 55 mg/kg is safe for liposuction.Dermatological
                                         Surgery 1996;22:921-927




                                          Dubai Congress on Anti-Aging & Aesthetic Medicine, 7-9 November 2008 Dubai, UAE



 Agnieszka Protasewicz - Laser lipolisis – new method of body contouring
         Laser lipolisis
                                  •    Marks
                                  •    Aproaches
                                  •    Anasthaesia
                                  •    Energy




                                         Dubai Congress on Anti-Aging & Aesthetic Medicine, 7-9 November 2008 Dubai, UAE



Agnieszka Protasewicz - Laser lipolisis – new method of body contouring
    Laser lipolisis – results -
      histological findings

                                                                        The histopathologic examination of adipose tissue
                                                                        after laser lipolysis showed cell swelling and less
                                                                        bleeding, as compared with the traditional method.
                                                                        The morphometric analysis showed that the mean
                                                                        diameter of the major adipocyte was 95.69 microm
                                                                        with laser lipolysis using 1,000 J (in), 82.63 microm
                                                                        using 3,000 J (in), and 84.54 microm with the
                                                                        traditional method The traditional method produced
                                                                        less reversible cellular damage (swelling) than laser
                                                                        lipolysis using 1,000 J (in). The area receiving 3,000
                                                                        J (in) showed major irreversible damage
                                                                        (cytoplasmatic retraction and disruption of
                                                                        membranes). For this reason, the mean diameter of
                                                                        the adipocyte was less.

–   Badin, Moraes, Gondek, Chiaratti,Canta, Laser lipolysis: flaccidity under control.Aesth.Plast.Surg :26:335-339,2002

–   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. Aesthetic Plast Surg. 2005;29:281–286.
                                                                       Dubai Congress on Anti-Aging & Aesthetic Medicine, 7-9 November 2008 Dubai, UAE



            Agnieszka Protasewicz - Laser lipolisis – new method of body contouring
Laser lipolisis – results -
  histological findings




                                              –     Goldman, A. Submental Nd:Yag laser-assisted liposuction.
                                                    Lasers Surg Med. 2006;38:181–184. doi: 10.1002/lsm.20270.
                                           Dubai Congress on Anti-Aging & Aesthetic Medicine, 7-9 November 2008 Dubai, UAE



  Agnieszka Protasewicz - Laser lipolisis – new method of body contouring
Laser lipolisis – results -
  histological findings




                          –   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;36:43–
                              46. doi: 10.1002/lsm.20118.
                                                 Dubai Congress on Anti-Aging & Aesthetic Medicine, 7-9 November 2008 Dubai, UAE



  Agnieszka Protasewicz - Laser lipolisis – new method of body contouring
Laser lipolisis – results - MRI
           findings




  –   Kim, KH; Geronemus, RG. Laser lipolysis using a novel 1,064 nm Nd:YAG Laser. Dermatol Surg. 2006;32:241–48; discussion 247.


                                                                     Dubai Congress on Anti-Aging & Aesthetic Medicine, 7-9 November 2008 Dubai, UAE



             Agnieszka Protasewicz - Laser lipolisis – new method of body contouring
     Laser lipolisis- mathematical
                 model
                                     Figure 3
                                     video recording of a laser lipolysis procedure inside the
                                     submentum. Conventional and infrared video recordings are
                                     performed simultaneously

                                     Figure 4
                                     infrared video recording of a laser lipolysis procedure inside
                                     the submentum (right) and mathematical modeling performed
                                     of a specific area (green square of submentum of the patient).



Mordon S R, Wassmer B, Reynaud JP, Zemmouri J. Mathematical modeling of laser lipolysis Biomed Eng Online.2008 Feb
29;7:10




                                                                                   Dubai Congress on Anti-Aging & Aesthetic Medicine, 7-9 November 2008 Dubai, UAE



                            Agnieszka Protasewicz - Laser lipolisis – new method of body contouring
     Laser lipolisis- mathematical
                 model
     to compare two different lasers used for laser lipolysis: a 1064 nm Nd:YAG laser and a 980 nm diode laser

     In patients, when using cooled tumescent anesthesia, 1064 nm Nd:YAG laser or 980 nm diode laser: (6 W, back and forth motion: 100 mm/s)
     give similar skin surface temperature (max: 41 degrees C).

     The fat reduction depends on the applied energy, typically 5 cm3 for 3000 J. At last, skin retraction was observed in patients at 6-month follow
     up. This observation can be easily explained by mathematical modeling showing that the temperature increase inside the lower dermis is
     sufficient (48-50 degrees C) to induce skin tightening Laser lipolysis can be described by a theoretical model.

     Fat volume reduction observed in patients is in accordance with model calculations.

     Due to heat diffusion, temperature elevation is also produced inside the lower reticular dermis.
     This interesting observation can explain remodeling of the collagenous tissue, with clinically evident skin tightening.In conclusion, while the heat
     generated by interstitial laser irradiation provides stimulate lipolysis of the fat cells, the collagen and elastin are also stimulated resulting in a
     tightening in the skin.

     This mathematical model should serve as a useful tool to simulate and better understand the mechanism of action of the laser lipolysis.




Mordon S R, Wassmer B, Reynaud JP, Zemmouri J. Mathematical modeling of laser lipolysis Biomed Eng Online.2008 Feb
29;7:10




                                                                                       Dubai Congress on Anti-Aging & Aesthetic Medicine, 7-9 November 2008 Dubai, UAE



                             Agnieszka Protasewicz - Laser lipolisis – new method of body contouring
Laser lipolisis – side effect,
  possible complications
Bruising
Swelling
Pain
Allergic reaction
Infection
Skin burn
Skin necrosis
Lidocaine toxicity
Seroma
                                                Dubai Congress on Anti-Aging & Aesthetic Medicine, 7-9 November 2008 Dubai, UAE



       Agnieszka Protasewicz - Laser lipolisis – new method of body contouring
   Laser lipolisis – training
Doctors
Surgeons, dermatologists




                                               Dubai Congress on Anti-Aging & Aesthetic Medicine, 7-9 November 2008 Dubai, UAE



      Agnieszka Protasewicz - Laser lipolisis – new method of body contouring
                  Laser lipolisis
14 months - 160 patients (268 areas) has been treated with
the laser lipolisi technique in two centres of aesthetic
medicine.


Skin and subcutaneous fat were irradiated with the pulsed
Nd:YAG laser 1,064 nm laser at 40 Hz and 150 mJ and
100 microseconds-long pulses were used. Power 6-10 W –
depending on the area which one was treated.


                                                  Dubai Congress on Anti-Aging & Aesthetic Medicine, 7-9 November 2008 Dubai, UAE



         Agnieszka Protasewicz - Laser lipolisis – new method of body contouring
                 Laser lipolisis

First group were treated only with laser lipolisi 115 person.



To improve the result I combined this technique with
lymphatic massage (endermologie) which one was
performed 7-10 days after the procedure and the group
which one undergo this combined treatment consist of 45
patients.

                                                 Dubai Congress on Anti-Aging & Aesthetic Medicine, 7-9 November 2008 Dubai, UAE



        Agnieszka Protasewicz - Laser lipolisis – new method of body contouring
                 Laser lipolisis
133 woman, 27 man
Age 23-58 average 37




                                                 Dubai Congress on Anti-Aging & Aesthetic Medicine, 7-9 November 2008 Dubai, UAE



        Agnieszka Protasewicz - Laser lipolisis – new method of body contouring
                 Laser lipolisis
Area treated most often
Lower and upper abdomen 40%
Chin and cheeks 20%
Love handles, thighs, banana fold, trochanderic area -5-7%
Knee, arms,back -2-5%
ankles,calves, gynecomastia -1%




                                                 Dubai Congress on Anti-Aging & Aesthetic Medicine, 7-9 November 2008 Dubai, UAE



        Agnieszka Protasewicz - Laser lipolisis – new method of body contouring
                Laser lipolisis




3500J, 6W, 40Hz, 150ms
1-before
2-10 weeks after procedure
                                                Dubai Congress on Anti-Aging & Aesthetic Medicine, 7-9 November 2008 Dubai, UAE



       Agnieszka Protasewicz - Laser lipolisis – new method of body contouring
         Laser lipolisis
                                        2x3500j, 6W,
                                        150ms, 40Hz 180mg
                                        Lignocainum
                                        1-before
                                        2-8 weeks after
                                        procedure

                                         Dubai Congress on Anti-Aging & Aesthetic Medicine, 7-9 November 2008 Dubai, UAE



Agnieszka Protasewicz - Laser lipolisis – new method of body contouring
         Laser lipolisis
                                        left-6000j, rirht-
                                        6000j, 8W, 150ms,
                                        40Hz 160mg
                                        Lignocainum
                                        1-before
                                        2-6 weeks after
                                        procedure
                                         Dubai Congress on Anti-Aging & Aesthetic Medicine, 7-9 November 2008 Dubai, UAE



Agnieszka Protasewicz - Laser lipolisis – new method of body contouring
                  Laser lipolisis
After 3 months self assessment evaluations reported higher
rate of improvement in second group.


Any changes in patients weight has been noticed, 85%
loose more than 5 cm, and noticed impovement. % 5 was
not satisfied with the treatment the improvement was
insufficient or not noticed by them.


There is a sharp learning curve for this procedure.

                                                  Dubai Congress on Anti-Aging & Aesthetic Medicine, 7-9 November 2008 Dubai, UAE



         Agnieszka Protasewicz - Laser lipolisis – new method of body contouring
                 Laser lipolisis
My study showed that the laser lipolisis appeared
to be effective technique for destruction of human
fat tissue, also for the reduction of the cellulite, and
improving tone of the skin.




                                                 Dubai Congress on Anti-Aging & Aesthetic Medicine, 7-9 November 2008 Dubai, UAE



        Agnieszka Protasewicz - Laser lipolisis – new method of body contouring
                 Laser lipolisis
This procedure can be used for the treating areas
typically unsuitable for traditional liposuction.
Laser-assisted lipolysis is the technique for delicate
body sculpturing in the submental region but also
for gynecomastia abdominal region, flanks, and
hips and smoothing asymmetry after liposuction.



                                                 Dubai Congress on Anti-Aging & Aesthetic Medicine, 7-9 November 2008 Dubai, UAE



        Agnieszka Protasewicz - Laser lipolisis – new method of body contouring
                Laser lipolisis
It is a precise method, and the advantages include
excellent patient tolerance, quick recovery time,
skin tightening,- and safety, procedure is less
traumatic than the conventional liposuction.




                                                Dubai Congress on Anti-Aging & Aesthetic Medicine, 7-9 November 2008 Dubai, UAE



       Agnieszka Protasewicz - Laser lipolisis – new method of body contouring
                                               References
  * Apfelberg, DB; Rosenthal, S; Hunstad, JP; Achauer, B; Fodor, PB. Progress report on multicenter study of laser-assisted liposuction. Aesthetic Plast Surg.
1994;18:259–264. doi: 10.1007/BF00449791. [PubMed]

   * Prado, A; Andrades, P; Danilla, S; Leniz, P; Castillo, P; Gaete, F. A prospective, randomized, double-blind, controlled clinical trial comparing laser-assisted
lipoplasty with suction-assisted lipoplasty. Plast Reconstr Surg. 2006;118:1032–1045. doi: 10.1097/01.prs.0000232428.37926.48. [PubMed]

  * Goldman, A. Submental Nd:Yag laser-assisted liposuction. Lasers Surg Med. 2006;38:181–184. doi: 10.1002/lsm.20270. [PubMed]

   * 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. Aesthetic Plast Surg. 2005;29:281–286. doi: 10.1007/s00266-004-0102-9. [PubMed]

   * Mordon, S; Eymard-Maurin, AF; Wassmer, B; Ringot, J. Histologic evaluation of laser lipolysis: Pulsed 1,064nm Nd: YAG laser versus CW 980nm diode
laser. Aesthetic Surgery Journal. 2007;27:263–268. doi: 10.1016/j.asj.2007.03.005.

  * Kim, KH; Geronemus, RG. Laser lipolysis using a novel 1,064 nm Nd:YAG Laser. Dermatol Surg. 2006;32:241–48; discussion 247. [PubMed]

  * 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;36:43–46. doi: 10.1002/lsm.20118. [PubMed]

  * Iizuka, MN; Vitkin, IA; Kolios, MC; Sherar, MD. The effects of dynamic optical properties during interstitial laser photocoagulation. Phys Med Biol.
2000;45:1335–1357. doi: 10.1088/0031-9155/45/5/317. [PubMed]

  * Mohammed, Y; Verhey, JF. A finite element method model to simulate laser interstitial thermo therapy in anatomical inhomogeneous regions. Biomed Eng
Online. 2005;4:2. doi: 10.1186/1475-925X-4-2. [PubMed]

  * Moussa, NA; Tell, EN; Cravalho, EG. Time progression of hemolysis or erythrocyte populations exposed to supraphysiologic temperatures. J Biomech Eng.
1979;101:213–217.

  * Pearce, J; Thomsen, S. Rate process analysis of thermal damage. Thermal reponse of laser irradiated tissue. Welch AJ. , editor. New York, USA , Plenum
Press; 1995.

  * Choi, B; Welch, AJ. Infrared imaging of 2-D temperature distribution during cryogen spray cooling. J Biomech Eng. 2002;124:669–675. doi:
10.1115/1.1517276. [PubMed]

  * Lowe, P; Lowe, NJ. 3D Photography and lip filler: A novel assay . Journal of Cutaneous Laser Therapy. 2007;9

                                                                                          Dubai Congress on Anti-Aging & Aesthetic Medicine, 7-9 November 2008 Dubai, UAE



                          Agnieszka Protasewicz - Laser lipolisis – new method of body contouring
                                              References
   * Muccini, JA, Jr.; O'Donnell, FE, Jr.; Fuller, T; Reinisch, L. Laser treatment of solar elastosis with epithelial preservation. Lasers Surg Med. 1998;23:121–
127. doi: 10.1002/(SICI)1096-9101(1998)23:3<121::AID-LSM1>3.0.CO;2-R. [PubMed]

   * Mordon, S; Capon, A; Creusy, C; Fleurisse, L; Buys, B; Faucheux, M; Servell, P. In vivo experimental evaluation of skin remodeling by using an Er:Glass
laser with contact cooling. Lasers Surg Med. 2000;27:1–9. doi: 10.1002/1096-9101(2000)27:1<1::AID-LSM1>3.0.CO;2-V. [PubMed]

  * Badin, AZ; Moraes, LM; Gondek, L; Chiaratti, MG; Canta, L. Laser lipolysis: flaccidity under control. Aesthetic Plast Surg. 2002;26:335–339. doi:
10.1007/s00266-002-1510-3. [PubMed]

  * Dai, T; Pikkula, BM; Wang, LV; Anvari, B. Comparison of human skin opto-thermal response to near-infrared and visible laser irradiations: a theoretical
investigation. Phys Med Biol. 2004;49:4861–4877. doi: 10.1088/0031-9155/49/21/002. [PubMed]

  * Bashkatov, AN; Genina, EA; Kochubey, VI; Tuchin, VV. Optical properties of human skin, subcutaneous and mucous tissues in the wavelength range from
400 to 2000nm. J Phys D: Appl Phys. 2005;38:2343–2355. doi: 10.1088/0022-3727/38/15/004.

  * Ichikawa, K; Tanino, R; Wakaki, M. Histologic and photonic evaluation of a pulsed Nd:YAG laser for ablation of subcutaneous adipose tissue. Tokai J Exp
Clin Med. 2006;31:136–140.

  * Salomatina, E; Jiang, B; Novak, J; Yaroslavsky, AN. Optical properties of normal and cancerous human skin in the visible and near-infrared spectral range. J
Biomed Opt. 2006;11:64026. doi: 10.1117/1.2398928.

  * Giering, K; Lamprecht, I; Minet, O. Specific heat capacities of human and animal tissues: San Jose, CA, USA. Meier GPDRWSLOSHATH. , editor. Vol.
2624. SPIE; 1996. pp. 188–197.

  * Valvano, J. Tissue thermal proerties and perfusion. In: Welch A. , editor. Opitcal-thermal response of laser irradiated tissue. New York, NY, USA , Plenum
Press; 1995.Maida M.M, Mencarelli What is Interstitial Laser Lipolisis

  * Badin, Moraes, Gondek, Chiaratti,Canta, Laser lipolysis: flaccidity under control.Aesth.Plast.Surg :26:335-339,2002

   * Aguilar, G; Majaron, B; Pope, K; Svaasand, LO; Lavernia, EJ; Nelson, JS. Influence of nozzle-to-skin distance in cryogen spray cooling for dermatologic
laser surgery. Lasers Surg Med. 2001;28:113–120. doi: 10.1002/lsm.1025. [PubMed]Burk RW,Guzman-Stein G,Vasconez, LO Lidocaine and
epinephrine levels in tumescent technique liposuction. Plast and Reconstr. Surg 1996;97:1379-1384
                                                                                         Dubai Congress on Anti-Aging & Aesthetic Medicine, 7-9 November 2008 Dubai, UAE



                          Agnieszka Protasewicz - Laser lipolisis – new method of body contouring
                                         References
 Butterwick KJ, Goldman MP, Sriprachya-Anunt S. Lidocaine levels during the first two hours of infiltration of dilute anesthetic solution for
tumescent liposuction:rapid versus slow delivery. Dermatological Surg. 1999;25:681-685

Hanke CW, Bullock Berntein G.Current status of tumecent liposuction in the United States: National Survey Results. Dermatological Surg.
1996;22;595-598

Klein Tumescent technique for regional anesthesia permits lidocaine doses of 35mg/kg for liposuction. Journal of Dermatological Surg in
Oncology 1990;16;248-263

Ostad A,Kageyama N,Moy RL. Tumescent anesthesia with lidocaine dose of 55 mg/kg is safe for liposuction.Dermatological Surgery
1996;22:921-927




                                                                                Dubai Congress on Anti-Aging & Aesthetic Medicine, 7-9 November 2008 Dubai, UAE



                       Agnieszka Protasewicz - Laser lipolisis – new method of body contouring
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