After 12 weeks, most patients (84.5%) showed an improvement greater than 50%. Mean chest circumference was significantly reduced from 109.6 ± 8.2 to 101.2 ± 4.4 cm12 weeks after LAL (p < 0.001). CT scans showed a significantreduction in mean breast thickness from 22.7 ± 3.2 to 15.6 ±2.4 mm (p = 0.016). Side effects (pain, edema, numbness andecchymosis) were minimal and disappeared shortly after thefirst manifestation. Gynecomastia can be safely treated with 1,444-nm Nd:YAG LAL to reduce fatty tissue and total breast volume.
Bromhidrosis is a disease presenting as malodor caused by interaction between the discharge of apocrine glands and bacteria. The main therapeutic modalities are applying topical agents, liposuction surgery, and elective surgery. Among these, elective surgery is reported to be most effective. However, the efficiency largely depends on surgical technique. Additionally, other side effects, such as hematoma and scarring, are occasionally reported. Currently, CO2 laser and 1,064 nm Nd:YAG laser therapy are used, but as the wavelength is not specific to apocrine glands, these laser therapies have certain limitations. Recently, a 1,444 nm wavelength Accusculpt™ laser (LutronicCorp., Seoul, Korea) has been developed which is now commonly used for facial fat plasty and laser liposuction therapy. The use of this laser for bromhidrosis therapy targeting apocrine sweat glands is currently being discussed. Still, no studies on practical clinical use and side effects of this 1,444 nm wavelength laser have been published. In this report, we treated one bromhidrosis patient with 1,444 nm wavelength Accusculpt™ laser therapy on one side while conventional surgery was performed on the other side using a modified Inaba's method. We compared the efficacy of this laser therapy to the surgical modality by measuring malodor severity and overall satisfaction by questionnaire. We also checked for other complications and recurrence for 12 months after the treatment. This patient was largely satisfied as it has a much shorter down time with the same therapeutic outcome. As subdermal coagulation treatment by 1,444 nm Nd:YAG laser may be less invasive but effective therapy, we would like to recommend this modality as a possible treatment option.
After 180 days of follow-up, malodor elimination was good in 20 axillae, fair in 12 axillae, and poor in four axillae. At the end point of the study, 14 patients were totally satisfied with the laser treatment, three patients were partially satisfied, and one patient was disatisfied. Pain and limitation of mobility were significantly reduced within 1 week post-operatively, and were almost resolved within 4 weeks post-operatively. A histopathological examination revealed decreased density and significant alterations to the apocrine glands. Subdermal coagulation treatment with a 1,444 nm Nd:YAG interstitial laser may be a less invasive and effective therapy for axillary bromhidrosis.
Many treatment modalities have been developed for axillary osmidrosis. It is well known that the surgical treatment has the best results. However, there is a high possibility of side effects. The 1,444-nm lipolysis laser has been recently introduced to remove the apocrine glands. So far, subdermal coagulation treatment with a 1,444-nm Nd:YAG laser may be the least invasive and most effective therapy for axillary osmidrosis. However, according to our previous experience, the recurrence rate was 20%~30%. This emphasizes the need for combination of surgical method and non-surgical method and we combined subcutaneous tissue removal and photothermocoagulation with a 1,444-nm Nd:YAG laser. Three patients for bilateral axillary osmidrosis were enrolled. After an incision of about one-third the length of the widest transverse diameter, the apocrine glands were separated from the skin. And then apocrine glands within the marked area were destroyed by irradiation with a 1,444-nm Nd:YAG laser thereafter. All patients exhibited no relapse of axillary osmidrosis and were satisfied with the treatment results. A combination of subcutaneous tissue removal and Interstitial laser photothermocoagulation with a 1,444-nm Nd:YAG laser could be an effective treatment for mild to moderate axillary osmidrosis.
All patients completed the study. Some degree of improvement was seen in the degree of cellulite in all patients, ranging from mild to very good. Although not specifically measured, thigh circumference decreased in most patients based on the clinical photography. Side effects were minimal and transient. A drop of around 1 grade was seen in average on the postoperative Nurnberger-Muller cellulite severity scale. Patients were in general satisfied with the results. The combination of ultrasound plus 1444 nm LAL for cellulite had reasonable to good results, which were better than ultrasound on its own based on the author’s previous experience. Further controlled studies should assess 1444 nm LAL as monotherapy, and attempt to establish the ideal protocol.
The 1,444-nm Nd:YAG laser effectively promoted clinical improvement of NLF and cheek laxity (p < .05). Significant differences in elasticity and roughness were observed (p < .05). Epidermal proliferation was stimulated as demonstrated by increases in epidermal thickness and Ki-67 expression (p < .05). Quantitative image analyses of pre- and post-treatment biopsies revealed that collagen fibers increased from baseline (p > .05). Transforming growth factor beta and heat shock protein-70 messenger RNA levels quantified using real-time reverse transcriptase polymerase chain reaction increased significantly from baseline (p < .05). The 1,444-nm Nd:YAG laser is an effective treatment modality with minimal complications for the treatment of NLF and cheek laxity, but further research with a larger group of patients is needed to confirm these findings.
Laser-assisted lipolysis is routinely used for contouring the body and the neck while modifications of the technique have recently been advocated for facial contouring. In this study, wavelength-dependence measurements of laser lipolysis effect were performed using different lasers at 1,064, 1,320, and 1,444 nm wavelengths that are currently used clinically. Fresh porcine skin with fatty tissue was used for the experiments with radiant exposure of 5-8 W with the same parameters (beam diameter = 600 μm, peak power = 200 mJ, and pulse rate = 40 Hz) for 1,064, 1,320 and 1,444 nm laser wavelengths. After laser irradiation, ablation crater depth and width and tissue mass loss were measured using spectral optical coherence tomography and a micro-analytical balance, respectively. In addition, thermal temporal monitoring was performed with a thermal imaging camera placed over ex vivo porcine fat tissue; temperature changes were recorded for each wavelength. This study demonstrated greatest ablation crater depth and width and mass removal in fatty tissue at the 1,444 nm wavelength followed by, in order, 1,320 and 1,064 nm. In the evaluation of heat distribution at different wavelengths, reduced heat diffusion was observed at 1,444 nm. The ablation efficiency was found to be dependent upon wavelength, and the 1,444 nm wavelength was found to provide both the highest efficiency for fatty tissue ablation and the greatest thermal confinement.
Laser lipolysis has a skin tightening effect by heating the deep dermis, in addition to the removal of fat tissues. The 1444-nm neodymium:yttrium–aluminum–garnet (Nd:YAG) laser has been expected to be more effective and safe for laser lipolysis, due to higher affinity to fat and water, than 1064-nm and 1320-nm wavelengths. The purpose of this study was to evaluate the skin tightening effect of the 1444-nm Nd:YAG laser through in vivo guinea pig models. The 1444-nm Nd:YAG laser was used to irradiate shaved dorsal skin of the guinea pigs and compared with controls (no power, only tunneling). Immediately, 1 week, 1 month and 3 months after laser administration, full-thickness skins were harvested and to evaluate dermal thickness, collagen organization, fibroblast proliferation, and intensity of elastic fibers and mucopolysaccharides, using hematoxylin–eosin, Massontrichrome, Verhoeff’s stain and Alcian blue stain. Dermal thickness showed an increase with time in all groups. In collagen organization, fibroblast proliferation, and intensity of elastic fibers and mucopolysaccharides, the treatment groups were higher than those of the control group, overall. Our study showed that the 1444-nm Nd:YAG laser appeared to be effective for the skin tightening effect in in vivo guinea pig models. The 1444-nm Nd:YAG laser can be used for skin tightening, as well as reduction of fat tissues.
Neurofibromatosis type 1 (NF-1) is an autosomal-dominant disorder of chromosome 17q11.2. Multiple cutaneous neurofibromas, one of the most characteristic clinical features, are mainly a cosmetic problem.1 Because of their sheer number and visibility, cutaneous neurofibromas are a major source of morbidity and psychological concern in NF-1, and most patients are willing to undergo removal of as many neurofibromas as possible. Although excision could completely remove the neurofibroma, it is time consuming and painful, and treatment of dozens of lesions at the same time is difficult.
Investigations of laser- or light-assisted antibacterial and antifungal treatments have been introduced. In the present study, we investigated the antifungal activities of 1,444-nm Nd:YAG lasers against onychomycosis by microbiologic analysis and scanning electron microscopy. Scraped toenails from 20 participants with mycologically-confirmed onychomycosis were prepared on polystyrene weighing dishes and treated with a 1,444-nm Nd:YAG laser. The samples were analyzed for the presence of colony-forming units (CFUs) and scanning electron microscopy was performed using an toenail treated with the 1,444-nm Nd:YAG laser. The mean reduction rate achieved by treatment with a total energy of 300J was 75.9% (range: 33.3-100), and by treatment with 450J was 85.5% (range: 66.7-100). However, the difference in CFU reduction rates between the laser settings of 300J and 450J was not significant. Analysis by scanning electron microscope revealed numerous disintegrated spores on the lower portions of the nail plate treated with the 1,444-nm laser, while the upper portion of the nail plate presented only a few small and greatly disintegrated fungal spores. Our results suggest that a Nd:YAG laser with a wavelength of 1,444-nm has antifungal effects on onychomycosis. However, further investigations should be performed to determine the long-term clinical and microbiologic effects of this treatment.
All patients successfully completed the study. Patient subjective satisfaction was high, and an objective clinician assessment from the clinical photography showed good efficacy. There were no major adverse side effects. Minor side effects were transitory, all resolved spontaneously and good results were maintained during a 2-3-month follow-up. The present study showed high efficacy for the 100 μs micropulsed Nd:YAG laser at 1444 nm for laser-assisted lipolysis of both body and facial areas, with no adverse side effects and virtually no downtime. The high absorption rate of 1444 nm in both fat and water, coupled with the 100 μs pulse, was believed to contribute highly to the success of the study and the satisfaction of the patients. Further larger studies are warranted.
The micropulsed 1444-nm neodymium-doped lipolysis laser exhibits favorable characteristics for novel application in facial contouring. The study described herein is the first clinical report of laser-assisted facial contouring (LAFC). We retrospectively reviewed records of 478 LAFC patients (mean age 52) who underwent contouring of 1278 individual mid- and lower facial treatment sites over 18 months. Along with clinical assessment, study parameters evaluated among "original" and "modified" (where protocol updates included deep dermal soft tissue coagulation as an optional step) protocol groups included laser power, pulse energy, and total energy delivery as well as lipoaspirate volume at each treatment site. Mean power and pulse energy were similar (within 5%) and total energy use was greater (70% higher for mid- and lower face) in the original protocol group. Lipoaspirate volume was similar for both groups for the midface (within 10%) but elevated in the modified protocol group for the lower face (40% higher). Treatment complications were observed in 47 of 363 treatment sites (13%) in the original and in 12 of 915 treatment sites (1%) in the modified protocol group with the majority (63%) of the complications comprising over- versus undercorrections of desired tissue contour. Clinical efficacy varied with improvements of mid- and/or lower facial contour ranging from marginal to subtle to very apparent. LAFC as detailed herein is a novel treatment modality that enables selective soft tissue removal for greater precision in three-dimensional contouring of the face. Protocol modifications based on laboratory and observed tissue photothermodynamics have improved LAFC safety.
A number of near-infrared wavelengths have been proposed and studied for laser lipolysis, but the histologic evaluation of tissue response to laser lipolysis during long-term follow-up has been lacking. A 1444 nm Nd:YAG laser with better absorption in both fat and water has recently attracted attention. The present study was designed to investigate the comprehensive histopathology of 1444 nm Nd:YAG laser-assisted lipolysis at different energy levels during a 3-month follow-up. Laser lipolysis was performed on porcine fat tissue in vivo using a 1444 nm Nd:YAG laser (AccuSculpt®, Lutronic Corporation, Ilsan, Republic of Korea) and the total energies delivered interstitially to 10x10 cm2 areas were 750 J, 1500 J, 2250 J, 3000 J, 3750 J, 4500 J, and 5250 J. Biopsy samples were taken and histologically analyzed immediately after biopsy and at 1, 2, 4, and 12 weeks postoperatively. With a fluence setting above 3000J/100 cm2, inflammation was severe and remained by the 3-month follow-up, resulting in severe scarring of the fat tissue. Below this energy level, mild lobular inflammation in the early phase biopsy had resolved with no scarring by the 3-month follow-up. No histologic changes in the epidermis or dermal connective tissue were present. This study suggested that controlling the energy level is important for clinical applications of laser lipolysis with no significant complications.
Digital mucoid cysts (DMCs), also known as ganglions or synovial cysts, are common tumors of the distal interphalangeal (DIP) joints.1 The most commonly involved sites of DMCs are the dorsal areas near the DIP joints and the proximal nail folds. DMCs contain translucent viscous fluid and are occasionally connected to the joint. Histologically, the cysts do not have an epithelial lining, and the cystic spaces are filled with mucinous stroma. DMCs can cause pain, cosmetic disfigurement, and nail deformities. Recently, the 1,444-nm Nd:YAG laser was developed for the purpose of lipolysis and skin rejuvenation.We hypothesized that the 1,444-nm Nd:YAG laser could serve as an effective mode of treatment for recurrent DMCs because it is highly absorbed by fat and water. Herein, we report two cases of relapsing DMCs successfully treated using the 1,444-nm Nd:YAG laser without recurrence.
The average period of follow-up was 12.3 months. Among the 25 patients presented during follow-up period, 22 patients (88%) had no recurrence. Two patients had partial recurrence and 1 patient had complete recurrence. Catheterized Nd: YAG laser assisted arthrotomy is considered to be an effective non-invasive method with a relatively low recurrence rate for the treatment of wrist ganglion.
The wavelength of 1444 nm is more highly absorbed in both fat and especially water than other near-IR wavelengths. When combined with a short pulse width,controlled heating is restricted to the tissue at, and adjacent to, the very end of the optical fiber, theoretically limiting the spread of secondary thermal damage. This phenomenon is termed thermal confinement. Facial contouring is thus achieved via collagen remodelling following neocollagenesis through the thermally- mediated wound healing process after lipolysis. Side effects and downtime are minimal, and the procedure is well-tolerated. Based on the results, facial contouring with 1444 nm offers a safe, effective and elegant solution for sagging of the lower third of the face.
Optimizing outcomes for rhytidectomy patients involves careful evaluation for conditions likely to benefit from adjunctive facial contouring and/or skin resurfacing procedures. On an individual basis, concurrent procedures should be performed only if benefits far outweigh any added risk and patient safety is not compromised. In this manner, physicians may improve practice productivity and overall patient satisfaction.
Based on the findings so far, this treatment of combining 1444nm Nd:YAG laser with suture suspension of sagging flap technique appears well suited for the treatment of Grade IIb and Grade III gynecomastia conditions. With growing interest in procedures requiring less downtime, minimal postoperative recovery period and optimal cosmetic outcome, the results of this pilot study suggest that laser-assisted liposuction using 1444nm laser in a larger cohort of gynecomastia patients warrants further study. If trained appropriately, this procedure could deliver good, reproducible results safely and successfully.
With enhanced targeting of the desired chromophore (adipocyte lipid content) and greater efficiency compared to earlier generation lipolysis lasers, the novel AccuSculpt™ 1444 nm lipolysis laser enables safe targeting of small volumes of fat in areas where tissues are delicate and the likelihood of undesirable secondary collateral thermal injury might otherwise be high. In addition, when non-adipose structures may be the main target (eg, water content in collagen in deep reticular dermis/upper subcutis) the superior specificity of this laser system enables rapid heating and lysis of structures in this tissue plane (eg, during flap elevation or release of deep dermal scars) with low energy requirements and short lasing times. These concepts have been safely and very successfully extended to new concepts in facial rejuvenation. In appropriate patients, minimally invasive subregional contouring of the melolabial fold and jowl via laser lipolysis with the AccuSculpt™ 1444 nm neodymium-doped laser is an attractive alternative to facelift, midface lift, mini-facelift, filler injections of the melolabial fold, midface filler injections, prejowl sulcus filler injections, autologous fat injections and various implant procedures. Minimally invasive subregional contouring of the face with the AccuSculpt™ laser is a great adjunct for concurrent treatment of heavy melolabial folds or jowls during facelift procedures and is a novel treatment option for certain patients with facial hemiparesis and related asymmetry. This procedure has also enabled improvement or “salvage” of mild, moderate or severe ptosis of the melolabial fold or jowl that may remain after rhytidectomy procedures. A modification of the technique that enables release of dermal attachments safely decreases the subsequent effort necessary to elevate skin flaps during rhytidectomy procedures and demonstrates the possibility of another useful treatment modality for deep, refractory acne scarring. Lutronic has elected to use the term AccuLift™ to refer to these new procedures. The AccuSculpt™ laser and the AccuLift™ procedures have changed the way that I envision and practice aesthetic facial rejuvenation.
A marked reduction in fat volume and more oil vacuoles and giant cells in histology were identified with the 1,444nm wavelength compared to the 1,064nm wavelength. Human fat in the in vitro experiments also revealed more oil production following the use of the 1,444nm laser. The 1,444nmNd:YAGlaser showed a greater lipolytic effect compared to the 1,064nmNd:YAG laser in in vivo minipig and in vitro human fat experiments. To achieve a full understanding of the effects of 1,444nm Nd:YAG laser lipolysis on the human body, in vivo experimentation will be necessary. Lasers Surg. Med. 41:721–727, 2009. 2009 Wiley-Liss, Inc.
As the first FDA approved device using a 1444 nm wavelength laser, AccuSculpt from Lutronic, Inc. (Princeton Junction, N.J.), photo-acoustically emulsifies fat, enabling easier removal during liposuction. This method facilitates a more aesthetically pleasing silhouette for patients regardless of where their trouble spots may be. AccuSculpt, offering laser-assisted liposuction, represents a step forward in body shaping technology. According to Daniel Man, M.D., a plastic surgeon in private practice in Boca Raton, Fla., the novel idea of using lasers for body shaping was derived from Italy and South America just before the turn of the century. “With less invasive and less traumatic alternatives to liposuction being the trend, the original idea was to use laser energy to emulsify adipose tissue beneath the surface, without mechanical removal, letting bodily processes remove the fat naturally,” he said. “However it did not work well. In the worst cases treatment produced lumpiness and patients were unhappy with their results. We realized that emulsified fat needs to be removed with suction in order to maximize outcomes.
The aim of this study was to evaluate wavelength dependence for laser-assisted lipolysis using a mathematical simulation. In this study, a Monte Carlo simulation was performed to simulate light transport in fat and dermal tissue with 3 different laser wavelengths (λ = 1064 nm, 1320 nm, and 1444 nm) that are currently used in clinic settings for laser-assisted lipolysis. The relative rates of heat generation versus penetration depth showed that the greatest amount of heat generation was seen in the tissues at λ = 1444 nm. This Monte Carlo simulation may help lend insight into the thermal events occurring inside the fat and dermal tissue during laser-assisted lipolysis
Optical Coherence Tomography (OCT) is an important noninvasive medical imaging technique that can reveal subsurface structures of biological tissue. OCT has demonstrated a good correlation with histology in sufficient resolution to identify morphological changes in articular cartilage to differentiate normal through progressive stages of degenerative joint disease. Current OCT systems provide individual cross-sectional images that are representative of the tissue directly under the scanning beam, but they may not fully demonstrate the degree of degeneration occurring within a region of a joint surface. For a full understanding of the nature and degree of cartilage degeneration within a joint, multiple OCT images must be obtained and an overall assessment of the joint surmised from multiple individual images. This study presents frequency domain three-dimensional (3-D) OCT imaging of degenerative joint cartilage extracted from bovine knees. The 3-D OCT imaging of articular cartilage enables the assembly of 126 individual, adjacent, rapid scanned OCT images into a full 3-D image representation of the tissue scanned, or these may be viewed in a progression of successive individual two-dimensional (2-D) OCT images arranged in 3-D orientation. A fiber-based frequency domain OCT system that provides cross-sectional images was used to acquire 126 successive adjacent images for a sample volume of <TEX>6×3.2×2.5????????36×3.2×2.5mm3</TEX>. The axial resolution was <TEX>8????????8μm</TEX> in air. The 3-D OCT was able to demonstrate surface topography and subsurface disruption of articular cartilage consistent with the gross image as well as with histological cross-sections of the specimen. The 3-D OCT volumetric imaging of articular cartilage provides an enhanced appreciation and better understanding of regional degenerative joint disease than may be realized by individual 2-D OCT sectional images.