Many doctors are claiming that laser liposuction causes skin contraction, tightening the skin from below, literally shrinking the skin safely. Somehow a burning hot laser below the skin reduces pain and therefore the need for unsafe general anesthesia. The boiling of tissues from below with the laser beam somehow makes recovery quicker. Old liposuction, dumb liposuction, does not use the laser and is therefore primitive and backward.
Should we be worried about tightening the skin from below with a red hot laser?
The blood supply to the skin consists of perforators, or blood vessels, coming from deep down, usually the muscle (musculocutaneous perforators) or sometimes through the fascia (fasciocutaneous perforators), from the deep artieries of the body, feeding into the skin. Plastic surgeons are very familiar with these perforators because they perform skin flaps which rely on their presence. If you kill the perforators, the skin dies. Skin can only "breathe" through these vessels, not through ambient air. Underneath the skin, there is a network of vessels which supply blood and oxygen to the skin. These vessels are located just below the skin in the subdermal plexus. They are critical to the blood supply of the skin. If you burn too many of them, the skin will scar, contract in a deforming manner, change color to a mottled blue appearance, and possibly die. What is the effect of a laser beam on perforating vessels? What is the effect of a laser beam on the subdermal plexus?
An experienced plastic surgeon will evaluate your skin elasticity and perform the liposuction conservatively enough so that excess skin is kept to a minimum. Claims of skin tightening with below the skin laser liposuction bring back bad memories of aggressive liposuction of the skin from below, a now disgraced technique. This technique did indeed cause skin tightening when it damaged the subdermal plexus, the blood supply to the skin, but also caused irreparable irreguarities and permanent changes in skin color. The scar tissue it formed simply deformed patients. In many patients who had aggressive subdermal liposuction, the entire arms now have a mottled cellulite appearance.
My patients will need to wait until the safety profile and effectiveness of laser liposuction are documented before I perform it on them given the checkered history of aggressive subdermal procedures in the past.
One telephone call, and any doctor with a medical degree and a pulse becomes a laser liposuction specialist. Patients should be aware of both sides of this coin, and of the underlying biology.
