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Treatment of Overweight Patients by Radiofrequency-Assisted Liposuction (RFAL) for Aesthetic Reshaping and Skin Tightening

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Treatment of Overweight Patients by Radiofrequency-Assisted Liposuction (RFAL) for Aesthetic Reshaping and Skin Tightening Aesth Plast Surg DOI 10.1007/s00266-011-9783-z ORIGINAL ARTICLE Treatment of Overweight Patients by Radiofrequency-Assisted Liposuction (RFAL) for Aesthetic Reshaping and Skin Tightening Dennis Hurwitz • Darren Smith Received: 3 January 2011 / Accepted: 13 June 2011 Springer Science+Business Media, LLC and International Society of Aesthetic Plastic Surgery 2011 Abstract the arms. The maximum vertical contraction was 15.7% for Background Patients with massive volume or skin laxity the abdomen, 7.4% for the thighs, and 3.3% for the arms. typically are not ideal candidates for liposuction treatment The average follow-up period was 13.3 months (range, due to the excess amounts o oose skin after the procedure. 3–26 months). The feasibility, safety, and efcacy of a novel radiofre- Conclusion The RFAL approach is a viable means of quency device (BodyLite system) for radiofrequency- energy-assisted liposuction for overweight and massive assisted liposuction (RFAL) were prospectively evaluated weight loss patients. Signicant volumes o at can be with overweight and weight loss patients. removed safely and eectively with improved contour and Methods In this study, 17 women with an average aspi- clinically signicant skin tightening. rated volume of 1,759 ml in the arms, abdomen, or thighs were treated. The treatment technique is described with the Keywords Radiofrequency Liposuction resulting weight, circumferential, and contraction mea- Skin tightening Body contouring surgery surements collected at a follow-up assessment after 6 and 12 weeks. Three-dimensional scanning was used to docu- ment volume changes in selected cases. Patient satisfaction Liposuction is a minimally invasive procedure intended also was recorded. Body contour and area tightening results primarily for healthy, younger, relatively t patients with were evident for all the patients, with high posttreatment rm elastic skin who are within 30% of their ideal weight satisfaction. Skin contraction was signicant at 6 weeks [1]. Patients who are overweight or older than 50 years and and continued past 12 weeks o ollow-up evaluation. those who have lost massive amounts of weight or exhibit Results On the average, after 12 weeks, patients had lost some skin laxity are suboptimal candidates for traditional 6.2% of their original abdominal circumference, 4.4% of liposuction. After reduction of their excess adipose tissue, their original thigh circumference, and 9.2% of their ori- they are likely to have further skin laxity, which creates ginal arm circumference. The mean vertical contraction was iatrogenic contour deformity. 7.9% for the abdomen, 3.6% for the thighs, and 2.4% for the For patients with considerably lax skin, the appropriate arms. The maximum results showed a circumference loss of approach is excisional surgery such as abdominoplasty or 16.5% for the abdomen, 11.4% for the thighs, and 17.7% for brachioplasty, which is far more extensive than liposuction, leaving long scars, which for some are unacceptable. Moreover, for the overweight or obese patient, abdomi- noplasty carries an increased risk of delayed wound healing D. Hurwitz ( & ) University of Pittsburgh Medical School, 3109 Forbs Avenue, and complications. For borderline conditions or patients Suite 500, Pittsburgh, PA 5213, USA who desire a less extensive operation, safe liposuction with e-mail: [email protected] some reliable contraction of skin and subcutaneous tissue has been an elusive goal. Ultrasonic and laser energies D. Smith University of Pittsburgh, 3109 Forbs Avenue, Suite 500, have been adapted to address these issues for the body- Pittsburgh, PA 5213, USA contouring patient with mild deformity2[, 3]. 123 Aesth Plast Surg Most recently, the destructive energies of radiofre- Brief case histories with photographs are provided to quency (RF) have been harnessed for liposuction, with demonstrate the aesthetic results in multiple views before some skin shrinkage 4[ ]. This prospective clinical study and after the study for each of the four groups. This report applied controlled RF to oversized, mildly loose-skinned, provides an in-depth description of the treatment technique. and massive weight loss (MWL) patients. Individuals who The outcomes for the 17 women are tabulated in Table1. do not qualify for RF-assisted liposuction (RFAL) include Men and women were recruited for the study. However, individuals with moderate to severely loose skin. the one man who started the study did not return for his follow-up treatment. Methods Device This report describes a subset of patients from one study Patients were treated in the areas of the torso, arms, or thighs site participating in pre–Food and Drug Administration using the BodyLite RFAL device. The BodyLite’s handpiece (FDA) investigational trials examining the clinical appli- is afxed with two electrodes to provide subdermal heating cation of RF-assisted lipoplasty using BodyLite and contraction. Radiofrequency energy is generated at a The inclusion criteria specied mild to moderate loose skin frequency of 1 MHz with a power range of 40 to 60 W. The with excess fat of patients who were overweight, had RF current travels between electrodes coagulating adipose sustained MWL, or had completed body-contouring sur- tissue and providing controlled heating of subcutaneous gery after MWL. The author reckoned that the patient collagenous tissue. The internal electrode, performing as would experience undesirable skin laxity after traditional both an energy source and a 3.9-mm-diameter liposuction liposuction. cannula, is inserted through a stab wound incision, and the The study was conducted under national institutional 3-cm disc-like external electrode is applied to the skin’s review board oversight (Essex Institutional Review Board, surface directly above the RF-emitting tip of the internal Inc, Lebanon, NJ; RAL 1, revised informed consent, May electrode (Fig. 1). During the procedure, the treatment 7, 2009). Each patient was given a number (1 to 17) and depth, RF power, and skin temperature are controlled. identied by age, weight, body mass index (BMI), site of treatment, amount o at aspirate, months o ollow-up Anesthesia and Tumescent Inltration evaluation, complications, fat volume, and skin laxity before and after treatment rated on a scale of 1 as the least All the treatments were performed with the patient under oral and 5 as the most change in circumference in terms of sedation (Vicodin ES and Keex 500 mg). Xanax (0.5–2 mg centimeters and comments. The comments were listed orally) and Toradol (60-mg injection) also were used in some along with a numeric patient rating of results as 1 (no cases. Patients sometimes reported intolerable heat in their improvement), 2 (minimal improvement), 3 (worthwhile treatment area, but their surface temperatures were not improvement), 4 (signicant improvement), and 5 (optimal higher than those of patients who did not complain. improvement). The typical superwet tumescent anesthesia used was Patient satisfaction was related to the subjective induced by infusing 100 ml of 1% lidocaine plus 1 ml of impression of the stability or reduction of skin laxity. Skin 1:1,000 adrenaline in 1,000 ml of Ringer’s lactate solution contraction was expressed as a percentage change betweeninto the treated area through the incision until the tissues the before and after measurements of the trunk circum- were turgid, with anticipation of removing 1 to 2 ml of ference times the vertical length of the anterior prole fatty emulsion for every milliliter o nfusion. (Table 1). Due to distinctly dierent clinical presentations, these Ultrasound Gel overweight patients were subdivided into four groups: group 1 (ageC 50 years, BMI C 27; patients 1–4), group Sterile ultrasound gel (Aquasonic 100; Parker Laboratories, 2 (age B 40 years, BMI C 27; patients 5–12), group 3 Inc, Faireld, NJ, USA) was used to hydrate the skin’s (MWL and body-contouring surgery with RFAL in areas surface to ensure better RF conductivity and smoother that had no previous surgery; patients 13 and 14), and movement of the external electrode. group 4 (MWL and body-contouring surgery with RFAL in areas that had previous surgery; patients 15–17). Selected Treatment Procedure patients were scanned using the Axis Three imager, (Axis Three, Boston, MA, USA) before and after their procedure, After attachment of the long electrical cord of the hand- with recording of changes in volume and area. piece to the slender and light computerized rolling power generator, the BodyLite machine was turned on, and the 123 Aest h Plas Table 1 Demographics, indications, and outcomes t Patient Age Weight BMI a Excess fat Total F/U Complication Fatb Lax c Circumferenced Vertical Area Patient satisfaction (1–5) and commentse Surg no. (years) (kg) and laxity aspirate (mos) reduction reduction volume (%) (%) (ml) 1 57 68.5 27.6 Trunk 1,800 9 None 4/2 3/2 –8 –15.75 –32.81 5. A 5-lb weight gain, smoothed wrinkled skin 2 59 88.9 37 Abdomen 2,000 6 Some nodules 5/4 3/3 ? 2 –0.81 3.03 3. Gained 8 lb, which reduced satisfaction 3 57 77.1 27.4 Arms 1,200 22 Swelling 3/1 3/2 –5.5 –3.28 –39.93 4. Right arm oversuctioned, with depressed areas, BMI now 23.4 4 58 74.4 26.5 Arms 300 7 Skin burns 2/1 5/4 –1 –1.60 –7.95 2. BMI down to 23.1, arms still loose, resolving red burn scars 5 39 62.1 27.8 Trunk 1,300 26 None 4/2 3/2 –8 –6.12 –28.46 5. Early lumpiness resolved 6 39 68.0 27.4 Trunk 2,300 7 Seroma, 5/2 4/3 –4 –13.46 –23.16 4. No suction, mildly uneven, scattered nodules catheterization 7 39 61.2 27.2 Abdomen 1,350 8 Seroma, 4/2 3/2 –7 –7.88 4.38 4.
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