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detached and irrigated until clear and then reat-
tached to the same syringe and the procedure
continued. If the syringe becomes filled with air,
the seal at the syringe hub may need to be tight-
ened or the percutaneous entry point may be too
close to the treatment area. If the latter is the
case, the procedure can usually continue with
gentle manual occlusive pressure placed over
the entry point area. Any air in the syringe can be
gently expelled but with care to not also expel
any fat already aspirated at this point. At the end
of the lipoaspiration, the fat aspirate volume (less
1.0 mL from sterile saline prefilling) from each
side is recorded in the treatment record. Mean vol-
umes removed during unilateral lower face LAFC
treatment approximate 2.5 mL in 2 studies, with
ranges extending from 0.5 mL to more than
5.0 mL.
1,7
Table 3
outlines major LAFC treatment
steps and typical treatment parameters.
Initially, the aspiration cannula should be more
superficial (immediately subcutaneous), with ports
directed down. Effective debulking in areas of
maximal subcutaneous tissue thickness, however,
generally requires guiding the cannula into these
areas at a deeper level. Although contrary to
what has been an accepted tenet for traditional
cold liposuction techniques, it is permissible and
often helpful to remove some of the immediately
subcutaneous fatty tissue adherent to the under-
surface of the skin by using the lipoaspiration can-
nula with the ports directed upward toward the
undersurface of the dermis. It is the author’s belief
that failure to do so may limit the facial contour,
related skin contraction, and the ultimate result
obtained.
Immediately after treatment, a compression
dressing is applied that consists of 1 or 2 layers
of 1-inch–thick roll cotton and a compression
garment (eg, Universal Facial Band, Design Vero-
nique, Richmond, CA, USA). The wound is evalu-
ated the next day and the cotton is removed but
patients are encouraged to wear the compression
garment as much as possible for at least 1 week
after treatment. Patient expectations must be
carefully managed during the recovery and
extended post-treatment period (as described
previously).
Fig. 3
depicts before and long-term
(>2 years) clinical photography following LAFC of
the mid- and lower face as well as laser-assisted
neck contouring.
INTERSTITIAL ND:YAG FIBER LASER–
ASSISTED NECK CONTOURING
Interstitial Nd:YAG fiber LANC may be performed
as a stand-alone percutaneous neck contouring
procedure. Appropriate patient selection should
include those with mild to moderate fullness in
the submentum and neck with accumulated sub-
cutaneous fatty tissue in these areas but without
excessive skin laxity. Patients with skin laxity but
Table 3
Major LAFC treatment steps and typical treatment parameters
LAFC Treatment Step
Detailed Information
Field block
a
Include percutaneous access point and target tissue
Infiltrate target tissue
a
3 mL each LAFC treatment area (21-gauge multihole infiltration cannula)
Apply laser energy
Up to 200 J midface; up to 400 J for jawline
Typical laser treatment parameters 5.4 W, 180 mJ, 30 Hz
Postcooling (thermal
quenching)
Infiltrate 3-mL room temperature sterile saline (21-gauge multihole
infiltration cannula)
Aspiration
Mean 2.5 mL (19-gauge dual port aspiration cannula attached to 6-mL
syringe prefilled with 1.0-mL saline)
Compression
Roll cotton and elastic compression garment
a
Local anesthetic mixture contains 0.5% lidocaine, 0.25% Bupivacaine hydrochloride, 1:200,000 epinephrine, and 2 IU
hyaluronidase per mL.
Fig. 2.
LAFC instrumentation. (
Top
) 21-Gauge multi-
hole infiltration cannula attached to 6-mL syringe
containing 3-mL local anesthetic solution. (
Middle
)
600-
m
m Bare laser fiber with red diode aiming beam
visible (
left
) and 18-gauge needle (
right
). (
Bottom
)
19-Gauge dual port aspiration cannula attached to
6-mL syringe prefilled with 1.0-mL sterile saline.
Fiber Laser in Aging Face and Neck