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tissue while actively lasing during LANC—this
facilitates even distribution of laser energy and
limits the potential for clinical thermal confinement
failure. Some latitude exists with regard to energy
delivery and treatment parameters but the author
suggests that surgeons proceed with caution
with energy delivery totals exceeding 1000 J dur-
ing LANC with these settings. At higher total en-
ergy delivery settings, the neck skin may become
slightly to noticeably warm. Immediately after
energy delivery, a similar volume (eg, 12 mL) of
room temperature sterile saline is infiltrated into
the treatment area.
Removal of emulsified tissue and liquefied fat via
manual lipoaspiration with a 2.1-mm offset triple
port aspiration cannula (Tulip) and a 12-mL
syringe (prefilled with 1-mL sterile saline) enables
definitive tissue contouring.
Fig. 4
depicts the full
minimal instrumentation requirement for LANC.
Use of the Tulip Snap Lok facilitates efficient lip-
oaspiration while allowing a surgeon to focus on
tissue contouring. As with performing LAFC, the
aspiration cannula may well become blocked
during lipoaspiration, so the blockage must be
cleared, as discussed previously, and the proce-
dure continued. If the syringe becomes filled with
air, then the same remedies can be applied as
described previously, taking care not to 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) is recorded in
the treatment record.
Initially, the aspiration cannula should be more
superficial (immediately subcutaneous) with the
ports directed down. Effective debulking in areas
of maximal subcutaneous tissue thickness, how-
ever, generally requires guiding the cannula into
these areas at a deeper level. Using a gentle tech-
nique, it is helpful to remove some of the
immediately subcutaneous fatty tissue adherent
to the undersurface of the skin by using the lipoas-
piration cannula with the ports directed upward to-
ward the undersurface of the dermis. Generally a
yellow or orange emulsion of subcutaneous fatty
tissue is obtained. Depending on the volume of lip-
oaspirate, a second syringe may be needed to
complete the procedure. The lipoaspiration
portion of the procedure concludes when the
desired tissue contour is achieved or when the
emulsified fat aspirate return wanes or becomes
blood tinged.
Persistent dermal to platysma fibrous attach-
ments may represent a potential limiting factor
with regard to the ability of the neck skin to
adequately contract. After the lipoaspirate is ob-
tained, the cannula is used in a sweeping motion
to manually avulse any remaining fibrous attach-
ments that may limit appropriate repositioning of
the skin. Occasionally it may be necessary to tran-
sition the percutaneous LANC procedure to an
open LANC procedure. If significant submental
fullness is still evident, then a submental incision
may be needed for direct evaluation for platysma
muscle laxity and ptosis, bulky fat adherent to un-
dersurface of the skin flap, and excess subplatys-
mal fatty tissue—if present, these findings are
addressed surgically.
Immediately after treatment, a compression
dressing is applied in a similar manner as for
post-LAFC with a layer or 2 of thick cotton and a
compression garment. The wound is evaluated
the next day and the cotton is removed, but pa-
tients are encouraged to wear the compression
garment as much as possible for at least 1 week af-
ter treatment. Patient expectations must be care-
fully managed during the recovery and extended
post-treatment period, as described previously.
Fig. 5
shows interim results (3 months) in a patient
with substantial submental fullness and skin laxity.
INTERSTITIAL ND:YAG FIBER LASER–
ASSISTED FACE AND NECK LIFT—TREATMENT
METHOD
Adjunctive use of the thermally confined micro-
pulsed 1444-nm Nd:YAG interstitial fiber laser
during face and neck lift surgery involves incorpo-
ration of the LAFC and LANC procedures where
indicated with additional use of the laser for devel-
opment of skin flaps and for lysis of osseocutane-
ous anchoring ligaments in the mid- and lower
face. It should be appreciated that the jowl may
encompass a significant volume of tissue above
and below (with aging) the caudal margin of the
mandible and that the jowl position may change
significantly with patient positioning for facial
Fig. 4.
LANC instrumentation. (
Top
) 1.6-mm Tulip mul-
tihole infiltration cannula attached to 12-mL syringe
containing local anesthetic solution. (
Middle
) 60-
m
m
Bare laser fiber with red diode aiming beam visible
(
left
) and 18-gauge needle (
right
). (
Bottom
) 2.1-mm
Tulip triple port (ports offset or nonaxial with only 1
port showing) aspiration cannula attached to 12-mL
syringe prefilled with 1.0-mL sterile saline (Tulip
Snap Lok not shown).
Holcomb