Discussion of Preoperative Indications and Postoperative Complications following Laser-Assisted Lipolysis by Non–Plastic Surgeons

Abstract

Sir:FigureIt is tempting, if the only tool you have is a hammer, to treat everything as if it were a nail. —Abraham Maslow Although there has been extensive research of alternative methods to conventional liposuction,1 the Rohrich survey indicated that 89.5 percent of responding plastic surgeons still use suction-assisted liposuction, ultrasound-assisted liposuction, or power-assisted liposuction. However, with proper indications, laser-assisted liposuction can be a valuable tool for body contouring. The reported benefits2,3 for both the patient and provider, when combined with the increased safety of outpatient procedures,4 has caused laser-assisted liposuction to become an attractive procedure in the outpatient setting to specialties other than plastic surgeons. The ever-increasing demand for body contouring, and the addition of new providers, has resulted in an explosion in body contouring procedures. The 403,684 liposuction procedures performed in 2006 were a 128 percent increase from the number of procedures performed in 1997.5 Despite the purported benefits of laser-assisted liposuction, it must still be performed in the appropriate situation on the appropriate patient. In the absence of proper indications, unintended complications can result. The preoperative photograph of one patient who underwent laser-assisted liposuction by a specialist other than a plastic surgeon and subsequently experienced complications was evaluated for the presence of proper indications for laser-assisted liposuction (Figs. 1 and 2). As can be seen in the preoperative photograph, this patient had excess neck skin only and no excess fat. If a plastic surgeon—who has access to the entire range of treatments available—sees this patient in consultation, the patient would be offered a neck lift, either through direct anterior excision or through postauricular incisions. However, if you are not a plastic surgeon who wants to treat this patient's neck, you may choose the only technique that you offer, even if that technique is inappropriate.Fig. 1: Before laser-assisted liposuction.Fig. 2: Four months after laser-assisted liposuction by a non-plastic surgeon.Although there is well-documented disagreement over the role of laser-assisted liposuction in lipoplasty, it appears that laser-assisted liposuction has a role in body contouring but must be used from the perspective of appropriate indications and safety—as with all techniques. This case demonstrates a presenting condition that is not conducive to treatment with laser-assisted liposuction. In an effort to avoid complications borne out of the use of laser-assisted liposuction when not indicated, patients, doctors, and the industry must be educated as to the appropriate use of laser-assisted liposuction. It is not enough to provide a weekend course on how to use any one of the many laser-assisted liposuction products on the market. Physicians need extensive education on when laser-assisted liposuction is indicated, when it is not indicated, and how to mitigate complications when they do occur. This level of education cannot be undertaken in a minicourse without an underlying and fundamental knowledge of the soft tissues. The above outcome seeks to point out that this fundamental knowledge can be gained only through accredited fellowships or residencies such as those provided in plastic surgery. Cpt. Charles Sasser, B.A. Craig Blum, M.D. Jonathan Kaplan, M.D., M.P.H. Louisiana State University Health Sciences Center, Baton Rouge, La. DISCLOSURE The authors have no financial interest to declare in any of the products or devices mentioned in this article.