Using multiple wavelengths in order to improve the facial contouring procedure by the lipolysis and sculpting

The process of fat redistribution during aging is well‐known to fat accumulation toward inferior and medial areas of the face. Utilizing laser devices with simultaneous multiple wavelengths has been employed for fat lipolysis and body and facial sculpting.


| INTRODUC TI ON
As people age, the fat redistribution in their face tends to move downwards and toward the center, leading to an accumulation of volume in the lower part of the face.To address the concern of sagging fat and attempt its elimination (Figure 1), various lipolytic treatments have been employed. 1spite notable advancements in liposuction techniques, their widespread acceptance is still under scrutiny concerning safety and effectiveness. 2 To overcome these limitations, several noninvasive approaches have emerged as viable alternatives.
Several approaches have been developed, making use of advanced technologies like radiofrequency ablation, injection lipolytic agent, and high-intensity focused ultrasonography devices.These methods work by specifically targeting and damaging subcutaneous layer through the induction of coagulation or apoptosis of the adipocyte. 3,4Nonetheless, these devices offer various advantages compared to surgical approaches.Despite their benefits, the primary drawback associated with their use is the issue of pain.[7] In the pursuit of lipolysis and sculpting, delivering an appropriate amount of energy to the subdermis is crucial.Historically, the long-pulsed Nd-YAG laser has been frequently employed for this purpose, but its drawback lies in the potential risk of causing burns.
As a result, researchers are now investigating various laser treatments for lipolysis and sculpting that involve raising the temperature to a range of 65-70 degrees Celsius. 8An encouraging option is the triple-wavelength diode laser (755, 810, and 1064 nanometers), extensively employed for hair removal. 9is laser system provides various levels of penetration and the capability to target multiple depths simultaneously.The research focuses on the clinical application of facial contouring using a distinct laser known as multiple wavelengths laser based lipolysis and sculpting.The aim of the research is to evaluate the efficacy of laser-driven fat reduction therapy, taking into account both patient satisfaction and pain levels as important measures of success.

| PATIENTS AND ME THODS
The study is case series with enrolled 10 female participants (24-45 years old) with inclusion and exclusion criteria (Table 1) who visited a private dermatologic clinic in Korea and had no underlying inflammatory facial skin conditions.Lipolysis and sculpting treatment were conducted using a triple-wavelength laser (755, 810, and 1064 nanometers) device (Soprano Titanium, Alma, Israel) (Figure 2).
The laser had fluence of 4 J/cm 2 and a spot size of 20*9 mm 2 , with a frequency of 10 Hz and a total energy of 30 kJ.
The inclusion criteria for nasolabial fold severity ranged from mild to extreme, following Kopera et al., 10 and for jawline sagging, it ranged from mild to very severe, as per Pooth et al 11 The treatment direction primarily targeted the superior and lateral areas of the face, especially for the nasolabial fold and jowl fat approaching from the skin surface.Each participant underwent up to three treatments at 3-week intervals.The final evaluation has been conducted at month six from the first treatment.
Photographs were taken before and after the treatments and evaluated independently by two dermatologists using the GAIS, which provides a rating from 0 (no improvement) to 4 (excellent improvement).Additionally, participants' satisfaction levels were assessed on a scale from 1 (not satisfied) to 5 (very satisfied).
Throughout the treatment sessions, pain scoring and any side The superficial fat of the face tends to move downward and toward the center, leading to an accumulation of volume in the lower part of the face.Many different treatments aimed at reducing this sagging fat have been introduced.

Criteria Inclusion Exclusion
Age range effects were meticulously recorded, and the VAS score was utilized to quantify the degree of pain experienced.
In conjunction with the clinical photographs, the treatment's effectiveness was further analyzed using the Quantificare Mini Pro (Quantificare Inc., France) device, which utilizes an image analysis system to assess skin and volume changes.Furthermore, patient satisfaction surveys were administered to gather additional insights and feedback.

| RE SULTS
The study findings indicate that all patients (24-45 years old) experienced improvement in both subjective and objective measures.

| DISCUSS ION
Surgical liposuction is a procedure intended to remove localized or significant amounts of subcutaneous fat.Despite its effectiveness in eliminating excess and unwanted fat deposits, liposuction comes with potential risks and side effects.These include extended recovery periods, postoperative discomfort, infection risk, scarring, deep vein thrombosis, fat embolism, and adverse effects related to anesthesia. 2,12r these reasons, there is needs for nonsurgical treatments.
One such alternative is laser hyperthermia-induced lipolysis, which has gained popularity as a noninvasive option for fat reduction, especially in facial contouring.Using laser-based treatment have been extensively studied to ensure efficacy and safety in treating unwanted subcutaneous fatty layer, with the effectiveness of laser treatment believed to be influenced by delivering wavelengths of 1064 nm and 1320 nm. 13 The 1064-nm laser exhibits low scatter, enabling it to penetrate deeper into the tissue and achieve controlled heating in the subcutaneous layer.Laser therapy were initially employed to deliver energy The technique utilized to address the movement of fatty tissue involved a laser device emitting multiple wavelengths (755 nm, 810 nm, and 1064 nm).Initially intended for hair removal due to their effectiveness in targeting hair follicles, these wavelengths allowed most of the energy to enter the skin via the hair follicle and partially through the skin.The extended duration and repetitive pulses of the laser enabled deep penetration into the fatty tissue while also cooling the surface area.at wavelengths ranging from 900 nm to 1000 nm, effectively used for long-term hair reduction and treating vascular lesions.However, they faced limitations in efficiently and precisely targeting the chromophores in the focal fat area. 14Studies have demonstrated that the 1064-nm wavelength can achieve deeper tissue penetration than the 980 nm wavelength. 15e primary mechanism of the 1064 nm based laser involves generating heat, which results in localized acceleration of adipose cell F I G U R E 5 A 24-year-old woman who came to the clinic with concerns about sagging on the left side compared to the right side and asymmetry.She also underwent three sessions of triple-wavelength laser treatment.Her satisfaction level was rated as 4, and both dermatologists scored her results as 3 points.She mentioned that the contour of her face had been improved.Before the treatment (A) and 6 months after the treatment (B).A decrease of approximately 3.1 mm in depth broadly from the lateral portion of the face.

5, 4 ,
and 3 while two dermatologists assessed the Global Aesthetic Improvement Scale (GAIS) with an average score of 3, 3, 4, 3, 4, 3, 4, 4, 4, and 4 (Table2, Figures3-5).The visual analog scale (VAS) scores, which measure pain perception during the procedure, were consistently low, ranging from 1 to 3, suggesting that the treatment was bearable with minimal pain.With the three-dimensional analysis there were minimum of 1.1 mm-3.7 mm depth decrease in nasolabial fold and jowl sagging.Notably, no side effects were recorded during the treatment sessions demonstrating the safety of the treatment without any undesirable side effects or complications.Overall, the use of the multiple wavelength laser for facial contouring resulted in significant improvements in patients' conditions, high levels of satisfaction, and a favorable safety profile.

TA B L E 2
Individual satisfaction scores for each patient, along with the dermatologists' individual scores on the Global Aesthetic Improvement Scale (GAIS).

F I G U R E 3
A 38-year-old woman visited the clinic seeking assistance with prominent nasolabial folds and jowls.She underwent three sessions of triple-wavelength laser treatment.After the treatment, she rated her satisfaction level as 5, and both dermatologists graded her results as 4 points.Before the treatment (A) and 6 months after the treatment (B).A decrease of approximately 3.2 mm in depth from the labiomandibular line to the gonion was noticed in the jowl.F I G U R E 4A 31-year-old woman who visited the clinic due to issues with a prominent right nasolabial fold and asymmetry.She underwent three sessions of triple-wavelength laser treatment.Her satisfaction level was rated as 4, and both dermatologists gave her a score of 3 points.Before the treatment (A) and 6 months after the treatment (B).A decrease of approximately 2.8 mm in depth from the superior to nasolabial fold to the jowl.