**10.2 Laser-assisted liposuction**

In addition to VASER and RFAL, another modality that utilizes energy for adipocyte lysis prior to aspiration and offers a degree of skin tightening is Laser-assisted liposuction (LAL). Multiple systems are marketed that utilize 1064 nm Nd:YAG, 1320 nm Nd:YAG, and 980 nm diode lasers conducted via an optical fiber within a cannula and placed in direct contact with adipose tissue. The laser produces photomechanical and photothermal effects that result in adipocyte lysis, small vessel coagulation, dermal coagulation, and subsequent neocollagenesis [36, 37]. While to our knowledge there are no published reports that directly compare VASER to LAL, a similar amount of skin retraction could be achieved with LAL (between 11 and 17%) [36, 37]. There are some limitations to the use of LAL: Since absorption of laser energy results in adipocyte rupture and death, this technique eliminates potential harvest of viable fat cells that can be utilized for fat grafting [36]. There is also a steep learning curve associated with LAL. Duration of laser activity in tissues is variable and affected by tissue thickness and volume as well as overall treatment size, previous scarring and fibrosis, and skin laxity. Loss of resistance denotes adipocyte lysis and is utilized as an endpoint. Surgeons must be vigilant to avoid excessive energy build up at the fiber tip that can rapidly build up and result in tissue necrosis [36].
