**4. Discussion**

After surgery, all patients had been discharged to outpatient after-treatment and returned to active social life in 7 days. Among postoperative complications, in 15% of cases the formation of small infiltrates up to 3 cm2 in the submental area at the subcutaneous fat level must be noted. However, they successfully responded to 4 weeks of treatment with medication and physiotherapy. In addition, there was III А degree skin burn with a diameter up to 1 cm in 2 (0.4%) cases, which ended in full-fledged epithelization within 1 month.

All clinical observations achieved good esthetic results. Control examinations conducted after 3 to 48 months demonstrate the persistence of the achieved effect.

Apfelberg first demonstrated the advantage of laser-assisted liposuction over tumescent liposuction in 1992, which involved reduction of pain syndrome, hematomas and edema of the surrounding tissues [17]. In 2006 by a magnetic resonance imaging examination carried out before and 3 months after this surgery Kim showed overt and significant reduction of adipose tissue in the submental area [18]. Mordon and co-authors calculated the amount of energy applied to adipose tissue to obtain the maximum effect with subsequent derma retraction, which usually is min. 3000 J of energy spent on 5 cm3 [19]. Gain and his co-authors analyzed more than 300 sources in Russian and foreign scientific literature concerning laser lipolysis and the conclusion of this work is the proven effectiveness and safety of this surgery, as well as the continuing research interest in the effects of lasers on adipose tissue [20].

The main advantage of the Nd:YAG laser is skin retraction due to the formation of new collagen, reduction of intra- and postoperative hemorrhage, as well as reduction of the number of adipocytes. The surgeries that we have already performed and the developed algorithm demonstrate the best esthetic results over a long observation period (about 8 years), allowing us to solve esthetic problems of the lower third of face, submental area, neck, associated with not only excess

fat deposit, but also gravitational ptosis. That being said, this approach provides an opportunity to reduce the recovery period. Positive results were achieved in all age groups under the different types of ptosis. In cases of I, II and III type of ptosis of soft tissues according to Baker's classification, we achieve proper correction of the lower third of the face with laser-assisted liposuction. In cases of patients with IV type of ptosis according to Baker's classification, this surgery allows for reverting involutional changes to I type.
