**3. Laser lipolysis effects**

LASER assisted lipolysis offers efficacious fat extraction, better hemostasis and finessed sculpting with thermal heating of fibrous septae in areas difficult to obtain tissue retraction. Multiple wavelengths, such as the 1064 nm and 1320 nm., have been shown to effectively coagulate small blood vessels, rupture adipocytes, coagulate adipose collagen strands and help to reorganize the reticular dermis. Light energy is delivered to subdermal tissue through a small fiber threaded through a 1 mm microcannula with the tip extending a few mm beyond the microcannula end. Data established by the works of Havenith, et al. [6] and Salzman, et al. [7] offer precise calculations to determine the laser energy required to cause collagen fiber contraction without causing a burn. Havenith et al., showed that it takes about 2.51 joules of laser energy to raise the temperature of 1 ml of fat 1° Celsius. Since the density of fat is 0.9 grams/cc, the resultant requirement is 2.3 joules per cc. As damage begins to occur at 43° C, the goal should be to raise the temperature no more than 5° Celsius. The volume of fat to be liquified is estimated roughly by measurements of the length X width X thickness of the treatment area. Hence, the amount of laser energy that should be delivered is the product of volume X 2.3 X 5. Following laser application, higher mean skin stiffness and tightening has been demonstrated at 3 months when compared to traditional manual liposuction alone [8]. Notwithstanding, studies that have shown modest decreases in skin surface area reduction, added operative time, sequalae such as local skin burns, and limited longevity have tempered the recent popularity of this modality.
