**6. Laser and the Vaser systems**

#### **6.1 Laser lipolysis (LL)**

Laser lipolysis technology was popularised following studies on the interaction between the laser and adipose tissue [28]. Laser assisted liposuction technology is one of the most advanced treatment of lipodystrophies and irregularities of adipose tissue. The laser beam preferentially targets the adipose tissue with which it keeps a direct contact [28].

Laser action causes the breakdown of the adipocyte membrane and releases the oily content into the extracellular fluid. It can cause neocollagen formation and remodelling with reticular dermis reorganisation [29, 30].

Laser technology has advantages and disadvantages compared to traditional liposuction and other energy delivered technology. The most common advantage is patient's quick recovery. Due to liquefaction of the fat and small laser probe size; less effort from the surgeon warranted to melt and remove the fat.

Some surgeons when treating small areas like submental, knees, thighs avoid aspirating the melted fat, further limiting direct tissue trauma. An important advantage seen in the early postsurgery stage is skin tightening related to laser energy delivery [31, 32]. Disadvantage of laser-assisted lipolysis is that the fat cannot be used for transfer following extraction. Skin burns have also been reported with Laser use [31, 32].

#### **6.2 VASER liposculpture (VLs)**

VASER energy delivery technology enabled the surgeon to melt, debulk large areas of fat including superficial fat layer, therefore creating high definition of muscles around the body (abdomen, back, arms and legs). It is imperative to avoid over-resection of fat and spare 1 cm of fat thickness from the deep dermis to avoid deep tissue scarring and irregularities [33, 34].

A Colombian plastic surgeon, Alferdo Hoyos, developed a significant improvement in the Vaser liposculpture technique adding a new approach to body contouring. He termed this High Definition Liposculpture (HDL). Dr. Hoyos defined his technique not just as a simple liposuction or fat removal, but as an artistic approach to sculpt the body and define the surface anatomy.

Vaser body sculpture technology allows the surgeon to go well beyond the simple fat removal of fatty bulges, and to use it as a sculpting tool to create the ideal profile [35].

VASER and high definition liposculpture allows great cosmetic outcomes with reduced trauma to the soft tissue and blood vessels. VASER assisted HDL breaks down the fat and allows it to be prepared for the surgeon to sculpt muscular anatomy in great details through gentle extraction aspiration, which cannot be achieved with traditional liposuction [36–38].

The combination of VASER and HDL can be challenging and more time consuming than traditional liposuction. It is important to keep in mind that VASER technology as in Laser technology adds one extra stage when compared to traditional liposuction; the emulsification of fat. High definition Three-dimensional sculpting, however, adds yet a further step namely the removal of the superficial fat [39].

Combining VASER with power assisted liposculpture-using Microair or Power-X systems atraumatically debulk the fat making it a less effortless and safer task [40]. Another advantage of the Vaser is the safety of the superficial emulsification and extraction of the fat from the subdermal lamellar layer to define relevant anatomy

#### *The Safe Evolution of Liposuction into Liposculpture DOI: http://dx.doi.org/10.5772/intechopen.97351*

for each muscle group. As the subdermal plexus of vessels is not significantly affected with VASER or the PAL system, this in our opinion is a major component in safeguarding the skin blood supply allowing for further refinement in superficial fat extraction and three-dimensional body sculpting.

Vaser liposculpture technology, however, is time-consuming when used for treating large areas. Hence, we recommend it to be performed by an experienced team, and perhaps when possible more than one team working in harmony. Having an experienced team/teams adds safety, reduced surgical time, reduces surgeon's fatigue and makes for excellent patient outcomes.

It must be taken into consideration in all the techniques described in the sections above, that patient's selection is crucial in achieving the best results as much as the surgeon's experience and skills are of profound importance.
