**4. Benefits of VASER®**

Like the LASER, the use of VASER® adds operative time but reduces operator fatigue. Yet, unlike the LASER, VASER® offered notable advances that allow for selective tissue emulsification, lower lipoaspirate hematocrit levels, and preservation of adipocyte derived stem cells for fat grafting [9]. VASER® probes designed with rings and grooves on the tip deliver vibratory energy from the end surface and sides, permitting mechanical penetration of fibrous tissue and micro-cavitation of adipose cell membranes, whilst preserving the musculocutaneous connective tissue matrix, nerves and vessels. Energy emanates from the probe tip and rings

continuously or in pulsed mode, a feature that provides additional safety with high energy probe vibration for shorter time bursts. Following tumescent solution infusion, probes are cross tunneled through multiple skin protector ports, smoothly and continuously until there is a loss of resistance. As VASER® proceeds, the resistance in the tissue is palpably diminished as adipose cells liquify. The acoustic streaming by VASER® prepares fat for suctioning, but when used alone at low energy levels, there is minimal thermal energy generation. Some thermal skin tightening has been reported at 90% energy levels when delivered continuously for 2 minutes [10]. Overall, there has been inconsistent coupling of clinically observable skin contraction with subsequent fat removal when using VASER® alone. Notwithstanding, the addition of VASER® to the operative sequence helps to expose the numerous fibrous septae amidst densely packed fat in the supra-Scarpal space and the widely spaced fibrous septae that run amidst loosely packed fat lobules in the supra-Scarpal space. The author purports that the exposure of the fibrous septal network for subsequent thermal energy targeting by Renuvion® is key to optimizing the heating of the low impedance collagen fibers for increased soft tissue contraction overall.
