11. BodyTite® RFAL and other liposuction technologies

BodyTite® RFAL is an industry leading lipocoagulation skin tightening technology and technique, with documented 35% soft tissue and skin area contraction. The physician still needs to perform final aspiration and contouring. Small, microcannula SAL, PAL (MicroAire, Vaser PAL or Tickle Lipo) are the most common aspiration options. UAL, Ultrasound assisted may be deployed prior to BodyTite®, particularly if fat grafting is being performed, as UAL will facilitate fat cell decohesion, separation and then aspiration and collection of the adipose tissue, BUT these adipocytes and adipocyte derived stem cells will be viable and survive the fat grafting process.

SmartLipo®, or laser assisted liposuction (LAL) is another viable thermocoagulation soft tissue tightening system, with documented 17% area contraction. LAL is not as efficient as RFAL with inferior published skin contraction data, but, is a very strong brand and can be easily marketed. Occasionally, the physicians with both SmartLipo® and BodyTite®, may use the laser lipolysis for a small, and often subdermal component of the procedure and then deploy the BodyTite® applicator for the majority of the thermal coagulation process. Propulsive water assisted liposuction (WAL), is gentle, with less bruising, but does not lead to enhanced soft tissue contraction, so is not a common technology in most regions of the world. Plasma assisted liposuction is relatively new and can deliver soft tissue contraction, but lacks internal thermal control, is relatively slow and plasma may be better suited and relegated to external skin resurfacing.

BodyTite® is usually the stand along soft tissue contraction system and can be performed before the final aspiration contouring or, after aspiration and contouring has been performed. There are no studies confirming which, RFAL before or after aspiration, delivers the best contraction and results. The author does prefer to perform BodyTite® RFAL first, not just to optimize the number of FSN architecture that can be shortened prior to aspiration, BUT, also to ensure, small venule and arterioles undergo a thermal coagulation and then, when aspiration is performed last, there is less injury and bleeding into the subcutaneous space with less patient ecchymosis. The coagulation and liquification of fat, means more gentle aspiration forces are required, which likely translates into less edema, swelling and pain.

#### 12. RFAL complications

The use of body tight RFAL applicators has evolved into a very safe and efficacious tool. Over 10,000 procedures have been performed worldwide with a very low complication rate. However, like any surgical tool untoward outcomes can occur and the risk of complication is often proportionate to the therapeutic index of safety of the device and the experience of the surgeon. Fortunately, over the past 10 years of BodyTite® innovation in the thermal lipocoagulation, there has been a tremendous evolution in the onboard sensing of soft tissue thermal profiles and automated modulation of the radiofrequency output around those variables.

#### 12.1 Thermal injury

Contact sensor, high and low impedance sensors, external and internal electrothermal cutoffs, audible warnings as temperature rises, automated cut off

BodyTite®: The Science and Art of Radiofrequency Assisted Lipocoagulation (RFAL)… DOI: http://dx.doi.org/10.5772/intechopen.83446

#### Figure 39.

A small full thickness BodyTite® burn during abdominal RFAL treatment. Secondary intent healing and remodeling, with dilute triamcinolone (Kenalog 2) injections will result is a very cosmetically acceptable result.

temperatures, and energy output linked to the rate of rise of temperature with temperature surge protection are all part of myriad of onboard thermal control systems. Despite these safety features there is a small risk of a thermal injury. Because the heating from the subcutaneous level up through the, any thermal excess, any thermal excess will result in a full thickness burn. The vast majority these thermal injuries are small and limited nature and heal by secondary intent and occasional required excision once the scar has softened and remodeled (Figure 39).

This risk a thermal injury far less than 0.25% (1 in 400 cases) and diminishes with the experience of the physician. To minimize the risk of a burner thermal injury conservative settings and parameters as outlined in this chapter and advanced training environments and experience, together with an adequate amount of tumescent anesthesia, and avoid peri-port injuries will make out the risk of the thermal excess very uncommon. When a peri-port burn occurs in a esthetically sensitive region, like the face or neck, the author will perform an epidermal closure over the injury, rather allow secondary intent healing and perform fractional RF or CO2 treatment once this is healed or, perform a secondary scar revision if necessary (Figure 40).

#### 12.2 Nodules

In the past BodyTite® and its RFL applicators lacked the sophisticated internal thermal monitoring and overheating of the adipose tissue occurred that often led to fibrous lumps and deep subcutaneous scar tissue. These internal areas of firmness and hardening are now extremely uncommon with sophisticated internal and external thermal monitoring the parameters are adhered to.

#### 12.3 Postinflammatory hyperpigmentation (PIH)

The risk of significant bruising following RFAL assisted liposuction bruising is lessened with RFAL mediated thermal coagulation of small venules and arterioles

Figure 40.

A small peri-port FaceTite® burn at the entrance of the nasolabial port. Simple epidermal 6–0 nylon closure over the injury will allow subdermal secondary intent healing without an obvious scab. Subsequent fractional RF or laser treatments or, even delayed excision will minimize the risk of any deleterious visible scar.

and the resulting hemosiderin induced PIH is hence far less than lipocontouring with more ecchymosis.

## 12.4 Seroma

The risk of a seroma is higher using RFAL thermal coagulation is higher, most probably due to a temporary, but reversible injury to the subcutaneous and sub- dermal lymphatic system and so, an internal close drain is used by the author on all abdominal BodyTite® and RFAL cases. BodyTite® and RFAL to other anatomic regions does not increase the risk of seroma, so closed drainage is not deployed.
