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Uniform heat induction, fat removal provides successful abdominoplasty results



Patients who want a tighter abdomen without the high risk and lengthy recovery associated with abdominoplasty are treated with a combination of circumferential abdominal liposuction and induction of thermal energy by Patrick McMenamin, M.D. The procedure employs a grid to help keep the surgeon focused on applying a uniform amount of energy to the entire treatment area.


Dr. McMenamin
"Patient satisfaction is high, and patients are typically back to work or enjoying everyday activities within a week," Dr. McMenamin says. He now reserves traditional abdominoplasty for patients with excessive skin laxity due to weight loss of 100 pounds or more.

"There's no question that a traditional tummy tuck is quite an invasive operation. The possibility of deep vein thrombosis is real, and complete recovery can take up to a month," Dr. McMenamin says.

"When we perform abdominoplasty, we are creating a very large wound reaching from one side of the abdomen to the other, lifting the flap up, pulling the excess down and then cutting it off. The complication rate is not as high as it was 30 years ago; nevertheless, the patient is left with a very large scar," he says.

ACHIEVING SKIN CONTRACTION Although the original goal of laser lipolysis was to remove fat deposits, Dr. McMenamin says that investigators have since found that contraction of the skin envelope is achievable as well. His abdominal laser lipolysis technique is all about improving skin-texture changes and achieving skin contraction.


A patient’s abdomen sectioned off into approximately equal squares to allow uniform application of energy in the subcutaneous space. (Photos credit: Patrick McMenamin, M.D.)
"What we're talking about is putting laser — heat — energy into a wound to make the skin contract, and we use the grid technique that was developed by (Barry) DiBernardo to ensure that we are relying on a scientific method to create a uniform wound," he says.

The treatment target area is divided into a series of approximately equal squares to allow uniform application of energy in the subcutaneous space. Each square is then treated individually by laser-assisted liposuction to surface temperature end points of 38 degrees Celsius to 42 degrees Celsius. Each square is treated with the Joule (Sciton) or the Smartlipo (Cynosure), using 1,064/1,319 nm or 1,064/1,320 nm Nd:YAG laser energy, respectively, delivered by an optical fiber (300, 600, or 1,000 mm diameter) enclosed in a stainless steel liposuction cannula and extending 2 mm to 3 mm beyond the distal end.


A 37-year-old female patient before (left) and six months after abdominal laser lipolysis. The patient was treated with 16 watts; 8 watts were 1,064 nm and 8 watts were 1,320 nm using a Cynosure MPX, then approximately 1,600 J to 2,500 J per square was applied.
Each square receives between 1,600 J and 2,500 J to achieve an endpoint skin temperature of 40 degrees Celsius to achieve skin tightening.

Surface-skin temperatures are monitored with a handheld infrared thermometer (MiniTemp MT6, Raytek).

To avoid epidermolysis, an optimal internal temperature of 45 degrees Celsius to 47 degrees Celsius is monitored with a TempAssure (Sciton) or ThermaGuide (Cynosure) internal sensor.


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