Internal liposuction remains the standard and most reliable method to remove fat and contour the body. However, laser lipolysis had become recently a widely accepted modality for removal of unwanted fatty tissue, that is in many cases superior to liposuction. Since its United States Food and Drug Administration (FDA) approval in October of 2006, multiple studies have discovered that laser lipolysis liquefies fatty tissue, coagulates small blood vessels, and promotes tissue tightening. They concluded that laser-assisted liposuction has a statistically significant effect on skin shrinkage and tightening of the skin when compared to liposuction alone.

There is a consensus in medical community that laser lipolysis both liquefies adipose tissue and more significantly produces and remodels collagen fibers.

Clinicians are also excited about the possibility of laser lipolysis for cellulite reduction.

Different wavelengths have been tried for laser lipolysis in an attempt to specifically target fat, collagen, and blood vessels. These wavelengths include 924, 968, 980, 1064, 1210, 1319, 1320, 1344, 1440 and 1720nm.

Some authors have suggested that certain wavelengths lead to superior lipolysis. For example, the 924nm wavelength has the highest selectivity for fat melting but may not be as effective for skin tightening as other modalities unless combined with another wavelength. On the other hand, the 1064nm wavelength has good tissue penetration, but relatively low fat absorption. The lower fat absorption of the 1064nm wavelength may be advantageous in treating large volumes of fat as heat distribution is more uniform. Finally, the 1320nm wavelength demonstrates greater fat absorption with less tissue penetration and scatter and, therefore, may be safer for treatment around more fragile areas, such as the neck, inner thighs, and arms. We have to note that these claims are not well supported in the literature.

The favored mechanism of action for laser lipolysis is photothermolysis. However, based on the successful application of pulsed 1320nm Nd:YAG laser the photoacoustic effects was put forward as an alternative mechanism. According to mathematical analysis and additional thermoregulatory studies, an internal temperature between 48 and 50°C must be reached for collagen denaturation and subsequent skin tightening.

One commonly promoted advantage of laser lipolysis is fast patient recovery. Most patients are able to return to normal daily activities within 1.5 days. Laser lipolysis may diminish postoperative pain, ecchymoses, and edema. Coagulation of blood and lymphatic vessels may explain these advantages. Additionally, due to the liquefaction of adipose tissue as well as small cannula size (~1mm), less trauma is needed to remove fat upon subsequent suction aspiration. Moreover. It had been reported that identical results were obtained whether or not post-laser suction aspiration was undertaken. In smaller areas, such as submental, inner thighs, and knees, many clinicians opt not to aspirate, further limiting direct tissue trauma. Consequently, patients experience a rapid return to daily activities.

While laser lipolysis brings many exciting advantages, some disadvantages still exist. For large areas, laser lipolysis alone may be inadequate for proper correction, and many surgeons still insist that laser lipolysis is an adjunctive treatment to liposuction rather than a liposuction replacement. Also, due to the relatively narrow window between heat accumulation that denatures and stimulates collagen and dermal-epidermal burns, thermal injury is an inherent risk. Finally, the cost of equipment, which can reach well over $100,000, certainly is an impediment to many physicians considering adding laser lipolysis to their menu of services.

Historically, solid state lasers Nd:YAG operating at 1064nm or 1320nm are very common instruments for the lipolysis. However, both of these wavelengths are not specific for the fat absorption and as such are inferior in their efficacy to semiconductor lasers operating at lipid-specific wavelengths. Lasers emitting light at wavelengths corresponding to the absorption peaks of fat, such as 924nm, 1210nm and 1720nm allow for controlled thermal disruption of adipocytes with the least potential injury for the dermis. On the other hand, the water-specific wavelength, such as 980nm and 1470nm, provide efficient heating of collagen, thus stimulating skin retraction and tightening. Multi-wavelength laser diode modules developed by AKELA Laser Corp. are perfectly suited for such medical instruments.