| 應用波長1064nm的Nd-YAG雷射消除臉部多餘的脂肪 邱正宏醫師 景升聯合診所 醫美中心 目的；使用雷射去除身上多餘的脂肪有越來越多的趨勢，藉由「雷射輔助吸脂」和「雷射溶脂」可達到很好的雕塑體型的效果。過去幾年內，波長1064nm的Nd-YAG雷射被使用來改善身體和下巴的脂肪堆積已經有很多文獻報導，本研究的目的是評估1064nm的Nd-YAG雷射治療臉部脂肪堆積的療效。 材料和方法：2008年6月和2011年6月之間，在景升聯合診所接受臉部雷射溶脂的患者中，排除手術前曾經接受過臉部填充物〈玻尿酸、微晶磁或自體脂肪〉注射的患者，總共有126位納入本研究。術前皆取得同意書的簽名，患者的平均年齡是31歲〈16至64歲〉，男女比例是104比22。手術使用1064nm, 6W或8W的能量，100μs 脈衝，40Hz頻率的Nd-YAG雷射〈Smartlipo, DEKA〉。所有患者於術前術後皆告知不須特別控制飲食或更改生活習慣，手術後2個月、4個月和一年回診。每次回診皆量測體重、體脂、BMI和手術部位照相，臨床改善程度和副作用皆須紀錄。臉部外觀和臉部皮膚的變化在術前和術後追蹤當中也給予評估，評估方式為5分：非常明顯，4分：很好，3分：普通，2分：沒效，1分：變差。最後並記錄患者的滿意程度，評估方式同前。此外，由一位不知情的臨床工作人員進行客觀評估，將術後和術前的照片加以比較，以VAS分數〈0-10分〉評估其變化情形，0分：沒變化，10分：非常明顯的變化。 結果：臉部外觀變化的結果，在最後一次回診的評估時如下：非常明顯27位〈21%〉，很好80位〈63%〉，普通14位〈11%〉，沒效5位〈4%〉，沒有患者評估為變差。皮膚膚質的改善結果是：非常明顯28位〈22%〉，很好74位〈58%〉，普通21位〈17%〉，沒效3位〈2%〉，沒有患者評估為變差。臨床工作人員的評估是臉部改善7.73分，膚質改善7.69分。副作用方面，總計有三例出現手術併發症。其中兩例在術後3天出現水泡，檢討其原因，一位在手術前兩周曾經接受過化學換膚治療，皮膚處在發炎狀態下可能是出現副作用的原因；另外一位雷射照射的能量達到9000焦耳，單邊臉部照射達4500焦耳，能量太高可能是水泡出現的原因。另外一例在術後第二天出現左側嘴角歪斜的現象，可能是左側顏面神經的Mandibular branch損傷造成的，給予積極的修復治療兩週後就回復正常。幾乎所有患者在術後皆有腫脹現象，但是很快就會消退，最遲兩周之內就會消腫。體重、體脂和BMI在術前和術後都沒有明顯的變化。總計有110位〈87%〉的患者表示對手術結果感到滿意〈圖一〉。 結論：雷射溶脂手術造成的腫脹、瘀青和術後疼痛問題比傳統抽脂手術少，在美容醫學的治療上有更高的安全性和更好的接受度。從本研究結果中可以看到患者的滿意度相當高，雖然有極少數的皮膚水泡和顏面神經的併發症，但是經過適當的處理之後，都可以在短時間內修復。我們的結論是Nd-YAG雷射對於臉部多餘脂肪的消除以及臉部膚質的改善有明顯的效果，而且沒有嚴重的副作用。
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Laser Lipolysis with Pulsed 1064 nm Nd: YAG Laser for the Treatment of Unwanted Fat in the Face Cheng-Hung Chiu, M.D. 邱正宏醫師 Aesthetic Department, Genesis Clinic 景升聯合診所醫學美容部 Taipei, Taiwan 台北台灣 Introduction Lasers are currently being used for body fat contouring through laser-assisted liposuction and laser lipolysis. Nd-YAG laser has been adopted for the treatment of lipodystrophy in the body and submentum. This study was conducted to evaluate the efficacy and safety of the use of the 1064 nm Nd-YAG laser for the treatment of unwanted fat in the face. Materials and Methods Between June 2008 and June 2011, 126 subjects with unwanted fat in the face were enrolled in this study. Informed consents were achieved from all of the subjects. Their mean age was 31 (from 16 to 64) years old. The female to male ratio was 104 to 22. A 100-microsecond-pulsed, 40 Hz-frequency, and 6W-power 1064 nm Nd:YAG laser system (Smartlipo, Deka) was used for lipolysis in this study (fig.1). All the patients were asked not to control their diets and exercises during the study period. They were visited before the treatment, and at 2 months, 4 months and 1 year after the treatment. At every visit, photographs of the face in different views were taken. The clinical improvement and side effects were recorded. Body weight, body composition and body mass index (BMI) were also obtained at every visit. Clinical assessment of facial size changes and skin texture changes was evaluated before the operation and at the end of follow up according to a 5 point scale (1:worse, 2: no effect, 3: mild improvement, 4: good, 5: excellent) and the level of patient satisfaction was determined by grading the final results as “excellent”, “good”, “fair”, “no change”, “worse”). Objective evaluations of the face were performed by one blinded clinician by comparing the face with their previous pictures. The clinician’s estimations were determined by employing a ten-point scale ranging from 0 to 10 with 0 as no change or worse and 10 as excellent. Fig.1 After local anesthesia with tumescent solution, a 100-microsecond-pulsed, 40 Hz-frequency, and 6W-power 1064 nm Nd:YAG laser system (Smartlipo, Deka) was used to treat facial cellulite. Results For the change of facial size, the clinical outcomes of the patients’ treatment at the end of follow up were excellent in 27 patients (21 %), good in 80 patients (63%), fair in 14 patients (11%), and no effect in 5 patients (4%). No patients reported their results as ‘worse’. For the change of skin texture in the face, the results were excellent 28(22%), good 74(58%), fair 21(17%) and no effect 3(2%). No patient reported as ‘worse’. Clinician’s evaluation scores were 7.73 for change of face size and 7.69 for change of skin texture. Two patients developed blisters on their faces 3 days after the procedure. One patient received chemical peel on the face 2 weeks before the operation. The other patient received 9000 J laser irradiation to her face which energy was considered too much for a single operation of facial laser lipolysis. Almost all patients developed swelling soon after the operation lasted only briefly and disappeared within 2 weeks after they first manifested. The body weight, body fat ratio and BMI before and after the operation had no significant change. Finally 110(87%) patients reported their results as very satisfied and satisfied. (fig.2-4) Fig.2 Results 2 months after one therapy of laserlipolysis. Total laser dose for this patient was 6029J ( 3016J for right side and 3019J for left side). Fig.3 Results 4 months after one therapy of laserlipolysis. Total laser dose for this patient was 7000J (3500J for right side and 3500J for left side) Fig 4. Results 9 months after one therapy of laserlipolysis. Total laser dose for this patient was 7028J (3518J for right side and 3510J for left side). Note the flattening of nasolabial folds after treatment. Discussion Laser lipolysis is cosmetically safte and favorable because it causes less trauma, swelling, bruising and postoperative discomfort than classic liposuction does. In this study, laser lipolysis also showed good tolerance to the patients. Its only side effects were pain, swelling and ecchymosis, all of which did not last long and disappeared soon after they first manifested. Our study demonstrated that Nd: YAG laser lipolysis reduced facial unwanted fat and improve facial skin texture without serious complications. Key Words face, laser lipolysis, fat Contact Dr. Cheng-Hung Chiu
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