While many people regularly sweat during exercise and exposure to high heat conditions, there are some people that do so under completely normal conditions. It is estimated that about 1% of the American population suffers from such excessive sweating known as axillary hyperhidrosis. It is both a source of embarrassment and clothing inconvenience.

While mild cases of axillary hyperhidrosis responds to strong antiperspirants, more significant and persistent conditions require other forms of treatment. The well known neurologic injections of Botox and Dysport  provide profound and sustained reduction in axillary sweating. The injection treatments are quick to do but not inexpensive, often ranging in cost of between $750 to $1,000 for treatment of both armpits. While the results are temporary and must be repeated to be sustained, they will often last for up to one year.

Numerous surgical approaches have been advocated over the years, all of which try to destroy the offending sweat glands which are largely situated underneath and around the axillary hair follicles. No single technique has been shown to be consistently effective. But the use of  heat (thermal destruction) is a logical method to permanently damage the sweat glands and hair follicles. The issue has always been how to deliver the heat to the underside of the skin without creating a full-thickness burn to the skin.

The use of laser liposuction (Smartlipo) is now a well accepted and effective method of liposuction. By introducing a small 1mm fiberoptic probe under the skin, heat energy is delivered to the fatty target tissues. When the laser probe is under the skin, it may not look like it is doing much but feeling the outer skin will soon dispel that perception. The tip of the laser probe can deliver a very significant amount of heat. While the tip energy is not as much as an electrocautery, it is still significant enough to thermally damage whatever it contacts.

The use of Smartlipo can be used in the treatment of axillary hyperhidrosis through the introduction of the laser probe. Running the probe underneath the axillary skin delivers heat exactly where the glands lie, causing either their vaporization and disruption of the ducts up into the skin.While complete elimination of sweating may not occur, reduction is significant and is reportedly maintained for up to several years after a single treatment. Using power settings of 30 watts with wavelengths blends of 1064nm and 1360nm, a high amount of heat can be selectively delivered.

This treatment can be done under local anesthesia or IV sedation, whichever the patient prefers. There are no dressings and any special care needed afterwards. The armpits will be a little sore and tender for a few days but there are no physical restrictions. One can return to work the following day in most cases. Very physical jobs may require a few days until the axillary soreness improves. I have seen a few partial skin burns which appear as blisters the following day. These will go on and heal on their own uneventfully. While on the one hand I don’t like to see blistering, those healed blistered areas will likely never sweat again.

The use of the Smartlipo laser probe  is a more contemporary approach to the concept of subdermal shaving in the treatment of axillary hyperhidrosis.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Indianapolis, Indiana

Advancements in methods of fat removal by liposuction continue to change and be ‘improved’. One of the most noteworthy methods that is currently marketed and touted is laser liposuction, or more accurately, laser-assisted liposuction. As opposed to the traditional technique of cannula insertion, eating up the fat tissue, and then sucking it out, the mechanical beat-up is replaced by laser energy. A laser fiber is inside the liposuction cannula which delivers heat to the fat cells, thus breaking them down inito a more liquid state making it easier to be sucked up the cannula. In theory, the heat from the laser also causes the overlying skin to tighten.

As of this date, there are three such laser-assisted liposuction systems available in the U.S. They are under the marketed tradenames of SMARTLIPO (Cynosure), COOLIPO (CoolTouch), and PROLIPO (Sciton). All of them tout more effective fat removal, less bruising and swelling, a faster recovery, and skin tightening.

The real question is….are they really better than traditional liposuction…and are there increased costs over traditional liposuction worth it? (someone has to pay for the equipment purchase…and that is you the patient!) To date, they remain tremendously appealing, particularly to the general public. Historically, any treatment associated with the word, laser, always causes mass patient allure. No clinical trials have yet been reported, that I have seen, that have ever directly compared any laser-assisted vs traditional liposuction procedure. Nor has any large clinical trial been done that even compares two differently-treated patient groups, no matter how impossible it really is to ‘match’ patients from different groups.

Much like ultrasonic-assisted liposuction when it was introduced 10 years ago, laser-assisted liposuction may be a popular trend that, in the end, will fare no better. It will undoubtably have its place in liposuction options and armamentarium but I doubt if it is magic and offers a quantum leap in patient outcomes and recovery times. It may offer some improvement in fat removal efficiency, but I am truly dubious of overall better outcomes, a much better and faster recovery, and skin tightening (of which I remain the most skeptical)

I am all for any form of advancement in liposuction, which is a fairly traumatic procedure on the tissues. While effective, liposuction is still one of the most ‘brutal’ procedures that we as plastic surgeons do. Is laser-assted liposuction a real improvement…ask me again next year!

Dr Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.eppleyliposuction.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis