LAS VEGAS Combining liposuction with Thermagea radiofrequency energy system that heats the skin to produce collagen tightening and shorteningled to clinically significant tightening of abdominal skin at 28 weeks, compared with either treatment alone, results from a small study suggest.
Combining the two procedures "can be particularly useful in patients with loose skin or striae prior to liposuction," David Avram, M.D., said at the 13th International Symposium on Cosmetic Laser Surgery. "This can be a way of enhancing our results in those patients. However, this was a small study. We obviously need to perform more studies with more patients."
For the study, Dr. Avram and his associates treated 14 patients with standard tumescent liposuction plus Thermage (group 1), four patients with liposuction only (group 2), and two patients with Thermage only (group 3).
After liposuction, patients in group 1 had four tattoo markers placed in a rectangular pattern in areas of loose abdominal skin. The area was calculated and recorded prior to treatment with Thermage, said Dr. Avram, a cosmetic dermatologist who practices in New York City.
Patients were treated three times with Thermage at 4-week intervals (4, 8, and 12 weeks postoperatively). The treatments were done in a single pass using the ThermaCool TC System. Energy levels ranged from 13.5 J/sec to 15.0 J/sec at each visit. Patients were asked to return for follow-up visits at 1 month and at 4 months after the last Thermage treatment. Two independent observers recorded the size of the treated area at each follow-up visit.
"We've heard a lot of subjective data about Thermage," Dr. Avram commented. "I think what's nice here is that we really went for objective data with tattoo markers to see if there would be any [skin] tightening."
Patients in group 2 had tattoo markers placed in the abdominal area 4 weeks after liposuction. Investigators recorded the area of tattoo markers during postoperative follow-up visits at 8, 12, 16, and 28 weeks.
Patients in group 3 had tattoo markers placed in the abdominal area on the initial visit and then underwent the same Thermage treatment and follow-up regimen as patients in group 1.
At 4 weeks, there were no differences in skin tightening among patients in the three groups. (See box.) However, by 28 weeks, patients in group 1 achieved 18% skin tightening while patients in groups 2 and 3 achieved only 10% skin tightening.
The 10% tightening seen in the group 2 patients "is probably from the trauma that's caused from liposuction," Dr. Avram said. So Thermage is as effective in tightening skin as is liposuction only. "When you combine the treatment modalities, you are able to have skin tightening up to 18%."
Dr. Avram noted that patients treated with Thermage had "moderate discomfort" during treatment, but no long-term adverse events were observed. Lidocaine topical anesthetic cream was applied 1 hour before treatment, and no oral pain medicines were given.
One patient had four superficial blisters after treatment, "but they healed without a scar," he said.
He added that he is using combined liposuction and Thermage to treat fat on the arms and noted that some clinicians are applying it to breast reduction.
The current Food and Drug Administration-approved indications for the ThermaCool TC System are for noninvasive treatment of wrinkles in the periorbital area as well as full-face treatment.