应用波长1064nm的Nd-YAG雷射消除脸部多余的脂肪 邱正宏医师 景升联合诊所 医美中心 目的；使用雷射去除身上多余的脂肪有越来越多的趋势，藉由「雷射辅助吸脂」和「雷射溶脂」可达到很好的雕塑体型的效果。过去几年内，波长1064nm的Nd-YAG雷射被使用来改善身体和下巴的脂肪堆积已经有很多文献报导，本研究的目的是评估1064nm的Nd-YAG雷射治疗脸部脂肪堆积的疗效。 材料和方法：2008年6月和2011年6月之间，在景升联合诊所接受脸部雷射溶脂的患者中，排除手术前曾经接受过脸部填充物〈玻尿酸、微晶磁或自体脂肪〉注射的患者，总共有126位纳入本研究。术前皆取得同意书的签名，患者的平均年龄是31岁〈16至64岁〉，男女比例是104比22。手术使用1064nm, 6W或8W的能量，100μs 脉冲，40Hz频率的Nd-YAG雷射〈Smartlipo, DEKA〉。所有患者于术前术后皆告知不须特别控制饮食或更改生活习惯，手术后2个月、4个月和一年回诊。每次回诊皆量测体重、体脂、BMI和手术部位照相，临床改善程度和副作用皆须纪录。脸部外观和脸部皮肤的变化在术前和术后追踪当中也给予评估，评估方式为5分：非常明显，4分：很好，3分：普通，2分：没效，1分：变差。最后并记录患者的满意程度，评估方式同前。此外，由一位不知情的临床工作人员进行客观评估，将术后和术前的照片加以比较，以VAS分数〈0-10分〉评估其变化情形，0分：没变化，10分：非常明显的变化。 结果：脸部外观变化的结果，在最后一次回诊的评估时如下：非常明显27位〈21%〉，很好80位〈63%〉，普通14位〈11%〉，没效5位〈4%〉，没有患者评估为变差。皮肤肤质的改善结果是：非常明显28位〈22%〉，很好74位〈58%〉，普通21位〈17%〉，没效3位〈2%〉，没有患者评估为变差。临床工作人员的评估是脸部改善7.73分，肤质改善7.69分。副作用方面，总计有三例出现手术并发症。其中两例在术后3天出现水泡，检讨其原因，一位在手术前两周曾经接受过化学换肤治疗，皮肤处在发炎状态下可能是出现副作用的原因；另外一位雷射照射的能量达到9000焦耳，单边脸部照射达4500焦耳，能量太高可能是水泡出现的原因。另外一例在术后第二天出现左侧嘴角歪斜的现象，可能是左侧颜面神经的Mandibular branch损伤造成的，给予积极的修复治疗两周后就回复正常。几乎所有患者在术后皆有肿胀现象，但是很快就会消退，最迟两周之内就会消肿。体重、体脂和BMI在术前和术后都没有明显的变化。总计有110位〈87%〉的患者表示对手术结果感到满意〈图一〉。 结论：雷射溶脂手术造成的肿胀、瘀青和术后疼痛问题比传统抽脂手术少，在美容医学的治疗上有更高的安全性和更好的接受度。从本研究结果中可以看到患者的满意度相当高，虽然有极少数的皮肤水泡和颜面神经的并发症，但是经过适当的处理之后，都可以在短时间内修复。我们的结论是Nd-YAG雷射对于脸部多余脂肪的消除以及脸部肤质的改善有明显的效果，而且没有严重的副作用。 Fig.1 
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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. 邱正宏医师 Aesthetic Department, Genesis Clinic 景升联合诊所医学美容部 Taipei, Taiwan 台北台湾 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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