• General Information

Lipolaser (Laser lipolysis) with Aspire ® (Palomar)

• Unit combining 920 and 975 nm emissions for preferential fat and dermal tissue absorption.
• With specific wavelengths for the destruction of fat tissue.
• Delivery at 920 for fat is seven times greater than for water.
• Single-use disposable cannulas.
• Continuous wave photo dermal technology.

Why? Aspire®

Fawcett Dw Raviola, E. Bloom and Fawcett: A textbook of Histology. 12th ed., New York: Chapman and Hall, 1994. Ross H. M. , Romrell Lj., Kaye Gl.: Histology- A Text and Atlas. 3rd edition, Williams and Wilkins, 1995. Ackerman, Bernad: Histological Diagnosis of Inflammatory Skin Diseases. An Algorithmic Method Based On Pattern Analysis, 3rd edition, 2005.

• Adipose tissue is a unique type of connective tissue comprised of adipocytes, blood vessels and fibrous septa. It is made up of approximately 75-85% lipids and 15-25% water and proteins. The unilocular white adipose tissue (WAT) is the most common type in adult humans and is composed mostly of mature adipocytes measuring 2-150 microns (75 µ on average) and that contain one large droplet of lipids (triglycerides).

• The adipocyte cytoplasm is divided from the surrounding interstitial spaces by an external lamina of a glycoprotein envelope that superficially resembles the basal lamina of epithelia. In addition, the lipid droplets are not surrounded by a membrane, although its interface with the cytoplasm contains a layer of lipid reinforced by microfilaments. This interface is known as LCI (Lipid Cytoplasm Interface).

• Adipocytes are surrounded by a loose network of fine reticular fibres containing collagen fibrils, fibroblasts, lymphoid cells, eosinophils and some mast cells. Adipocytes are nourished by blood and lymphatic capillaries and appear oval or polyhedral with the nucleus flattened and pushed towards the periphery. The larger diameter of the adipocyte is conditioned by the volume of accumulated lipid in the cells and ranges from 25 to 125 microns. The volume ratio of lipid to the surrounding cytoplasm appears to be as the cytoplasm in the adipocyte is barely visible and is completely taken up by the lipid droplets.

• Physiologically, the adipose tissue is classified into primary (±1 mm) and secondary (±1 cm) microlobules, which are enclosed within a layer of connective tissue called fibrous septa composed of collagen and elastic fibres. Each primary microlobule is composed of grouped adipocytes and its capillary network. Each secondary microlobule is composed of a group of primary microlobules with larger arteriole networks and venules located within the connective fibrous septa which are visible to the naked eye.

The objective of laser sculpture or laser lipolysis is to provide all the benefits of laser-assisted liposuction through the selection of:

• Optimised selection of wavelengths
• Efficient and optimised use of power levels
• Superior treatment tip design

Obtaining:

• The greater degree of fat cell destruction in one laser treatment session.
• Greater degree of heat deposited achieving tissue shrinkage or skin tightening and subsequent tissue contraction in problem areas where skin contraction is doubtful due to the patient’s age or the skin’s fine structure as occurs in the inside thigh and arms or abdomens with stretch marks and weakened dermis.
• Increased coagulation to avoid bruising.
• Better penetration in the fat tissue with extra fine optical fibre that is less aggressive on the tissue and maintains the tissue structures.

The benefits include:

• Immediate skin tightening or contraction that guarantees a good response from the skin and its contraction with the volume reduction achieved by the elimination of fat cells.
• Reduced tissue trauma.
• Reduced patient recovery period and post-treatment discomfort.
• Easy removal of lipids using a small cannula as a supplementary technique if needed.

The final objective is important tissue contraction while destroying the fat tissue and preventing bruising.

For this, the wavelength is selected, then the pulse length and a power level that achieves fat tissue destruction with laser.

The SlimLipo Aspire handpiece has been designed to free the intracellular fat from the adipocytes and to coagulate without tearing the fibrous septa of the structures.

When the temperature of the lipids increases over 43 ºC, the LCI of the adipose cells is irreversibly damaged and the lipids are liberated into the extracellular space. When the temperature continues to rise to 60-70 ºC, it leads to coagulation of collagenous septa, the network of collagen fibrils surrounding adipocytes, capillaries and blood vessels. The result is skin contraction that appears with the coagulation of the collagen. The final result is the creation of a channel through the adipose tissue of free-flowing lipids surrounded by a wall of shrunken coagulated fibrous tissue.

The manner by which the surrounding tissue is heated is of great importance. The power levels needed to vaporize lipids or water are significantly greater than the power levels needed for lipid liberation and coagulation of surrounding cells and tissue. When operating at high temperatures, excess energy deposition can occur that not only lowers efficiency but is highly unsafe particularly in regions close to the dermis. To most effectively and safely disrupt the adipocytes, free the entrapped lipid and coagulate the surrounding cells and collagenous structures, it is best to perform smooth heating with continuous wattage or long pulses without overheating to the point of bubble formation or mechanical shock wave alterations.

In standard liposuction, the physical force needed to penetrate the tissues is greater, with Aspire, the fibrous trabecula is partially debilitated and is penetrated more easily because the optical fibre is very fine and ductile. The surrounding tissues are not affected and a fine cannula can be introduced afterwards to extract part of the lipids in the destroyed fat cells.

Dr Weiss, President Elect, American Society for Dermatologic Surgery (ASDS), and Associate Professor of Dermatology, Johns Hopkins University School of Medicine asserts the following regarding results in his report in “Touch Briefings” (US Dermatology Extract):

Our less than optimal results with a number of devices on the market led us to investigate a better method of laser lipolysis.

The SlimLipo combined system of wavelengths and unique optical delivery compared with has delivered impressive results in our current experience. The theoretical advantages to the combination of two wavelengths have translated into actual improved clinical outcomes and end-user utility. Conventional 300–500 µm diameter fibres in competitive systems require the use of greater force, pose an increased risk of snagging or breaking when used in fibrous areas. Additionally, competitive systems with conventional fibres deliver more concentrated energy at the tip; this may result in irregular heating of fat and dermis, more easily punctured skin, and a resulting increased risk of irregular results.

Data from our studies using SlimLipo to treat excess fat in the abdomen, thighs and arms show impressive results. Improved results are typically observed. Fifty percent of patients exhibited good improvement in their cosmetic outcomes in less than two weeks and by 6 weeks, 90% demonstrated improvement. Given that progressive improvement over time is typically observed, we anticipate these results will show further enhancement at six and 12 months post-operatively with further retraction and contouring of treated areas.

Compared with other wavelengths used in our clinic, the patients treated with the SlimLipo handpiece experienced less pain and fewer side effects.

While some patients reported minor tenderness, bruising was minimal and most patients were able to return to work the following morning. Patients experienced bruising and oedema, but most of this was completely resolved by one week. Marked improvements in side effects and downtime may be attributed to more complete heating and subsequent breakdown of fat conferred by the 924 nm wavelength. We observed other benefits, including smaller and fewer numbers of incisions. This is believed to have contributed to quicker recovery, reduced postoperative pain, and reduced tissue trauma.

• Aspire emits at 924 nm, the type of laser that displays an optimal absorption peak in human fat. This is the wavelength that is best absorbed by fat and allows for better volumetric heating of the fat tissue surrounding the optical fibre tip.

• The second wavelength that Aspire works at is 975 nm, in which the maximum absorption coefficient is for water as the predominant chromophore. This wavelength causes skin tightening as it is absorbed by the dermis, which contains 70% water. It also improves effectiveness by combing with 924 nm in the mixed mode on adipose tissue hydrated with tumescent infiltration. Heating of the fat tissue fibrous tracts is produced according to the dispersion of heat through conduction from the surrounding lipid droplets heated by the laser light.

This graph shows the heat profile at the end of a one-second pulse around the optical fibre tip. There are two areas of damaged defined around the tip. The largest area affects the liberation of lipids by destroying the adipocytes, characterised by increases in temperature to approximately 43º C and the smallest area with temperatures over 60º C describes the protein area (collagen) that would be affected by tissue coagulation.

• The first image shows the heat profile at 924 nm with 17 W in normal adipose tissue with an average of 15% water in its composition. The second one shows the same in hydrated fat which contains approximately 30% water.

• The following two graphs show the heat profile for dual delivery at 17 W of 924 nm and at 8 W of 975 nm. In the dual delivery under super-hydrated conditions, the area of fat tissue destruction is larger due to the water's better absorption at 975 nm than at 924 nm.

This graph shows the liberated lipid volume and coagulated volume in adipose tissue in normal physiological conditions.

This image shows the temperature profile for combined emissions in two different mediums, normal fat and super-hydrated fat with tumescent infiltration.

SlimLipo wavelengths – James J. Childs PhD, Mikhail Simirnow PhD, Alex Zelenchuk Ph D, and Gregory Altshuler, Pd, D Sc.

• The melting process refers to the laser lipolysis performed in an ideal situation due to the direct absorption of power by the lipids. The absorption of this power causes the lipids to heat sufficiently to suffer a thermal alteration in the dense lipid and protein cover that envelopes the lipids and finally provokes an adipocyte escape, that is, a lipid liberation mechanism induced by selective photothermolysis. Liberation of lipids occurs both in the delivery phase and depending on the latent result to the changes thermically induced in the permeability of the LCI covering.

The effectiveness of 924 nm:

• Laser light at 924 nm is highly absorbed with the fat, its lipid absorption ratio is two times higher than by water. To demonstrate the effect of fat tissue of the lasers at different wavelengths, a comparative study was performed between the temperature profiles reached in each case for each laser output.

Each laser was used on continuous at 20 W through a straight optical fibre measuring 600 microns and 300 msec pulse durations. The remaining parameters were constant. The solid line in each image represents the temperature of 64º C of the contour which is the external border of the coagulation area around the fibre where the immediate liberation of lipids and tissue coagulation occurs. The external line represents the outer limit of 50º C and represents the external limit of the lipid liberation area. For the same power deposited by the four lasers at four different wavelengths, the 924 nm laser creates the largest lipid liberation, protein coagulation and fibrous tissue area. The following table shows the obtained values:

The coagulated tissue volume using the 924 nm wavelength is 33 times higher than for 980 nm, approximately 6 times greater than 1,064 nm and 2.7 times higher than with 1,320 nm.

If the comparison is made on the liberated lipid volumes, laser light at 924 nm is 10 times more effective than at 980 nm, four times more than at 1,064 nm and 2.5 more than 1,320 nm.

Safety at 924 nm:
It is vital to prevent burning the skin for maximum safety in the treatment. Given that 924 nm has twice the fat absorption specificity of the value of water (the skin predominantly contains water), this wavelength is shown to be safer for working with areas close to the dermis.

The following figure shows the same image previously displayed but at 2 mm under the dermo-hypodermic junction which is marked in the image by a continuous horizontal line.

The dermis has significant damage at 1320 nm, however there is no dermal lesion with the other laser outputs.

The energy of the light for all the wavelengths was then adjusted to reach the same level of effectiveness in melting the fat (same volumes of damaged adipose tissue) than for the level achieved with 924 nm at 20 W. In this case, all the wavelengths except 924 nm caused dermal damage.

This table shows the degree of power for each wavelength to achieve the same volume of damaged fat tissue that 924 nm at 20 W. In this table, the percentage of damage shown is for a 1.5 mm thick dermis. It has been proven that at 1320 nm there is complete damage to all the dermis, given that at a temperature over 50 ºC it extends over the dermo-hypodermic junction more than 1.5 mm. In contrast, due to the selectivity of fat absorption for 924 nm, there is no damage to the skin at this wavelength.

It should be noted that while there is no appreciable skin damage with 1064 nm at 20 W, the amount of total volume of destroyed fat tissue is four times less than at 924 nm. So, it seems that 924 nm is the safest and most effective wavelength for the “melting” of fat.

The above table shows that a considerable increase in power is necessary at 980, 1064 and 1320 nm to reach the fat melting effects achieved with 924 nm. In any case, increases in the power of other wavelengths to achieve the liberation of lipids as effectively as with 924 nm lead to an increase in the risk of damage to the skin and other high water-content structures.

Finally, in the case of haemostasis, it should be taken into account that both the 924 nm and 975 nm laser are easily absorbed by the blood compared with other wavelengths. The following table displays the absorption coefficients for blood with 15 gm/dL of haemoglobin at the four wavelengths:

The flexibility of 975 nm:

Emission at 975 nm is a good choice to supplement the 924 nm effect on the fat tissue, above all for treatment of fat tissue after tumescent infiltration. This wavelength was chosen because it facilitates a greater water absorption rate to ease penetration in the tissue and sufficient volumetric heating. Light at 975 nm is highly selective of water as opposed to lipids, its absorption rate for water is 10 times its rate for lipids.

By selecting the wavelengths and modulating the output power of each, one with high specificity for fat (924 nm) and another with high specificity for water (975 nm), each physician can adjust the ideal combined type of delivery for each case.

For example:

For slightly tumescent fat, 924 nm alone can be used.

In the case of significant tumescence or specific heating of the dermis to work on skin tightening, 975 nm can be used to make the best of absorption of this light by the structures high in water content.

Moreover, the following figure shows how the total volume of melted fat tissue increases when a 975 nm wavelength is added to the 924 nm applied to hydrated fat (hydration increase of 30% fat tissue is the correct degree of over hydration) with mixed wavelengths of 924 nm + 975 nm. This proves that a system which combines the two wavelengths, each selective for one of the two primary chromophores, is optimised with great flexibility to treat a large variety of clinical situations.

Laser Lipolysis of Fat

Continuous versus pulsed output

James J. Childs Pd D, Mikhail Smirnovs Pd D, Alex Zelenchuk PhD, and Gregori Antshueler Pd, D Sc

• Palomar has recently introduced a new product, the Aspire® Platform with the SlimLipoTM Diode laser module, a technological advance in laser-assisted lipolysis. The SlimLipo Laser Diode Module facilitates the use of two wavelengths, each with continuous output and independent power control. These wavelengths ease “fat melting” in a selective and safe manner: 924 nm to reach the triglycerides and fatty acids in the interior of the adipocytes, more commonly known as fat cells , and 975 nm to selectively reach the water content in the connective tissue and the dermis.

• Fat melting is understood as the process of lipid liberation from the adipocytes and the reduction of viscosity of the lipid for simpler aspiration. The liberation of lipids also continues after the laser lipolysis treatment from the damaged adipocytes remaining intact from the adipose tissue during the recovery postoperative.

• Adipocytes are completely full of lipids, the stored triglycerides are encapsulated in a fine covering of a dense weave of lipids and proteins (with a structure similar to that of caviar). Lipids are in a liquid state, normally at a body temperature of 37 ºC, although they have a somewhat viscid structure. Selective heating during laser-assisted lipolysis damages the external covering and heats the lipids, originating less viscosity which eases aspiration. Other secondary benefits of this system is that it reduced trauma in other tissue and improves skin laxity.

Wavelength selectivity

• There are four wavelengths that are preferentially absorbed by human fat in comparison with the absorption of the dermis or interstitial water. These four wavelengths are 924 nm, 1208 nm, 1715 nm and 2308 nm. With each of these, human fat can be heated at temperature several times higher than the surrounding dermis or the interstitial water thanks to its selectivity.

• In any case, 924 nm laser differs from other wavelengths in its fat absorbency ability. Light at 924 nm is absorbed less by the fat in comparison with the other wavelengths however its absorption rate is sufficient to achieve fat melting at safe power levels. Lower absorption allows for better penetration of light in the fat tissue and homogeneous heating of a larger area than is possible with wavelengths with higher fat absorption ratios. Emission at 924 nm greatly facilitates the melting capacity of the fat at safe and effective temperatures.

Output mode: Continuous versus Pulsed

•For the references to pulsed lasers, the Neodymium:YAG laser was used for laser-assisted lipolysis. The laser output for all the short pulse Neodymium:YAG lasers is typically 150 to 200 microseconds. The first studies carried out on the destruction of fat tissue with laser date from the 1990s, using laser outputs of up to 60 W. The most recent Neodymium:YAG laser is used in dentistry as a soft tissue and coagulation tool, as well as for dental canal sterilisation.

• These short pulse devices produce large energy peaks but with low penetration in targets with water since this is its primary chromophore. This is important in areas of fine epithelium such as the gum mucous membranes. The first system was developed by Sunrise Technologies, Inc (USA), followed by a similar prototype from Deka (Italy). Afterwards, a similar short pulse at 6 W Neodymium:YAG unit was launched. This device was followed by a version at 10 W and later another of 18 W. More recently, several laser companies have added laser systems at 1320 nm and 1440 nm to this technology. As well as combined outputs of 1320 nm and 1064 nm. Both the selected wavelength as well as the method used to emit laser power to the fat (output power, for example) play a highly important role in the effectiveness of the laser and its ability to melt the fat.

Application of physical theories used (for the selection of the best laser output method)

Extended Theory versus Selective Photothermolysis Theory

• A laser system should use the appropriate wavelength that reaches the laser lipolysis, lipid, water and haemoglobin chromophores. The method of delivering the power is equally important, which should adapt to optimise its effect on the fat and guarantee safe treatment. With the Palomar Aspire Platform and the SlimLipo Diode Laser handpiece, the mean output power is equal to the peak power given that it uses Continuous Output. In a short pulse laser system (Neodymium:YAG, for example), the power peak is much higher than the average power output. The mean power output is much more important than the peak power in laser lipolysis treatments, we shall see why following.

• In the adipose tissue, the adipocytes contain more than 90% fat and are grouped closely in the shape of lobules. There are structures interwoven between the lobules such as septa, nerves, vessels, capillaries and elements of connective tissue which are basically made up of water. The structures high in water content are arranged in the fat tissue in a more uniform manner than in the fat lobules.

• When a short pulse laser that is absorbed by water is used, with a limited target and very high power peaks, only one part of the energy is absorbed in these small targets. With the repetitive pulsed emission, the small parcels of energy slowly filter into the interior of the areas rich in fatty material around them via the phenomena of conduction and convection.

• While a short pulse Neodymium:YAG laser is used, reaching high temperatures, these temperatures are only reached in these structures high in water that are relatively small and only if they are sufficiently close to the optical fibre tip, where the power density reached is high. This type of heating is described in the Extended Theory of Selective Photothermolysis, given that the main aim of laser lipolysis is the destruction of fat, Neodymium:YAG is not appropriate due to the high amount of fat tissue to be heated with this method. This theory is appropriate when the target (adipocytes) is not significantly predominant faced with the heater that in this case is the water, since the conduction and convection of heat are slow and scarcely controlled processes.

• On the other hand, when a laser specifically absorbed by the fat is chosen, which is not too intensely absorbed by it, such as 924 nm, the fat tissue heats in a more uniform manner. The achievement is that both the adipocytes and the laser light are homogenously distributed throughout large areas. The lipids of the adipocytes are heated directly by this laser light through a process called "relative heating". Given that the thermal relaxation time of these large volumes of hot adipocyte lobes is long (more time is used in cooling the larger the heated structure is according to cooling through heat diffusion to structures that have not been heated by emission), the continuous wave delivery is more efficient and with safer power levels for fat tissue melting.

• This could be explained with the Selective Photothermolysis Theory, with refers to the heating by energy. It is a safer and more homogenous heating method. Considering that the SlimLipo handpiece is in constant motion through the adipose tissue during treatment, no part of the irradiated tissue receives real laser light of several hundred milliseconds which is much shorter than the thermal relaxation time of the irradiated tissue volume. This describes how it functions in the adiabatic limit (thermodynamic process that is produced with no heat interchange with the exterior). This is the ideal mode of increasing tissue temperature.

In summary, the adipocytes are closely grouped in the fat tissue in the shape of larger lobes with a high lipid content in comparison with the other chromophores such as water. The degree of temperature needed to achieve melting of the adipocytes is determined by the constant power output in lengths of seconds and not milliseconds or microseconds. In this case, it is also important to deliver the power as gently as possible but fast enough to achieve sufficient increase in temperature of the lobes containing the lipids to melt the fat.

Cavitation and bubble formation

• A photomechanical or photo acoustic effect has been attributed to the Neodymium:YAG laser in the process of fat tissue destruction, so that a mechanical impact is produced in the area surrounding the exposed area. Damaged induced by cavitation or vaporisation originates from a purely mechanical effect of the vibration produced during the formation of the bubbles and their collapse. In any case, given that the adipose tissue is not rigid and that the energy required to achieve efficiency is close to the delivery area, most of the destroyed fat cells are in a reduced area, around the optical fibre. Furthermore, only one part of the laser power is converted in mechanical vibration, the rest of the power is converted into heat. The Neodymium:YAG laser pulse is the ideal method for achieving cavitation of the fat tissue. As mentioned before, the high peaks of this laser produces a very abrupt increase in the temperature of water found in the immediate proximity of the fibre. The greater capacity of generating bubbles with this laser (1064) in the presence of water than with diode laser has been proven.

What do the bubbles mean?

• Basically, that the adipose tissue contains liquids (lipids and water). When discussing this subject, the amount of power needed to change the state of a liquid to gas should be quantified (bubble formation). The heating of a liquid that exceeds boiling point requires much less power than that needed to vaporise the same volume of water. Highly intense formation of bubbles around the tip of the optical fibre means that most of the heat remains localised in the area of the fibre and that very little power is spread outside of the surrounding area. There is no heat diffusion.

• The bubble imply the reach of very high temperatures in the medium, much greater than those needed to reach fat tissue melting. The excess power in this area exists as thermal energy but it can only be transmitted beyond the laser output through thermal conduction or convection, which are slow and imprecise processes in a medium such as fat. The excess heat can also spread and heat the structures that should not be heated.

• In contrast, with an optimised continuous output, at an appropriate wavelength and with energy that heats the subdermal fat tissue just above the precise temperature required for the destruction of the external envelope of lipidic vacuole (LCI), which is 50º C and attaining a coagulation of the fibrous matrix temperature (60º C) is sufficient. This is achieved without energy loss in the formation of bubbles, sound waves or plasma generation. A continuous laser wave is safer for the tissue because the increase in temperature on the tip of the fibre never reaches more than 100º C while with a short pulse laser, the temperature in the area surrounding the fibre can reach several hundred degrees. Furthermore, very abrupt and high temperature increases (1500º C) could cause rupturing, carbonisation and melting of the optical fibre itself. The result could be an incandescent element that would significantly reduce the surface of the treated area. The size of this area is conditioned by heat conductivity of the hot tip and not by the penetration of laser light.

Optical fibre design

• Besides the continuous delivery and the selection of wavelength, an adequate design of the optical fibre itself could be decisive in the distribution of power in the fat tissue. Fibres with small diameters are ineffective for in-depth heat delivery since the exit of the optical fibre could have too much divergence.

• The SlimLipo fibre facilitates a lower average power output as well as having a conical design that reduces tissue damage. There are no angles or rugged edges that could latch onto the fibrous tissue.

The unit consists of a series of components and resources:

Some of the interesting features of the unit are related to the development of its handpiece:

- The unit’s handpiece is designed to liberate fat through photo-thermolytic heating, through the advanced design of its tip and the assorted wavelengths that the unit employs.

- The handpiece's angles are all rounded to minimise the mechanical damage observed with other handpieces.

- The liberation of power from the optical tip is designed to avoid the high temperature peaks in its delivery and facilitate immediate diffusion of the energy to surrounding tissue, which allows for more homogenous and gentler heating which eases lipolysis and the subsequent extraction of fat. This also prevents abrupt over heating peaks in the tissue with the generation of carbonisation and bubbles. Heating with SlimLipo is more controlled and homogenous through continuous delivery or in long pulses.

- These features prevent overheating in the region and at the same time facilitate the disruption effect of the adipocytes and coagulation of the surrounding tissue.

- The availability of delivery at 924 nm that is absorbed more specifically by the fat tissue.

- The selection of this wavelength facilitates better selectivity by the fat tissue while providing optimal penetration for maximum volumetric heating of the fat tissue surrounding the optical fibre tip. Evidence of the liberation of lipids is observed in the oily stage of aspiration.

- This heating of the fat tissue also produces heating by diffusion of the collagen fibrous septa of the subdermal fat tissue which facilitates the effect of tissue contraction on this level.

- Delivery at 975 nm with a predominant attraction to the water, more abundant in the dermis offers very complete therapeutic alternatives. This delivery optimises its effectiveness in the presence of hydrated fat through tumescent infiltration. It is possible to work immediately under the dermis to achieve heating and retraction.

- The presence of less mechanical trauma in the fat tissue with preservation of the septal trabecula, as well as its heating facilitates the phenomena of skin contraction on several planes as well as the dermal plane. The respect of the fibrous structures of the fat tissue seems to be of importance in this sense to reach maximum skin contraction.

- The 924 nm delivery facilitates liberation of the lipids from the adipocytes and 975 nm delivery produces an increase in the effectiveness of the laser light and the effect on the fat tissue in a hydrated state after tumescent infiltration, while at the same time being able to heat the dermis.

- Both are also partially absorbed by the capillaries, which causes less bleeding the area. With a shorter recovery period and less oedema.

We have a tactile display which allows us to select the amount of total power delivered by unit of volume at 924 nm and 975 nm according to the characteristics of the area to be treated.

One inch equals 2.54 cm.

Hacemos cuentas sobre 2.5, 2.5 x 2.5:6.25 cm2.

Therefore, the calculations are based on 6.25 cm2, 100 cm2 and 625 cm2

- For a surface of 6.52 cm2, the suggested power used is between 0.1 and 0.25 kJ: 100 and 250 J

- For a surface of 100 cm2, the total power suggested is 1.6 to 4 kJ: 1,600 J and 4,000 J

- For a surface of 625 cm2, the total power suggested is 10 to 25 kJ, 10,000 and 25,000 J.

For the introduction of this energy, different power levels can be used:
7 W
10 W
15 W
20 W
22 W

And the total delivery time will be less as the energy used increases. To treat an area of 100 cm2 with a fluence of 20 W at maximum power (4 kJ) 3.3 minutes are required for delivery. To deliver 25,000 J in an area of 625 cm2 with maximum output at 22, 18.9 minutes are required.

* Area of approximately 600 cm – 18,000 J with mixed delivery limit 18 W with 924 nm and 6 W with 975 nm.

* For this same area measuring 600 cm2 with the two outputs, 6 W with 924 nm and 6 W with 975 nm, returning another 12,000 J.

* We are introducing 30 kJ in an area of 600 cm2.

* Combined delivery power is between 10 and 23 W with a fibre of 1.5 mm.

* Combined delivery of 924 nm is between 10 and 15 W with a fibre of 1.5 mm.

* Combined delivery of 975 nm is between 5 and 7 W with a fibre of 1.5 mm.

* The number of passes at 2.5 cm per second at maximum output would be, with a fibre of 1.5 mm:

With a 1.5 mm fibre
- 924 / 975 nm: 3 to 6
- 924 nm: 3 to 6
- 975 nm: 5 to 10

The tumescent infiltration that is being used is approximately one litre of infiltration for an area of 600 cm2.