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      Remodelación de la grasa localizada con ultrasonidos de baja frecuencia, intensidad media y múltiple focalización: conclusiones preliminares Translated title: Abdominal fat remodeling using low frequency, medium intensity ultrasounds and multiple focalization: preliminary conclusions

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          Abstract

          RESUMEN Introducción y objetivo. Los ultrasonidos focalizados de alta intensidad (HIFU) producen lisis del adipocito por calor con la finalidad no invasiva de remodelar la grasa corporal localizada. Observamos de forma prospectiva los efectos de un sistema que emite ultrasonidos de baja frecuencia, intensidad media y múltiple focalización, y sus posibilidades de disminución y remodelación de los acúmulos de grasa subcutánea del abdomen. Material y método. Presentamos el primer análisis técnico específico de un sistema de emisión diferente a los clásicos HIFU, y los resultados en 10 pacientes entre 24 y 56 años e IMC<28, que recibieron 3 sesiones de tratamiento en abdomen con idéntico protocolo y separadas por 3 semanas. Evaluamos resultados finales a los 3 meses de la tercera sesión, comparando con el estado al inicio del tratamiento. Medimos con plicometría el contorno abdominal y el grosor del pliegue graso. Comparamos fotografías estandarizadas y obtuvimos muestras para microscopía en 3 tiempos de control del estudio empleando tinciones de hematoxilina, tricrómico de Masson e inmunohistoquímica. Implementamos cuestionarios para que pacientes, terapeuta y 2 médicos ajenos al estudio evaluaran resultados. Resultados. El control específico de las características técnicas del sistema empleado indicó que, a diferencia de los HIFU, la emisión es de ultrasonidos de baja frecuencia, intensidad media y múltiple focalización. En las fotografías, plicometría y circunferencia abdominal encontramos reducción significativa del volumen abdominal. Las respuestas a las preguntas de los cuestionarios fueron positivas en cuanto a resultados, tanto por las pacientes como por los médicos evaluadores y la terapeuta que realizó los tratamientos. En las histologías observamos cambio de la forma típica del adipocito y lisis de su membrana tras la primera sesión de tratamiento. Identificamos desarrollo de nuevo colágeno y mejoría de la elastosis, significativas de mejoría de la tensión en las áreas tratadas. De las 10 pacientes, 9 confirmaron estar muy satisfechas y 1 satisfecha con la reducción del contorno y volumen del abdomen que se mantuvo 3 meses después del último tratamiento. No observamos efectos adversos importantes salvo ligero eritema y edema tras las sesiones, que desapareció a las 24 horas. Conclusiones. El sistema empleado, con su particular modo de emisión y actuación sobre el tejido subcutáneo, resultó eficaz en la remodelación de la grasa localizada. Consideramos que además puede emplearse como tratamiento no invasivo para complementar las liposucciones quirúrgicas.

          Translated abstract

          ABSTRACT Background and objective. High intensity focused ultrasound (HIFU) produce fat cell lysis during the treatment of subcutaneous tissue due to thermal effect. In this study, an ultrasound system of low frequency, medium intensity and multiple focalizations was used for reduction and remodeling of the subcutaneous fat layer. Methods. This study presents the first specific technical analysis of a system which differs from the traditional concept of HIFU energy emission. Ten patients received 3 sessions of treatment, following the same protocol, 3 weeks apart from each other. Patients ages were between 24 and 56 with a BMI <28. Final control was done 3 months after the third session to compare the results with the status at the beginning of treatments. Abdomen circumference was measured, as well as the fat fold using a plicometer. Equal photographs of before and 3 months after the last treatment session were compared. Samples were obtained for microscopic analysis at the 3 points of control of the study, stained with hematoxilin, Masson trichromic and immuno-histochemical techniques. Questionnaires were implemented for evaluation of results by patients, the nurse who did the treatments and 2 doctors estrange to the study. Results. Plicometry and abdominal circumference measurements found a significant objective and subjective reduction in the abdomen volume, which was also verified by comparing photographs. Histology following treatment showed adipocite changes in shape and membrane lysis. New collagen formation was present in samples taken before the third treatment session. At this control, dermis showed better condition regarding elastosis which was notable less. Patients' satisfaction degrees coincided with that of the nurse and the 2 doctors. Nine of the 10 patients were very satisfied and 1 was satisfied with the reduced circumference and decreased abdomen volume achieved. Results were maintained 3 months after the last session. No significant adverse effects were observed, only slight erythema and edema at the end of sessions, which disappeared within 24 hours. Conclusions. The system used in the study, with its particular mode of emission and action on fat tissue, is efficacious in decreasing and remodeling localized fat accumulation, and could be used as a non-invasive complementary treatment to surgical liposuction.

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          Most cited references21

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          The mechanical properties of human adipose tissues and their relationships to the structure and composition of the extracellular matrix.

          Adipose tissue (AT) expansion in obesity is characterized by cellular growth and continuous extracellular matrix (ECM) remodeling with increased fibrillar collagen deposition. It is hypothesized that the matrix can inhibit cellular expansion and lipid storage. Therefore, it is important to fully characterize the ECM's biomechanical properties and its interactions with cells. In this study, we characterize and compare the mechanical properties of human subcutaneous and omental tissues, which have different physiological functions. AT was obtained from 44 subjects undergoing surgery. Force/extension and stress/relaxation data were obtained. The effects of osmotic challenge were measured to investigate the cellular contribution to tissue mechanics. Tissue structure and its response to tensile strain were determined using nonlinear microscopy. AT showed nonlinear stress/strain characteristics of up to a 30% strain. Comparing paired subcutaneous and omental samples (n = 19), the moduli were lower in subcutaneous: initial 1.6 ± 0.8 (means ± SD) and 2.9 ± 1.5 kPa (P = 0.001), final 11.7 ± 6.4 and 32 ± 15.6 kPa (P < 0.001), respectively. The energy dissipation density was lower in subcutaneous AT (n = 13): 0.1 ± 0.1 and 0.3 ± 0.2 kPa, respectively (P = 0.006). Stress/relaxation followed a two-exponential time course. When the incubation medium was exchanged for deionized water in specimens held at 30% strain, force decreased by 31%, and the final modulus increased significantly. Nonlinear microscopy revealed collagen and elastin networks in close proximity to adipocytes and a larger-scale network of larger fiber bundles. There was considerable microscale heterogeneity in the response to strain in both cells and matrix fibers. These results suggest that subcutaneous AT has greater capacity for expansion and recovery from mechanical deformation than omental AT.
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            High intensity focused ultrasound: physical principles and devices.

            High intensity focused ultrasound (HIFU) is gaining rapid clinical acceptance as a treatment modality enabling non-invasive tissue heating and ablation for numerous applications. HIFU treatments are usually carried out in a single session, often as a day case procedure, with the patient either fully conscious, lightly sedated or under light general anaesthesia. A major advantage of HIFU over other thermal ablation techniques is that there is no necessity for the transcutaneous insertion of probes into the target tissue. The high powered focused beams employed are generated from sources placed either outside the body (for treatment of tumours of the liver, kidney, breast, uterus, pancreas and bone) or in the rectum (for treatment of the prostate), and are designed to enable rapid heating of a target tissue volume, while leaving tissue in the ultrasound propagation path relatively unaffected. Given the wide-ranging applicability of HIFU, numerous extra-corporeal, transrectal and interstitial devices have been designed to optimise application-specific treatment delivery. Their principle of operation is described here, alongside an overview of the physical mechanisms governing HIFU propagation and HIFU-induced heating. Present methods of characterising HIFU fields and of quantifying HIFU exposure and its associated effects are also addressed.
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              Fat liquefaction: effect of low-level laser energy on adipose tissue.

              Low-level laser energy has been increasingly used in the treatment of a broad range of conditions and has improved wound healing, reduced edema, and relieved pain of various etiologies. This study examined whether 635-nm low-level lasers had an effect on adipose tissue in vivo and the procedural implementation of lipoplasty/liposuction techniques. The experiment investigated the effect of 635-nm, 10-mW diode laser radiation with exclusive energy dispersing optics. Total energy values of 1.2 J/cm(2), 2.4 J/cm(2), and 3.6 J/cm(2) were applied on human adipose tissue taken from lipectomy samples of 12 healthy women. The tissue samples were irradiated for 0, 2, 4, and 6 minutes with and without tumescent solution and were studied using the protocols of transmission electron microscopy and scanning electron microscopy. Nonirradiated tissue samples were taken for reference. More than 180 images were recorded and professionally evaluated. All microscopic results showed that without laser exposure the normal adipose tissue appeared as a grape-shaped node. After 4 minutes of laser exposure, 80 percent of the fat was released from the adipose cells; at 6 minutes of laser exposure, 99 percent of the fat was released from the adipocyte. The released fat was collected in the interstitial space. Transmission electron microscopic images of the adipose tissue taken at x60,000 showed a transitory pore and complete deflation of the adipocytes. The low-level laser energy affected the adipose cell by causing a transitory pore in the cell membrane to open, which permitted the fat content to go from inside to outside the cell. The cells in the interstitial space and the capillaries remained intact. Low-level laser-assisted lipoplasty has a significant impact on the procedural implementation of lipoplasty techniques.
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                Author and article information

                Journal
                cpil
                Cirugía Plástica Ibero-Latinoamericana
                Cir. plást. iberolatinoam.
                Sociedad Española de Cirugía Plástica, Reparadora y Estética (SECPRE) (Madrid, Madrid, Spain )
                0376-7892
                1989-2055
                March 2020
                : 46
                : 1
                : 85-98
                Affiliations
                [1] orgnameVilafortuny Laser Centre Emiratos Árabes Unidos (UAE)
                [2] orgname
                [3] orgname
                [4] orgname
                Article
                S0376-78922020000100013 S0376-7892(20)04600100013
                10.4321/s0376-78922020000100013
                01a3e540-dbc3-42fe-b58c-1b7bbaeaac88

                This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

                History
                : 16 November 2019
                : 03 February 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 25, Pages: 14
                Product

                SciELO Spain

                Categories
                Tratamientos no quirúrgicos

                Tejido graso subcutáneo,Adipocyte,Low-frequency ultrasounds,Ultrasonidos no focalizados,Subcutaneous fat tissue,Ultrasonidos media intensidad,Ultrasonidos baja frecuencia,Medium-intensity ultrasound,Non-focused low-frequency ultrasound,Adipocito

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