Knee High

By: Dr Ayoubi
Created on 09th November 2009

It is rumoured that Demi Moore had her knees done and now it is possible to resolve the problem of lumpy, bumpy and dimply knees with laser knee sculpting. Dr Ayoubi of the London Medical & Aesthetic Clinic, who was the first person in the UK to perform this procedure, explains

The challenge we faced as plastic surgeons over the years has been how to deal with fat removal because we have two different types of fat under the skin. We have deep fat (or loose fat) and superficial fat which is just under the skin layer; from a structural point of view these two fats are very different.

Initially, we used a surgical technique for fat removal, where we would lift the skin, remove the fat and then replace the skin. The advantage of that technique was that you could see what you were doing, could remove a lot of fat and could tighten the skin as it was replaced.

The problem was that you would end up with scarring. This might be acceptable in a tummy tuck but doesn't work if you're doing the inner or outer thigh or the knee as there was nowhere to hide the scar.

As a result, liposuction was introduced about 30 years ago and this became the accepted technique. A small incision is made and the fat sucked out through this incision. The challenge is that you can only suck out the deep fat because it is not possible to suck out the superficial fat with traditional liposuction for two reasons.

Unlike the deep fat, the superficial fat is extremely vascular which means it has a strong blood supply and the patient would bleed significantly if you tried to tackle it. Also you could risk damaging the skin from the inside which could result in cellulite or a collapsed effect in the skin.

So there were a number of techniques developed that tried to deal with superficial fat such as radiofrequency. These techniques were combined with traditional liposuction but they didn't have the desired result because the energy was aimed at the surface of the skin and you risked damaging the skin before you reached the target.

So SmartLipo was developed; there are two lasers - one targets the fat membrane and the other laser targets the water and blood vessels. This laser cauterises the blood vessels and also targets water so it dehydrates the area which helps with the tightening effect. Another effect of the laser energy is to create an inflammation which will give you further skin tightening effect.

How it works
The laser sculpting is done under local anaesthetic, so there is no need for a general anaesthetic or overnight stay. A very small incision of one or two millimetres is made which will fade away completely and local anaesthetic is injected into the incision. Then in the same place we insert a needle containing the laser fibre and tackle the deep fat. The laser doesn't destroy the fat cell; it works by disturbing the structure of the cell and the fat leaks away as a liquid.

Then we change the setting on the machine and, using the same two lasers, we tackle the superficial fat. This is where the revolution comes as this is the first time we can remove the fat under the skin without causing any of the associated problems.
The laser energy fractures the fat cells and then we suction away most of the fat. We don't need to do the aggressive suction associated with traditional liposuction because the fat is very liquid and has been heated up.

We used to leave the fat in the areas such as the knees to vacate the body naturally through the lymphatic system, but I now suction most of it out. Otherwise you are relying on the patient to follow up the procedure with exercise and a healthy diet and not all patients do this. They also don't want to wait for three to four months to see the results. It is possible for them to see the results straightaway and feel the skin tightening effect working as they are lying there.

About 50 to 60 per cent of the fat is removed at the time of the procedure and the rest is left to drain out through the lymphatic system. There are two reasons for this. If I took it out all at once then you risking leave the patient with a big dip under the skin.

The second reason is that we are doing it under local anaesthetic and it would be very painful if I went too close to the muscle and can also cause bruising. There is no need to be aggressive because the rest will clear out of the system naturally - within four weeks time you'll have amazing results.

It is important to emphasise how little downtime there is associated with this procedure. Patients can go to work the next day and can start going to the gym within a week whereas traditional liposuction can mean a week off work and a lot of discomfort.
CS&AM