Use of Thulium Fiber Laser for Precise Dissection in Facial Rejuvenation Surgery

Summary:

In the current era of advanced surgical technologies, new methods are being used in all aspects of surgery that enhance safety and improve dissection and patient outcomes by minimizing tissue trauma, ensuring hemostasis, and reducing the postoperation rehabilitation period. In this article, we discuss the use of Urolase+ surgical thulium fiber laser device within the context of plastic surgery for the dissection of soft tissues in a female patient, undergoing face lift, brow lift, blepharoplasty, and cheiloplasty operations, which, according to our knowledge, has never been done before.

The field of plastic surgery is constantly expanding and applying new technological methods, using new techniques, robots, and other advanced technologies to ensure safety and superior outcomes.¹

One aspect of modern surgical techniques is the use of lasers for dissection instead of traditional methods such as a scalpel, scissors, or electrocautery. Urolase+ is a thulium fiber laser that combines a unique wavelength of 1.94 μm with its new optimized pulse mode. This type of laser is particularly effective for procedures involving both soft tissues and stones of the genitourinary system.² The implementation of this project is aimed at optimizing the surgical stage of soft tissue dissection, particularly during procedures such as face lift. Laser tissue dissection allows for precise and careful dissection with minimal recovery time. According to global data, lasers possess hemostatic properties,³ which reduce the risk of hematomas in the early postoperative period. Additionally, the use of lasers minimizes mechanical trauma to the skin flap, reducing the risk of ischemia and necrosis of the tissues.

Despite the complexity of the device, we conducted a series of experiments on laboratory rodents with histological analysis in a related article, using the laser dissection method, which proved the effectiveness of the laser.

Additionally, we conducted multiple trials in vitro as well as in vivo, which resulted in success, matching the expected outcomes, such as precision in dissection as well and good hemostasis and supporting the use of such lasers within the field of plastic surgery. All patients signed informed consent (as approved by the local ethics committee of Sechenov University, protocol no. 02-23, dated January 26, 2023).

Finally, we have registered patents for this method: no. 2024128779/14 on September 27, 2024, and no. 2024128781/14 on September 27, 2024. The patent approval underscores the novelty and clinical significance of our approach, as verified by the successful outcomes of the trials.

CLINICAL CASE

A 48-year-old woman consulted the Department of Plastic Surgery at I.M. Sechenov First Moscow State Medical University, raising concerns about visible signs of facial aging. She reported being unhappy with sagging facial skin, drooping eyebrows, excess skin around both the upper and lower eyelids, and diminished lip fullness (Figs. 1 and 2).

Fig. 1.

Anteroposterior view before the operation.

Fig. 2.

Lateral view before the operation.

Her past treatments included several photothermolysis procedures and the use of dermal fillers. After evaluation, the team opted to use a thulium fiber laser for the dissection of soft tissues. The patient wanted to address these issues by improving facial proportions and enhancing the aesthetics of her eyebrows and eyelids and the appearance of her lips.

Upon physical examination, moderate eyebrow ptosis, excess upper eyelid skin, under-eye bags, visible tissue laxity in the lower face with early signs of jowls, and age-related lip thinning were noted. The surgical plan included a face lift, upper and lower blepharoplasty, brow lift, and cheiloplasty.

The patient was placed in a supine position on the operating table. The tissues were infiltrated using a tumescent solution containing adrenaline and lidocaine. A thulium fiber laser was used for precise tissue dissection with an irrigator using a ringer solution to cool down the tissues. The laser was used for upper and lower blepharoplasty, brow lift, face lift, and cheiloplasty in different settings depending on the area operated. (See Video 1 [online], which displays the clean dissection during brow lift with great hemostasis.) Blepharoplasty was performed using 13 V, 0.2 J, with 75-Hz mode; cheiloplasty used 8 V, 0.1 J, with 80-Hz mode; and face lift and brow lift used 15 V, 0.2 J, with 75-Hz mode.

During the dissection process, fibrotic tissue was noted due to the previously done cosmetic procedures. Compared with traditional methods such as scalpel, scissors, or electrocautery, the laser ensured minimal bleeding with good hemostasis control throughout all procedures allowing for fast and clean dissection, providing efficient and controlled tissue manipulation. (See Video 2 [online], which displays clean dissection after face lift with great hemostasis following thulium fiber laser dissection.)

The laser was particularly useful in the delicate areas of the eyelids and lips, where its precision provided controlled reshaping of tissues, minimized tissue trauma and carbonization, ensured good hemostasis, and reduced operating time with rapid recovery.

The surgery was successful: blepharoplasty was completed in 25 minutes, cheiloplasty in 20 minutes, brow lifting in 30 minutes, and face lifting in 80 minutes. No postoperative complications were observed, and the patient was discharged the following day. The patient was monitored for a month postoperatively. The standard follow-up protocol includes evaluations on postoperative days 1, 3, and 7; week 2; and month 1. However, in this case, additional follow-up appointments were conducted as needed. The rehabilitation period was short, and follow-up examinations showed no signs of complications (Figs. 3, 4).

Fig. 3.

Anteroposterior view after the operation.

Fig. 4.

Lateral view after the operation.

DISCUSSION

In plastic surgery, the only case in which the CO₂ laser was used was in 2014, by Italian plastic surgeons who used the DEKA SmartXide² CO₂ laser for skin dissection within the context of blepharoplasty, which shortened the recovery time, improved the rejuvenation effect, and demonstrated satisfactory and long-term results. The laser system allows for precise, controlled, and minimally invasive interaction with soft tissues.⁴

CO₂ lasers are used in dentistry to reduce pain, prevent recurrence, remove excess benign formations, correct ligaments on the lips and tongue, and achieve hemostasis of soft tissues.⁵

Thulium fiber lasers have been used in different fields, such as in urology to treat benign prostatic hyperplasia, bladder tumors, and lithotripsy^2,6; in gastroenterology for partial liver resection and liver tissue incisions³; and in cosmetic dermatology to eliminate pigmented spots, spider veins, and the early signs of facial aging,⁷ showing promising results and providing good hemostasis, precision, and excellent tissue separation and results.

The thulium fiber laser demonstrated superior performance around human tissues when compared with other lasers, offering better hemostasis, less oxidation, less soft tissue burning, and more precise cutting.

The 1927-nm thulium laser falls within a specific range where water absorption is very high, enabling precise soft tissue dissection with minimal surrounding damage. Its shallow thermal effect reduces collateral injury while ensuring effective coagulation, and its wavelength allows for fine, precise cutting.

Due to the novelty of the technique, further clinical application is necessary to optimize its use in the field. The results of the use of thulium fiber laser are promising in aesthetic plastic surgery.

CONCLUSIONS

Thulium laser dissection in aesthetic plastic surgery has proven to be viable when used correctly, as it provides multiple benefits over traditional dissection methods such as a scalpel, scissors, or electrocautery due to its precision and good hemostasis, leading to a reduction in postoperative complications, as well as minimizing trauma to the skin flap.

The authors concluded that laser dissection provides numerous advantages and presents a safer alternative to traditional methods of dissection, especially in patients with prior surgical procedures or cosmetic interventions that result in fibrotic tissues that are hard to dissect using traditional methods.

This is the first clinical trial using the innovative method of thulium fiber laser dissection in the field of plastic surgery that has the potential to improve surgical results as well as decrease the postoperative rehabilitation period, ensuring both safety and aesthetically pleasing results.

DISCLOSURE

The authors have no financial interest to declare in relation to the content of this article.

PATIENT CONSENT

The patient provided written consent for the use of her image.