Pilot Study: Lipolifting: A Minimally Invasive Facial and Body Contouring Technique

Abstract

Background:

Subcutaneous lasers represent a paradigmatic change in aesthetic procedures and have increased the demand for effective and minimally invasive treatments for fat compaction and skin sagging, revolutionizing face and body contouring techniques. Selective photothermolysis induced by the 1210-nm lasers can modulate fat without inducing damage to the surrounding tissues.

Methods:

This pilot study evaluated a minimally invasive technique using a subcutaneous 1210-nm laser for face and body contouring using a 3-dimensional imaging technique.

Results:

This study evaluated 5 facial and 10 abdominal body contouring cases using the minimally invasive lipolifting technique in a single session. Patients, predominantly woman (80%) with a mean age of 36 years, were assessed before procedure and at least 90 days after procedure. Facial treatments demonstrated average volume reductions of 2.06 mm³ in the cheek, 3.02 mm³ in the jowl, and 1.42 mm³ in the jawline regions. Among body contouring patients, most were classified as overweight and exhibited an average waist circumference reduction of 3.81 cm (SD = 1.86 cm). All patients rated their aesthetic outcomes as “very much improved” on the Global Aesthetic Improvement Scale throughout the follow-up period.

Conclusions:

The 1210-nm laser technique proved to be safe and effective in enhancing facial and body contours through adipose tissue compaction. Additionally, it reduced skin laxity by inducing a regenerative response, promoting the differentiation of adipose-derived mesenchymal cells into fibroblasts, and stimulating collagen production.

Takeaways

Question: The study addressed a minimally invasive technique using a 1210-nm laser for improving facial and body contours.

Findings: The 1210-nm laser technique provides fat compaction, preserving the adipocytes and improving the contour and sagging of the face and body. The results are illustrated with pre- and postprocedure images, demonstrating a significant aesthetic improvement, high patient satisfaction, and no serious adverse events.

Meaning: This minimally invasive technique, using a 1210-nm laser, emerges as a safe and efficient approach for improving facial and body contours, compacting fat, and reducing sagging with no patient downtime.

INTRODUCTION

Aging induces progressive physiological changes that impact muscle function, skin integrity, bone structure, fat distribution, cellular renewal, and vascularization. The skin, a primary indicator of aging, undergoes sagging due to decreased collagen and elastin synthesis,¹ loss of muscle convexity, and superficial fat redistribution.²

Additionally, with age, there is a reduction and migration of the fat pads and senescence of the stem cells present in the adipose tissue, formation of the malar mound, nasolabial and labiomental groove, accumulation of jowls, and loss of facial contour that further contribute to the sagging process.³ Moreover, increased body weight, fat accumulation due to attenuated metabolism, and skeletal muscle mass are associated with aging and affect body contours.⁴

Although liposuction remains a gold standard for body contouring, advancements in laser-based techniques offer less invasive, safer alternatives with minimal downtime.^5,6 Selective photothermolysis enables targeted interaction with chromophores such as water, proteins, hemoglobin, and pigments.⁷ Notably, 1210-nm lasers exhibit a strong affinity for lipids; it promotes a nondestructive photoacoustic effect, facilitating selective photothermal modulation of adipose tissue while preserving regenerative cell function. This wavelength effectively photostimulates adipocytes and mesenchymal stem cells, promotes controlled inflammation, enhances collagen biogenesis, and releases the stromal vascular fraction, rich in adipose-derived stem cells.^8–10 This laser wavelength has also been shown to promote dermal fibroblast proliferation by paracrine action due to upregulated collagen types I and III, and fibronectin mRNA expression.¹¹

They also induce mechanical tissue responses, fostering elastogenesis and skin tightening, thus addressing both volume and skin laxity simultaneously.¹² By compacting fat and activating the subcutaneous regenerative system, which includes mesenchymal stem cells, fibroblasts, endothelial precursors, pericytes and immune cells, it is possible to trigger a cascade of regenerative processes. Upon stimulation, pericytes differentiate into mesenchymal stem cells capable of producing growth factors, cytokines, exosomes, proteins, and peptides, promoting angiogenesis, fibroblast activation, and collagen fiber organization, ultimately enhancing tissue regeneration and improving skin quality.¹³

Because the 1210-nm laser stands out for its specificity to lipids without the risk of significant inflammation or damage to surrounding tissues,¹⁴ this pilot study evaluated the lipolifting technique to determine whether the 1210-nm laser can achieve effective facial and body contouring outcomes while preserving adipocyte viability and stimulating collagen production to counteract skin sagging.

METHODS

This descriptive pilot study described a minimally invasive technique using a subcutaneous 1210-nm laser to compact facial and body fat and improve face and body contour and skin tightness. This study was conducted in compliance with the Brazilian resolution on human research. All patients provided authorization for participation in the study and signed the free informed consent form.

Patient Selection

Inclusion Criteria

• Patients older than 18 years of age with mild to moderate facial sagging, classified according to the Merz scale¹⁵ as level 1 or 2 by dermatological doctors, were eligible for this pilot study.

• Presence of ptosis or fat accumulation in the fat pads of the face and body.

• Body mass index (BMI) between 18.5 and 29.9 kg/m² (normal weight, BMI ≥18.5–24.9 kg/m²; overweight, BMI ≥25–29.9 kg/m²).¹⁶

• Abdominal skinfold between 10 and 30 mm (measured 2 cm above the navel).

Exclusion Criteria

• Patients who presented decompensated systemic and autoimmune diseases, acute inflammatory diseases, exacerbation of chronic diseases, inflammatory diseases on the skin or procedure area, pregnancy, coagulation disorders, and nondegradable injectable implants previously installed in the procedure area were excluded.

Anatomy-based Marking

A comprehensive understanding of the anatomical structure of the facial and abdominal region is fundamental for performing this technique. The marking process involves structural points based on the patient’s anatomy for a more natural result. Patients were positioned supine, and target areas were marked based on anatomical structures such as fat pads, muscle boundaries, and skin laxity. Five vectors in the facial and 10 in the abdominal region were marked for retroinjections, ensuring even fat distribution and stimulation of adipose tissue. The areas included the face, neck, abdomen, and flanks.

Patients’ faces and bodies were photographed and analyzed using a QuantifiCare LifeViz 3-dimensional (3D) imaging system (France). The 3D images generated by the device facilitated measurements taken before and after the procedures. The assessments were carried out at least 60 days after the procedure. On the body, the abdominal circumference was measured in centimeters, and on the face, the data included loss of volume in the cheek, jowl, and submental (jowl) regions.

The QuantifiCare LifeViz 3D imaging system has demonstrated accuracy and consistency in assessing skin changes. In a study published by Petit et al,¹⁷ the LifeViz Micro exhibited excellent repeatability in the quantification of atrophic acne scars, with an intraclass correlation coefficient of 0.98, indicating high reliability in volume and depth measurements. Another study validated LifeViz 3D stereophotogrammetry by comparing it with the IGAIS clinical scale in the assessment of wrinkles and scars following laser treatment. The results showed a strong correlation between the system’s objective measurements and clinical evaluations, confirming its effectiveness in quantifying topographical skin changes as well as documenting and evaluating aesthetic and dermatological treatments.¹⁸

Device

The treatments were administered with a 1210-nm diode laser (Thera Esthétique—DMC, São Carlos, SP, Brazil) with a 5.0 W ± 20% power range. A 300-mm optical fiber was used for laser lifting, and a 600-mm fiber was used for lipo-laser procedures, using single-use sterile kits. The optical fiber was housed inside an atraumatic tip cannula—external diameter of 0.7 and 2.0 mm, respectively—with only the distal tip of the fiber exposed. The equipment has presets for regenerative face and body laser-lifting procedures and improved tightening protocols.

Preparation

After marking and rigorous asepsis and antisepsis with aqueous chlorhexidine and alcoholic chlorhexidine, 0.1 mL of lidocaine (2% lidocaine solution with vasoconstrictor) was injected at each entry point using a half-inch 30-gauge needle to block the anesthetic and make the patient comfortable for the pertussis. The pertussis is performed with a half-inch 30-gauge needle.

Technique

To perform lipolifting, the area to be treated is first defined. For the facial region, the rule of 5 (face/neck), through 3 facial points, is marked following the anatomical guidelines. The first point is a horizontal line from the lateral corner of the eye to the hairline. The entry point is marked before the hairline. This point coincides with the upper edge of the zygomatic bone. This point draws vectors from the entry point to the area to be treated. The coverage area encompasses 5 vectors in a 45-degree area (valid for the temporal malar and zygomatic regions). The second point follows the modiolus anatomically, with a 2.5-cm marker for the medial region, also working on an area of 45 degrees distributed over 5 vectors. The third point has the mandibular bony ridge (angle of the mandible) and tragus as its reference points; a midpoint is drawn equidistant from the points, and the same rule of 5 is followed (Fig. 1). During the treatment, 5 retroinjections are made per vector on the face and neck.

Fig. 1.

Facial marking. A and B, Facial markings for the lipolifting technique following the rule of 5. Three anatomical entry points are identified: a temporal point aligned with the upper border of the zygomatic bone, a medial point corresponding to the modiolus region, and a mandibular point defined by the midpoint between the mandibular angle and the tragus. From each entry point, 5 vectors distributed over a 45-degree area are drawn to guide retroinjection.

For the neck and subneck regions, the rule of 5 (face/neck) uses 3 points; the first 2 points are equivalent (same anatomical reference) and are marked equally on the right and left hemiface; these points use the anatomical reference of the mandibular bone ridge (angle of mandible) 3 cm below, following the rule of 5 (5 vectors in an area of 45 degree); the third point is made 3 cm below the bone ridge following the medial reference of the mental protuberance (following the rule of 5). This marking is shown in Figures 2 and 3.

Fig. 2.

Cervical anatomical marking. Anatomical markings and directional vectors for the neck region based on the rule of 5. Two symmetrical entry points are positioned 3 cm below the mandibular angle on each hemiface, and 5 vectors distributed over a 45-degree area are drawn from each point to guide retroinjection.

Fig. 3.

Submental and cervical marking. A and B, Markings and directional vectors for the submental and cervical regions following the rule of 5. A medial entry point is positioned 3 cm below the mandibular ridge along the midline, using the mental protuberance as an anatomical reference, with 5 vectors distributed over a 45-degree area.

For the abdominal region, the rule of 10 is followed using 6 points. Six 10 × 10 cm quadrants are made for the abdominal area with a coverage of 10 vectors per quadrant. Anatomical knowledge of the abdominal wall, specifically the abdominal muscle structure, is essential for marking. Marking should be carried out with the subject in the supine position and with the abdominal muscles contracted to identify better the desired area of projection of the abdominal “buds” and inguinal muscles. The abdominal midline and the rectus abdominis muscles as packs are drawn as desired (Fig. 4). During the treatment, 10 retro applications are made per vector on the body.

Fig. 4.

Marking of the abdominal midline and the rectus abdominis muscles as packs, as desired, and the vectors.

Patient Satisfaction

The Global Aesthetic Improvement Scale scores were used (5–very much improved, 4–much improved, 3–improved, 2–no change, and 1–worse.) to verify satisfaction with the treatment and aesthetic improvement. Previous studies have used this universal scale to assess the progress in facial and body aesthetics and treatment results.^19–21

RESULTS

The present study was performed with 15 patients, 5 facial and 10 abdominal body contouring patients, using the described minimally invasive lipolifting technique in a single session. All patients were evaluated before and at least 60 days after the procedure. The average age of the participants was 36 years (Table 1). Most of the patients were woman (N = 12, 80%). None of the participants had a history of previous illness; 1 patient had diabetes mellitus and 2 had hypothyroidism. Additionally, 73.3% of patients were overweight (BMI 25–29.9 kg/m²) and 23.7% were considered to be of average weight (BMI 18.5–24.9 kg/m²). According to the Merz Aesthetics Scale, 4 facial treatment patients were classified as having mild sagging and 1 as moderate sagging.

Table 1.

Sample Characterization of Lipolifting Procedure, 2024

Variable	N	%
Sex
Female	12	80
Male	03	20
Previous illnesses
Diabetes mellitus	01	6.7
Hypothyroidism	02	13.3
No illness	12	80.0
BMI, kg/m2
18.5–24.9	04	26.7
25.0–29.9	11	73.3

Assessments were carried out before the procedure and at least 60 days after with the QuantifiCare device. On the face, patients demonstrated an average volume reduction of 2.06 mm³ in the cheek region, 3.02 mm³ in the jowl, and 1.42 mm³ in submental fullness. It is possible to notice in the photographic images of the patients an improvement in the facial contour and the compaction of the fat, preserving the fat pad and demonstrating rejuvenation. Most patients who underwent the body procedure were classified as overweight and presented an average reduction of 3.81 cm (SD = 1.86 cm) in the abdominal waist, with a minimum of 2.11 cm and a maximum of 7.81 cm. Table 2 shows the facial volume reduction values and abdominal measurements.

Table 2.

Reduction in Facial and Body Measurements in Relation to Age and BMI

Variable	Mean	SD	Minimum	95% CI, Average	Maximum
Age, y	36.13	6.78	28.00	35.00	50.00
BMI, kg/m2	25.53	2.14	21.15	25.50	29.00
Waist reduction, cm	3.81	1.86	2.11	3.29	7.81
Cheek reduction, mm3	2.06	0.75	1.25	2.07	3.21
Jowl reduction, mm3	3.02	1.55	0.47	3.50	4.28
Submental fullness, mm3	1.42	0.45	0.62	1.16	1.86

CI, confidence interval.

Figures 5 and 6 show the preprocedure and 60-day postprocedure images of a 36-year-old patient, which demonstrate a significant improvement in facial contour and fat compaction, preserving the adipose pads and favoring rejuvenation. It is possible to observe changes even in the immediate postprocedure period, as shown in Figures 7–9 of a 35-year-old patient.

Fig. 5.

Lateral facial contour. Preprocedure (A) and 60-day postprocedure (B) lateral facial views demonstrating improvement in facial contour and reduction of localized fat volume following the lipolifting technique.

Fig. 6.

Frontal facial contour. Preprocedure (A) and 60-day postprocedure (B) frontal facial views illustrating repositioning and compaction of facial fat pads after the lipolifting procedure.

Fig. 7.

Immediate frontal facial response. Preprocedure (A) and immediate postprocedure (B) frontal facial views demonstrating early repositioning and compaction of facial fat pads following lipolifting treatment.

Fig. 9.

Immediate lateral facial contour. Preprocedure (A) and immediate postprocedure (B) lateral facial views demonstrating fat compaction and contour enhancement after lipolifting treatment.

Figure 10 shows other patients’ images depicting their body before and 60 days after the procedure, with a fat reduction and compaction of 5.98 cm in the waist. Figures 11 and 12 also show the compacting of fat, improving body definition. All patients rated aesthetic results as “very much improved” on the Global Aesthetic Improvement Scale and throughout the follow-up period. Adverse events were minimal; besides swelling between the third and seventh day, occasional bruising between 5 and 7 days, and mild pain between 5 and 7 days, there were no other complications.

Fig. 10.

Abdominal contour. Preprocedure (A) and 60-day postprocedure (B) abdominal views demonstrating waist circumference reduction, fat compaction, and improvement in body contour following the lipolifting technique.

Fig. 11.

Body contour definition. Preprocedure (A) and 60-day postprocedure (B) body views illustrating fat compaction and enhanced body definition after lipolifting treatment.

Fig. 12.

Long-term body contour outcome. A and B, Postprocedure body views demonstrating sustained fat reduction and fat compaction 8 months after the lipolifting procedure.

DISCUSSION AND CONCLUSIONS

Distinguished by its unique features, the 1210-nm laser technique stands out with regard to fat modulation. It enhances face and body contour by reducing lipid-rich tissue and stimulating mesenchymal cells to produce collagen and elastin, thereby reducing sagging in the treated region.

Its photoacoustic action and lipid-selective photothermolysis make it highly effective for targeting adipose tissue without significantly affecting surrounding tissues, blood vessels, or water.¹⁴ This targeted absorption minimizes the risk of thermal damage and results in more controlled fat reduction and regeneration.

Studies have shown that the 1210-nm lasers induce minimal inflammation and simultaneously promote the release of mesenchymal stem cells and collagen synthesis, improving fat reduction and skin firmness.²² It was previously reported that the preferential subcutaneous fat injury was reliably produced without dermal damage by wavelengths near 1210 nm and that the adjacent fat, overlying dermis, and epidermis were preserved.⁷

Another study compared traditional liposuction to a 1210-nm laser protocol and demonstrated that it is a low-trauma procedure that could preserve up to 98% of aspirated adipocytes. Moreover, only minor complications have been recorded, with ecchymosis on less than 2% of the total body surface area being the most common.²³

Unlike 1210-nm lasers, 980- and 1470-nm lasers are primarily absorbed by water and hemoglobin, leading to their prevalent use in procedures like endovenous laser ablation.²⁴ Although these lasers are effective for tissue coagulation and collagen remodeling, their interaction with water means they are less specific to fat cells. There have been reports of introducing 980-nm and 1470-nm lasers into aesthetic dysfunctions to attenuate body fat and enhance skin tightening; however, these wavelengths are not without risks. Indeed, despite their demonstrated effectiveness, the increasing number of complications and serious consequences for patients are a cause for concern. For example, several studies have shown adverse events due to generating higher thermal energy, which can result in bruising, burns, or necrosis when used for fat modulation.²⁵ Another study using a 1470-nm laser for body contouring found that hematoma, seroma, and dehiscence occurred in 9% of the sample.²⁶ Additionally, a study conducted in Brazil revealed adverse events such as peripheral neuropathies, burns, local infection, and steatonecrosis with this wavelength. The same study also identified general complications, including severe hematoma, edema, hyperchromia, and optic fiber breaks associated with 1470-nm lasers.²⁷

The procedure described in this article involves an effective and safe technique for the patient. Its ability to precisely target lipid-rich tissues and its minimal thermal side effects position the 1210-nm laser as a safer and more effective option for fat modulation procedures such as face and body sculpting and tightening. In this sense, this technique is applicable for reducing adipose tissue, tissue replenishment, and body contouring. Furthermore, it preserves and stimulates the mesenchymal cells in the adipose tissue, maintaining collagen and elastin production.

Notably, we interpret the role of fat not as a villain but as a supportive element, housing the mesenchymal cells that are fundamental for differentiation into fibroblasts. Furthermore, this technique compacts fat, preserving the fat pad due to its regenerative properties and thus slowing down the process of cellular senescence, combating sagging.

Despite the promising results, future studies and long-term monitoring are needed. However, this protocol could help health professionals to achieve highly satisfactory results in treatments when applied appropriately and executed with care and precision.

Study Limitation

The primary limitation of the present study is that the lipolifting technique was initially restricted to obese patients with a BMI greater than 30 kg/m². This cutoff point was selected to refine areas of accumulated fat and not control patients’ weight. Future studies could also evaluate slimming methods using the 1210-nm laser as an adjuvant in weight loss.

Fig. 8.

Immediate lateral facial response. Preprocedure (A) and immediate postprocedure (B) lateral facial views illustrating early improvement in facial contour following the lipolifting procedure.

DISCLOSURE

Dr. Dziabas is a speaker for Galderma, Merz Aesthetics, IBSA Derma, Entera, and LMG Lasers, and has participated in lectures and medical events for these brands. Dr. Kasai is a scientific consultant for Ilikia Brasil and has participated in lectures, consulting, and medical events. Dr. Chicone has no financial interest to declare in relation to the content of this article.