IPL treatment of PWS
IPL devices are broadband filtered xenon flashlamps that work based on the principles of selective photothermolysis. The emission spectrum of 515–1200 nm is adjusted with the use of a series of cut-off filters, and the pulse duration ranges from approximately 0.5 to 100 msec, depending on the technology. The first commercial system, Photoderm VL (Lumenis, Yokneam, Israel) became available in 1994, and has been used to treat vascular anamolies. Another, IPL Technology (Danish Dermatologic Development [DDD] Hoersholm, Denmark) with a dual mode light filtering has also been used to treat PWS. Many other IPL system have recently been developed, and the appropriate parameters for congenital vascular lesions are being developed. The IPL has been used successfully to treat PWS (Fig. 39.7),78–80 but pulsed dye laser remains the treatment of choice.
IPL technology has also been used to treat pulsed dye laser-resistant PWS. In the study by Bjerring and associates seven of 15 patients achieved over 50% lesional lightening after four IPL treatments. Most of these patients had lesions involving the V2 dermatome (medial cheek and nose), which are relatively more difficult to lighten. Six of seven of these patients showed over 75% clearance of their PWS. A 550–950-nm filter was used with 8–30-msec pulse durations and fluences of 13–22 J/cm2 to achieve tissue purpura. The 530–750-nm filter can also be used with double 2.5-msec pulses, with a 10-msec delay and fluence of 8–10 J/cm2. Epidermal cooling was not required. Treatment resulted in immediate erythema and edema, and occasional crusting. Hypopigmentation was observed in three patients, hyperpigmentation in one patient, and epidermal atrophy in one patient.
The basics of body fat
Let’s start with the basics. Not all fat is created equal. We have two distinct types of fat in our bodies: subcutaneous fat (the kind that may roll over the waistband of your pants) and visceral fat (the stuff that lines your organs and is associated with diabetes and heart disease).
From here on out, when we refer to fat, we are talking about subcutaneous fat, as this is the type of fat that cryolipolysis targets. A recent study showed that the body’s ability to remove subcutaneous fat decreases with age, which means we are fighting an uphill battle with each birthday we celebrate.
From popsicles to freezing fat
Cryolipolysis machine — which literally translates into cold (cryo) fat (lipo) destruction (lysis) — was invented, in part, by observing what can happen when kids eat popsicles. No kidding here. The cofounders of this process were intrigued by something called “cold-induced fat necrosis” that was reported to occur after young children ate popsicles that were inadvertently left resting on the cheek for several minutes. Skin samples taken from pediatric patients like these showed inflammation in the fat, but normal overlying skin. Thus, it appeared that fat may be more sensitive to cold injury that other tissue types.
HOW DOES IT WORK?
Coolplas Fat Freeze Machine uses rounded paddles in one of four sizes to suction your skin and fat “like a vacuum,” says Roostaeian. While you sit in a reclined chair for up to two hours, cooling panels set to work crystallizing your fat cells. “It’s a mild discomfort that people seem to tolerate pretty well," he says. "[You experience] suction and cooling sensations that eventually go numb.” In fact, the procedural setting is so relaxed that patients can bring laptops to do work, enjoy a movie, or simply nap while the machine goes to work.
