Dr. Natasha Teovska Mitrevska-Body Contour and Skin Laxity with Laser

Current Status
Please make sure you are logged in
Free for students
Get Started
This course is currently closed

Body contouring is a procedure that alters the shape of the human body by eliminating or reducing excess skin and fat. When most people hear the word “body contouring,” they automatically think of surgery and liposuction. However, with the introduction of TightSculpting® and its advancements in laser technology, an effective form of non-invasive body contouring has finally become available. By combining two different laser wavelength treatments, fat-dissolving and skin-tightening can be both achieved during a single TightSculpting® procedure with just a single laser device. The TightSculpting® solution involves a deeply penetrating Nd:YAG laser operating in the PIANO® mode for thermic adipocyte destruction (i.e., “sculpting”) and a superficially absorbed Er:YAG laser operating in the FotonaSmooth® mode for improved skin laxity, collagen remodeling and tightening. The Smooth® and PIANO® components of TightSculpting® represent a complete body contouring solution, which can be, depending on the type of patient and the goal of the treatment, used individually or in concert, during a single procedure and with a single laser device. The combined procedure can be thus used to treat a variety of conditions, including temporary reduction in the appearance of cellulite.


Unwanted fat, cellulite and flaccidity are three of the top reasons for consultation in aesthetic medicine, especially when it comes to body contouring. Body contouring is a procedure that alters the shape of the human body by eliminating or reducing excess skin and fat. When most people hear the word “body contouring” they automatically think of surgery and liposuction.

Er:YAG is the ideal laser for skin resurfacing in all skin types:

  • Highest absorption
  • The most efficient ablation
  • VSP to control ablation/coagulation ratio

Nd:YAG is the optimal laser for deep thermal processing:

  • Deepest penetration
  • Safe for all skin types
  • High reliability
  • Extreme versatility

Combination of both enables large number of various applications. Smooth ErYAG is thermally processing epidermis and upper dermis. Piano NdYAG targets deep dermis and specially fat and is developed to utilize painless deep bulk heating of tissue. TightSculpting mechanism of action is hyperthermic injury to adipocyte cells. It will also cool the skin surface while heating deep fat. Patients can comfortably sustain skin surface temperature below 40°C, while at 45°C large majority of patients already feel pain. If the surface is mildly cooled with the aim to keep skin surface temperature at 37-38°C during laser irradiation, deeper (fat) layers can be heated up to 45°C without patient’s discomfort.

VSP (variable square pulse) technology enables unprecedented range of treatment modes, from extremely short, microsecond pulses for intense targeting of selected targets to very long, sub-second to greater-than-1-second pulses for gentler bulk tissues. When laser beam get absorbed in the tissue, its optimal energy is transformed to the heat. Scattered parts of the laser beam are internally refracted and reflected from cell membranes, cell nuclei, etc. Most of the scattered beam parts are finally absorbed, only the small part succeeds to escape from tissue by backscatter.

Smooth mode delivers Er:YAG optical laser energy in temporally optimally-spaced, short laser pulses in order to prevent temperature build-up at the surface and to achieve homogeneous heating within a several hundred micron thick superficial layer of the skin.

Discomfort of the patient is directly related to the temperature at the surface of the skin. It s based on the combination of 3 parameters:

  • Fluence
  • Pulse duration
  • Number of pulse stacks

STP (surface temperature parameter) is calculated from a tissue model and correlates to long exposure temperature peak on the skin surface and to the reported heat pain threshold. A complex algorithm was developed to calculate the STP and to use it as a measure for patient discomfort.

Tight sculpting can be used for:

  • Noninvasive transcutaneous lipolysis
  • Unwanted fat areas (fat reduction)
  • Adipose cellulite (fat reduction and improve vascularization)
  • Edematous cellulite (fibrosis remodeling)
  • Flaccid cellulite (skin tightening and collagen remodeling)

The heat generated is transmitted by radiation and conduction troughs the entire thickness of the fat layer. It accelerates all organic chemical reactions and cell metabolism. It activated a chemical messenger in the fat cells (AMPc), that induces the mechanism of lipolysis (TGL) for the breakdown of stored triglycerides (fat) into fatty acids and glycerol.

In comparison with other EBD for body sculpting, TightSculpting is:

  • Achieving equal or better results for sculpting
  • Plus additional skin tightening
  • Dual mode treatment possible in single session (2D!!)
  • Faster
  • Treatment of all body areas
  • No consumables protocol
  • Not a single application in Dynamis