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United States Patent m
 METHOD OF LASER COSMETIC SURGERY
 Inventor: Gregory S. Keller, 2323 De La Vina, Santa Barbara, Calif. 93105
 Appl. No.: 473,495
 Filed: Jun. 7, 1995
Related U.S. Application Data
 Division of Ser. No. 314,659, Sep. 29, 1994, Pat. No. 5,445,634, which is a division of Ser. No. 102,851, Aug. 2, 1993, Pat. No. 5,370,642, which is a continuation of Ser. No. 766,638, Sep. 25, 1991, abandoned.
 Int. CI.6 A61B 17/36
 U.S. CI 606/9; 128/878; 606/15
 Field of Search 606/9, 10, 15,
 References Cited
U.S. PATENT DOCUMENTS
4,519,390 5/1985 Home 606/15
4,627,435 12/1986 Hoskin 606/16 X
4,791,927 12/1988 Menger 606/10 X
FOREIGN PATENT DOCUMENTS
1512572 10/1989 U.S.S.R 128/898
[ii] Patent Number: 5,505,727
 Date of Patent: Apr. 9,1996
1595481 1/1990 U.S.S.R 606/9
1621901 1/1991 U.S.S.R 128/898
Tsuyoshi Nishisaka et al., Rounded Tip Fiber—Optics, The
Journal of Japan Society and Laser Medicine, 1984, p. 178.
Primary Examiner—Mary Beth Jones
Attorney, Agent, or Firm—Lyon & Lyon
Laser surgery is utilized to perform cosmetic surgery. A quartz fiber is used to direct the laser energy to the target area for the incision, division or resection of tissue. An endoscope may be utilized in conjunction with the quartz fiber to perform the cosmetic surgical techniques. One application utilizes laser energy to eliminate glabellar frown lines and/or forehead wrinkles. Another application employs laser energy to rectify brow descent. A further application uses laser energy to perform a neck lift. In yet another application, laser energy is utilized to reduce nasolabial folds. The use of laser energy in cosmetic surgical procedures greatly reduces the size of the incision required in the skin to perform cosmetic surgical procedures, and as a result greatly reduces the risks of potential complications.
6 Claims, 2 Drawing Sheets
U.S. Patent Apr. 9, 1996 Sheet 1 of 2 5,505,727
The field of the present invention is cosmetic surgery.
In recent years, laser technology has been utilized in a variety of applications in industry, surveying, communications and the medical field. In the field of cosmetic surgery, 15 however, standard procedures typically involve extensive use of scalpels for incising, dividing and resecting tissue. Depending upon the particular procedure, disadvantageous complications may result including scarring, nerve damage and reduced blood flow to the affected area which can result 20 in skin slough.
For example, to remove glabellar frown lines (between the eyebrows) and forehead wrinkles, standard cosmetic surgical technique involves an extensive procedure called a forehead lift which entails a large incision that extends from 25 ear to ear over the top of the forehead. The forehead lift is particularly disadvantageous because it opens the patient up widely requiring the physician to stop bleeders and risk cauterizing nerves. Since this procedure creates a large thin skin flap and reduces the blood supply to the skin, there is 30 also an increased risk of skin slough and alopecia (balding). An alternate procedure for removing glabellar frown lines and forehead wrinkles is collagen treatment. However, this treatment is temporary at best and also involves a risk of allergic reaction. Moreover, collagen has been reported to 35 cause autoimmune disease and blindness.
SUMMARY OF THE INVENTION
FIG. 1 is a frontal view of a human head with a small incision in the forehead to insert an endolaser for removal of glabellar frown lines and forehead wrinkles.
FIG. 2 is a lateral view of a human head with a small 55 incision in the temple to insert an endolaser for removal of crow's-feet.
FIG. 3 is a lateral view of a human head with a small incision in the neck to insert an endolaser for performing a neck lift.
DESCRIPTION OF THE PREFERRED
While the invention has application with utility and 65 advantage in a plethora of cosmetic surgical procedures, the following will describe the invention in four such applica
tions. All four applications utilize a laser energy source which is principally transmitted to a target area usually by, but not limited to, a quartz fiber with a 300 to 700 micron diameter and a 100 to 250 micron tip. The laser energy wavelength used is typically, but not limited to, 532 to 1060 nm. In a specially preferred embodiment, a 400 micron diameter quartz fiber with a 100 micron tip is utilized with a laser having a 532 nm. wavelength appears to produce the best results. An optional means for directing the laser transmitting means to the target area is an endolaser which is composed of a endoscope with or without a channel containing the laser transmitting means and/or balloon retractors that allow retraction in two directions.
FIG. 1 illustrates a frontal view of a human head with glabellar frown lines 2 and forehead wrinkles 4. The supraorbital and supratrochlear foramen and nerve courses are marked. A small incision 6 or pair of incisions are made at or behind the hair line for the insertion of the endolaser 8. If the quartz fiber is used without an endoscope, a larger incision is required. Using hooks, retractors, a bivalve speculum, and the endolaser or quartz fiber, a supragaleal elevation of the forehead is undertaken.
The fusion layer of fascia is found and separated either above the periosteum with the laser or below the periosteal layer with an elevator. Using retraction and/or a balloon around the endoscope, the corrugator and procerus muscles are divided and/or resected with the laser, preserving, when possible, the supratrochlear nerves. Following this the frontalis muscle is divided in similar fashion. Retraction may be with a wire frame retractor. The supraorbital nerve corridor is preserved. Fascia is used to fill any defects. If the mid-brow/glabellar area is depressed a calibrated resection of forehead and/or frontal hair bearing skin is resected and galea and skin closed. If necessary, the wound may be drained. The incision is then closed utilizing a galea! as well as a cutaneous closure.
In males with alopecia, a similar procedure is performed, but the approach is through a unilateral or bilateral temporal incision.
FIG. 2 depicts a lateral view of a human head with brow descent, skin over the lateral eye and crow's-feet 10. To diminish these problems, the temple and lateral brow may be elevated. The incision lines and the supraorbital nerve course and a vertical line extending from the lateral canthus are marked. A small incision 6 or pair of incisions are made in the hair of the temple for the insertion of the endolaser 8. Again, when using only a quartz fiber a larger incision is required.
The deep temporal fascial layer is developed using the hooks and/or retractors and/or balloon retractors. Once the avascular plane is found, the dissection under the danger area of the frontal branch of the facial nerve is performed with blunt dissection with small dissecting sponges. The fusion layer with the galea is divided and, over the frontal and/or zygomatic bone the supragaleal plane developed with the laser or a subgaleal plane developed with the elevator. The corridor of the supraorbital nerve is avoided. The fusion layer of fascia below the brow is divided either in a supraperiosteal plane with the laser or blunt instrument or in the subperiosteal plane with the elevator.
The frontalis muscle is incised three centimeters above the brow and medial to the vertical line from the lateral canthus. A suture is placed from an area immediately below the brow to the temporalis fascia to achieve a predetermined elevation. Resection of skin and/or hair is rarely necessary, but performed if needed. The incision is closed at the galeal and skin levels.