Angelenos undergo experimental laser-liposuction procedure.

An experimental laser/liposuction system being tested by doctors across the country, including one in Encino, already has been used on dozens of Los Angeles patients even though it hasn't been tested on animals and may cause more problems than it solves, according to prominent Los Angeles cosmetic surgeons.

The laser, made by Milpitas, Calif.-based Heraeus Lasersonics Inc., first melts the fat tissue and then the hose or cannula or catheter around it sucks out the liquefied fat. Doctors using traditional liposuction equipment insert the little hose or canal under the skin and the fat is sucked loose from the surrounding tissue.

Heraeus Lasersonics is a division of privately held Heraeus Inc. of Hanau, Germany. The Milpitas plant employs 150 workers and will produce the new lasers if the firm can get U.S. Food and Drug Administration approval and spark cosmetic surgeons' interest, said Barbara Eichorn, marketing manager.

Heraeus Lasersonics produces just under $50 million per year in sales and is developing the new technique in hopes of spurring sales in an otherwise sluggish market, Eichorn said.

Some doctors in Los Angeles, the cosmetic surgery capital of the U.S., say traditional liposuction causes more bleeding and bruising than does the laser/liposuction method because the cannula and vacuum connected to it actually rips the fat loose from the surrounding tissue. Laser/liposuction causes less bleeding and bruising because it melts the fat and then sucks it out of the tissue.

At the same time, it cauterizes the tiny blood vessels that are ripped open when the fat is melted and sucked away from the surrounding tissue. Therefore, it reduces bleeding and the possible need for blood transfusions, said Los Angeles cosmetic surgeons.

Other doctors, such as Dr. Larry David, a Westside dermatologist, say if the laser/liposuction equipment made by Heraeus Lasersonics doesn't stop burning and melting at the fat cells, it can damage nerves and muscles. Dr. David said he tested similar technology years ago.

"I'd be a lot more comfortable seeing this tested on pigs than on people," he said. "Even if it were proven 100 percent safe, there is no way I'd pay that much money for a machine that doesn't really offer anything new."

Eichorn of Heraeus Lasersonics disputed David's fears and said he would not make such a claim if he ever had used the encapsulated laser that doctors are using in the FDA's required testing period.

Rather than using lasers or traditional liposuction, Dr. David injects fluids under the skin and on top of the fat to be removed so that the patient loses less body fluid and suffers less tearing as the fat cells are sucked out. That way, bleeding is minimized and the patient doesn't risk complications caused by laser damage to tissue under the fat layers.

Extensive liposuction procedures cause so much bleeding under the skin that blood transfusions are required. Dr. David said injecting fluid before sucking out the fat cells helps patients avoid transfusions.

Heraeus Lasersonics, despite criticism from doctors such as David, hopes it can sell the laser/lipoplasty machines all over the world.

"We've been working on this product for two and a half years and hope to have testing finished and submit the results to the Food and Drug Administration by the end of the year," Eichorn said.

Since the laser is encapsulated in a tube, Eichorn said, doctors and patients need not worry about damage to surrounding tissue.

The market for the $50,000 to $100,000 lasers produced by Heraeus Lasersonics will be limited because of its cost, but the company sees a large potential market for the disposable fiber tube that encapsulates the cannula and laser. Since the cannula is inserted under the skin and has direct contact with the body's blood supply, doctors must buy a disposable fiber cover for the cannula for each operation to eliminate any risk of transmitting diseases such as AIDS. The fiber covers would sell for $200 each, Eichorn said.

Plastic surgeons estimate that 120,000 liposuction procedures are performed in the United States each year. The price of the procedure varies depending on region and the size of the body area being treated, said Dr. Sheldon A.E. Rosenthal of Encino, who has used the new Heraeus Lasersonics laser liposuction technology on 30 patients since the beginning of this year. But the price typically ranges from $3,500 to $4,500, he said. Cosmetic surgeons would have to charge $500 to $1,000 more to remove fat from a similar-sized abdominal area with the laser/liposuction machinery developed by Heraeus Lasersonics, Dr. Rosenthal said.

Once Heraeus Lasersonics submits test findings, the FDA will take three to 18 months to decide whether to approve the laser/liposuction device, Eichorn said.

Dr. Rosenthal said the device reduced trauma to blood vessels as it was supposed to. He added that the new method will let doctors remove more fat than with traditional liposuction. He expects FDA officials will approve the process this fall.

"This (new technology) may let some people have the procedure performed who shouldn't be eligible for liposuction because many patients who need the procedure can't take the drugs needed to constrict the blood vessels (and minimize bleeding) before a regular liposuction," Dr. Rosenthal said.

Dr. David Apfelberg, a San Francisco area plastic surgeon participating in the test program, has performed 15 procedures with the new Heraeus Lasersonics equipment and said the patients had less pain, bleeding and bruising than when liposuction was performed with traditional suction cannulas. However, he isn't sure the Heraeus Lasersonics laser and cannula will generate enough additional income to encourage plastic surgeons to buy the machines.

Bradenton, Fla.-based John C. Fisher, a Ph.D. scientist who specializes in medical lasers, predicted a somewhat brighter future for the Heraeus Lasersonics laser and cannula if it gets FDA approval. He claims skilled physicians will be able to use the laser/liposuction technology satisfactorily and that the global market for safe cosmetic surgery is so vast that many cosmetic surgeons will be interested in the new technology.

"The same types of lasers Heraeus Lasersonics is testing have been used successfully in gynecological, throat and urinary tract procedures for years," Fisher said.

But cosmetic surgeons interested in the laser/liposuction device should get extensive training from the manufacturers representatives, Fisher said.

"Using too much power with a laser like the one being tested by Heraeus Lasersonics is bad news because it can scatter the energy and damage tissue other than the fat cells," he said. "It's important that the manufacturer educates its factory representatives so they can teach doctors the proper use of the device."

Accordingly, Fisher stressed the need for an extensive training program for doctors who eventually use laser liposuction technology.

Heraeus Lasersonics is testing another laser for use in prostate surgery. It heats and kills the excess tissue that clogs the ureter without the trauma associated with traditional prostate operations, Eichorn of Heraeus Lasersonics said. The equipment developed for prostate surgery also faces a long testing and FDA approval process, Eichorn said.