Application of Low-Level Laser Therapy for Noninvasive Body Contouring

Non-invasive Body Contouring Technologies: An Updated Narrative Review

INTRODUCTION

Nowadays, a lot of body contouring devices and methods are introduced all over the world. The object of the present narrative review was to update and classify existing evidence on these methods and devices.

METHODS

We searched databases including PubMed, Cochrane, and Google Scholar for 11 essential keywords, including cryolipolysis, high-intensity focused ultrasound (HIFU), shock wave, low-level laser therapy (LLLT), radiofrequency (RF), capacitive resistive electrical transfer (TECAR), high-intensity focused electromagnetic (HIFEM), electromyostimulation (EMS), carboxytherapy, mesotherapy, and acupuncture and their abbreviations, in addition to obesity, overweight, cellulite, subcutaneous fat, and body contouring.

RESULTS

Totally 193 references were used in 11 main topics.

CONCLUSION

In order to help physicians with finding the best evidence in different methods, the data were summarised in 11 topics. Furthermore, FDA-approved devices, side effects and common protocols were described in each section.

LEVEL OF EVIDENCE I

This journal requires that authors 39 assign a level of evidence to each article. For a full 40 description of these Evidence-Based Medicine ratings, 41 please refer to the Table of Contents or the online 42 Instructions to Authors www.springer.com/00266 .

Noninvasive lipolysis modalities in aesthetic medicine

BACKGROUND

Adipose tissue is a vital metabolic organ that takes part in body homeostasis. However, an increase in fat tissue can be detrimental for one's health and lead to undesirable changes in body shape. Noninvasive lipolysis is becoming an increasingly popular method to destroy and remove excess body fat and improve one's satisfaction with their body appearance.

AIM

The aim of this study was to perform an evidence-based review of the clinical efficacy and safety of noninvasive lipolysis modalities in fat reduction.

MATERIALS AND METHODS

An evidence-based review was performed to evaluate the scientific evidence available on the subject. Three electronic databases (PubMed, Scopus, and Embase) were searched between February and May 2022 for randomized controlled trials and observational studies performed on adult population in the last 20 years investigating the clinical outcomes of noninvasive lipolysis modalities. The selected studies were divided by modality type (cryolipolysis, ultrasound therapy, radiofrequency, and laser therapy), and the data on the efficacy and safety were extracted.

RESULTS

In total, the search identified 55 papers which met the inclusion criteria. All four energy-based modalities, including cryolipolysis, ultrasound therapy, radiofrequency, and laser therapy, were shown to be clinically effective in terms of both objective body measurements, such as fat layer thickness or circumference reduction, and subjective patient satisfaction. Furthermore, the abovementioned methods were proven to have a low side effect profile.

CONCLUSION

In conclusion, although evidence supports safety and efficacy, further well-designed trials are needed to strengthen confidence in long-term effectiveness and safety of noninvasive lipolysis.

Can the use of photobiomodulation for localized fat reduction induce changes in lipid profile? A critical integrative review

The objective of this study is to clarify whether PBM for measures reduction can cause significant changes in the lipid profile. This is an integrative review and only original articles, both in vivo and clinical trials, that were published between 2010 and 2022 were selected. The article references were also analyzed to identify additional studies. A total of 15 articles were critically analyzed. The wavelength used ranged from 532 nm (green) to 956 nm (near infrared), and many authors failed to describe dosimetric parameters properly, as well as other important characteristics for the reproducibility of those found. Although it is not fully clear about the PBM interference level on the lipid profile, in general, there was no significant difference in lipid parameters when PBM was used alone, and when associated with techniques that promote beta-oxidation, there was an improvement in these biochemical variables. PBM use for localized fat reduction do not affect lipid serum levels. Clinical trials using standardized parameters are crucial to obtain more reliable results.

Experimental evaluation of high intensity focused ultrasound for fat reduction of ex vivo porcine adipose tissue

PURPOSE

The present study was stimulated by the continuous growth of commercially available high intensity focused ultrasound (HIFU) systems for fat reduction. Herein, HIFU was utilised for fat ablation using a single-element ultrasonic transducer operating in thermal mode.

METHODS

The custom-made concave transducer that operates at 1.1 MHz was assessed on excised porcine adipose tissue for its ability to reduce fat. Ultrasonic sonications were executed on the adipose tissue utilising acoustical power between 14 and 75 W and sonication time in the range of 1-10 min. The mass of the adipose tissue sample was weighed afore and after ultrasonic sonications and the effect of the sonication on the mass change was recorded.

RESULTS

Mass change was linearly dependent with either increasing acoustical power or sonication time and was in the range of 0.46-1.9 g. High acoustical power of 62.5 W for a sonication time of 1 min and a power of 75 W for a sonication time of 5 min, respectively resulted in the formation of a lesion or possible cavitation on the piece of excised adipose tissue.

CONCLUSION

The study demonstrated the efficacy of the proposed transducer in achieving a reduction of excised fat tissue. The present findings indicate the potential use of the transducer in a HIFU system indicated for the reduction of subcutaneous adipose tissue where increased values of acoustical power can result in increased amounts of fat reduction.

Effects of LED photobiomodulation therapy on the subcutaneous fatty tissue of obese individuals - histological and immunohistochemical analysis

Photobiomodulation therapy (PBMT) has become an adjuvant therapeutic possibility in body remodeling procedures. Given this scenario, this study was proposed with the aim of evaluating the effects of PBMT to Light Emitting Diode (LED) associating the red (630 nm) and infrared (850 nm) wavelengths in the subcutaneous fatty tissue. This controlled study of comparative intervention that evaluated a sample of subcutaneous fatty tissue from women with grade II obesity. The participants received the LED PBMT treatment with associated red and infrared wavelengths sequentially on the left side of the abdomen and the right side was considered as control, with the collection of biological material performed at the time of bariatric surgery. For histological and immunohistochemical evaluation, Caspase 3, Cleaved Caspase 3, CD68+, HSL and adipophilin markers were used. The participants showed positivity in the expression of Caspase 3 and Cleaved Caspase (p < .0001), CD68+ macrophages (p < .0001), HSL (p < .0001) and adipophilin (p < .0013) in the intervention sample when compared to the control. PBMT and LED associating red and infrared wavelengths were able to promote autophagic lipolysis induced by adipocyte cell apoptosis in the subcutaneous tissue of obese individuals.

The Effect of Laser Therapy Along With Mediterranean Diet Versus Mediterranean Diet Only on Older Adults With Non-alcoholic Fatty Liver Disease: A Randomized Clinical Trial

Introduction: Obesity is the major pathogenesis of the non-alcoholic fatty liver disease (NAFLD). The combination of low-level laser therapy (LLLT) and Mediterranean diet (MD) is a new approach for improving liver function. Methods: 60 obese older adults (65-75 years old) with NAFLD were randomly assigned equally to two groups: a study group and a control group. The study group received LLLT and MD, while the control group followed MD only. These findings evaluated the changes in the level of liver enzymes, serum lipid profile, and anthropometric measurements (body mass index [BMI] and waist circumference [WC]) after 12 weeks of intervention. Results: Both study and control groups showed a significant reduction in the levels of liver enzymes, serum lipid profile, BMI, and WC (P < 0.001 and P < 0.01 respectively); however, the study group showed more significant results compared to the control group (P < 0.01). Conclusion: LLLT and MD may be considered as a treatment approach for NAFLD in older adults to improve their liver function, control dyslipidemia, and help in losing weight.

Photobiomodulation: The Clinical Applications of Low-Level Light Therapy

BACKGROUND

Low-level light therapy (LLLT) is a recent addition to the pantheon of light-based therapeutic interventions. The absorption of red/near-infrared light energy, a process termed "photobiomodulation," enhances mitochondrial ATP production, cell signaling, and growth factor synthesis, and attenuates oxidative stress. Photobiomodulation is now highly commercialized with devices marketed directly to the consumer. In the gray area between the commercial and therapeutic sectors, harnessing the clinical potential in reproducible and scientifically measurable ways remains challenging.

OBJECTIVES

The aim of this article was to summarize the clinical evidence for photobiomodulation and discuss the regulatory framework for this therapy.

METHODS

A review of the clinical literature pertaining to the use of LLLT for skin rejuvenation (facial rhytids and dyschromias), acne vulgaris, wound healing, body contouring, and androgenic alopecia was performed.

RESULTS

A reasonable body of clinical trial evidence exists to support the role of low-energy red/near-infrared light as a safe and effective method of skin rejuvenation, treatment of acne vulgaris and alopecia, and, especially, body contouring. Methodologic flaws, small patient cohorts, and industry funding mean there is ample scope to improve the quality of evidence. It remains unclear if light-emitting diode sources induce physiologic effects of compararable nature and magnitude to those of the laser-based systems used in most of the higher-quality studies.

CONCLUSIONS

LLLT is here to stay. However, its ubiquity and commercial success have outpaced empirical approaches on which solid clinical evidence is established. Thus, the challenge is to prove its therapeutic utility in retrospect. Well-designed, adequately powered, independent clinical trials will help us answer some of the unresolved questions and enable the potential of this therapy to be realized.

Effect of 808-nm Laser Photobiomodulation Treatment in Blepharitis Rat Model

PURPOSE

Blepharitis, simply defined as eyelid inflammation, is one of the common ocular conditions associated with discomfort and irritation. Because blepharitis causes meibomian gland dysfunction and dry eye, this study aimed to confirm the effect of photobiomodulation (PBM) on blepharitis.

METHODS

A total of 20 rats were randomly assigned to 4 equal groups, including control, blepharitis, PBM, and eye drop. Blepharitis was induced in rats by injecting complete Freund's adjuvant in the eyelid margins. PBM intervention was given every 3 days after blepharitis induction. Clinical signs including tear volume, tear breakup time (TBUT), meibomian gland swelling, fluorescein, telangiectasia, and meibomian gland secretion scores were measured every week, and the rats were killed for histological analysis after 4 weeks. Immunohistochemistry was performed to compare the level of inflammatory cytokines, interleukin-1β and tumor necrosis factor-α, and terminal deoxynucleotidyl transferase dUTP nick end labeling staining on retina was performed to observe any retinal damage.

RESULTS

Tear volume and TBUT increased with PBM intervention, and with improved eyelid swelling, corneal staining, telangiectasia, and meibomian gland secretion scores increased. Hematoxylin and eosin staining showed no structural abnormalities of meibomian gland caused by blepharitis induction. Immunohistochemistry revealed that the levels of inflammatory cytokines interleukin-1β and tumor necrosis factor-α were lowered with PBM treatment in both eyelid and conjunctiva. Terminal deoxynucleotidyl transferase dUTP nick end labeling staining showed no retinal damage.

CONCLUSIONS

Laser PBM at 808 nm was effective in alleviating ocular signs and controlling inflammation in blepharitis rat model. The in vivo results suggest that PBM has the potential to be used in treating blepharitis patients.

Effect of one session of aerobic exercise associated with abdominal laser therapy in lipolytic activity, lipid profile, and inflammatory markers

BACKGROUND

Increased abdominal fat and sedentary lifestyles contribute to cardiovascular disease risk. The combination of exercise and low-level laser therapy (LLLT) appears to be an innovative method to increase the lipolytic rate of abdominal adipocytes, in order to reduce abdominal fat.

OBJECTIVES

To evaluate the effect of one session of aerobic exercise associated with abdominal laser therapy in lipolytic activity, profile lipid, and inflammatory markers (C-reactive protein-CRP).

METHODS

Experimental randomized controlled study in 36 participants of female sex divided into three groups: placebo group (PG) (n = 12), experimental group 1 (EG1) (n = 11), and experimental group 2 (EG2) (n = 13). The EG1 and EG2 performed the laser therapy protocol followed by 50 minutes of aerobic exercise on cycle ergometer, of 45%-55% of reserve heart rate; however, in EG2 the laser therapy was applied without power. The PG only performed the laser therapy protocol without power. The anthropometric measures were evaluated, and all participants were subject to blood samples at the beginning and at the end of the intervention for measure glycerol, lipid profile (total cholesterol, triglycerides, HDL, and LDL), and CRP. One-way ANOVA was used to compare the groups in the quantitative variables and Fisher's test to compare the groups in the qualitative variables. To compare the variables between moments (M0 and M1), we used the t test for paired samples.

RESULTS

In the group that performed physical exercise and lipolytic laser and in the group that performs only physical exercise, there was a significant increase in glycerol mobilization between M0 and M1 (P < .001). The same did not occur in the placebo group. Regarding the CRP levels and lipidic profile, no significant differences were observed between moments in the experimental groups.

CONCLUSION

It is concluded that one session of aerobic exercise associated with LLLT and one session of aerobic exercise appears to be able to increase the lipolytic activity. However, it appears that LLLT does not provide increased value to the aerobic physical exercise by itself in lipolysis process.

Alterted Adipogenesis of Human Mesenchymal Stem Cells by Photobiomodulation Using 1064 nm Laser Light

BACKGROUND AND OBJECTIVES

Photobiomodulation (PBM) describes the influence of light irradiation on biological tissues. Laser light in the near-infrared (NIR) spectrum has been shown to mitigate pain, reduce inflammation, and promote wound healing. The cellular mechanism that mediates PBM's effects is generally accepted to be at the site of the mitochondria, leading to an increased flux through the electron transport chain and adenosine triphosphate (ATP) production. Moreover, PBM has been demonstrated to reduce oxidative stress through an increased production of reactive oxygen species (ROS)-sequestering enzymes. The aim of the study is to determine whether these PBM-induced effects expedite or interfere with the intended stem cell differentiation to the adipogenic lineage.

STUDY DESIGN/MATERIALS AND METHODS

To determine the effects of 1064 nm laser irradiation (fluence of 8.8-26.4 J/cm² ) on human mesenchymal stem cells (hMSCs) undergoing adipogenic differentiation, the ATP and ROS levels, and adipogenic markers were quantitatively measured.

RESULTS

At a low fluence (8.8 J/cm² ) the ATP increase was essentially negligible, whereas a higher fluence induced a significant increase. In the laser-stimulated cells, PBM over time decreased the ROS level compared with the non-treated control group and significantly reduced the extent of adipogenesis. A reduction in the ROS level was correlated with a diminished lipid accumulation, reduced production of adipose-specific genetic markers, and delayed the chemically intended adipogenesis.

CONCLUSION

We characterized the use of NIR light exposure to modulate adipogenesis. Both the ATP and ROS levels in hMSCs responded to different energy densities. The current study is expected to contribute significantly to the growing field of PBM as well as stem cell tissue engineering by demonstrating the wavelength-dependent responses of hMSC differentiation. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.

A Randomized, Controlled Trial on the Effectiveness of Photobiomodulation Therapy and Non-Contact Selective-Field Radiofrequency on Abdominal Adiposity in Adolescents With Obesity

BACKGROUND AND OBJECTIVES

Structured physical activities and dietary control have traditionally been used with the aim of controlling obesity. However, effective auxiliary modalities still needed to reduce local obesity, specifically abdominal obesity. This study examined the adjunct effect of photobiomodulation therapy (PBMT), and non-contact selective-field radiofrequency (NcRF) on abdominal adiposity in adolescents with obesity.

STUDY DESIGN/MATERIALS AND METHODS

Fifty-four adolescents with obesity (33 females and 21 males) took part in this study and were distributed randomly into three treatment-based groups. Control group (n = 18, age; 14.61 ± 1.14 years), PBMT group (n = 18, age; 14.22 ± 0.88 years), and NcRF group (n = 18, age; 15.11 ± 0.96 years). A dietary control plan of 1,000-1,200 kcal/day, and a 60-minute aerobic exercise program conducted day-by-day over 4 weeks were provided for all participants. Additionally, the PBMT group received 12 20-minute PBMT on the abdominal area (energy/session ~4.08 J/cm² ) thrice/week, and the NcRF group underwent four 30-minute treatments with NcRF on the abdominal area once/week. Waist/hip ratio (W-to-H ratio), intra-abdominal fat thickness (IAFT), and the subcutaneous-abdominal fat thickness (SAFT) were observed at the baseline and after 4 weeks.

RESULTS

The W-to-H ratio and SAFT reduced significantly in the PBMT group compared with either the control group (P = 0.001 and 0.001, respectively) or the NcRF group (P < 0.001 and P = 0.046, respectively) post-intervention. However, the IAFT and IAFT/SAFT ratio did not differ significantly among the study groups (P > 0.05).

CONCLUSION

Our analysis shows that PBMT is more efficient than NcRF for the reduction of W-to-H ratio and SAFT in adolescents with obesity. Lasers Surg. Med. © 2020 Wiley Periodicals, Inc.

Insulin resistance is improved in high-fat fed mice by photobiomodulation therapy at 630 nm

Photobiomodulation therapy (PBMT) in the infrared spectrum exerts positive effects on glucose metabolism, but the use of PBMT at the red spectrum has not been assessed. Male Swiss albino mice were divided into low-fat control and high-fat diet (HFD) for 12 weeks and were treated with red (630 nm) PBMT or no treatment (Sham) during weeks 9 to 12. PBMT was delivered at 31.19 J/cm² , 60 J total dose per day for 20 days. In HFD-fed mice, PBMT improved glucose tolerance, insulin resistance and fasting hyperinsulinemia. PBMT also reduced adiposity and inflammatory infiltrate in adipose tissue. Phosphorylation of Akt in epididymal adipose tissue and rectus femoralis muscle was improved by PBMT. In epididymal fat PBMT reversed the reduced phosphorylation of AS160 and the reduced Glut4 content. In addition, PBMT reversed the alterations caused by HFD in rectus femoralis muscle on proteins involved in mitochondrial dynamics and β-oxidation. In conclusion, PBMT at red spectrum improved insulin resistance and glucose metabolism in HFD-fed mice.

Low-level laser therapy for weight reduction: a randomized pilot study

Obesity and overweight is a global health crisis and novel methods of treatment are needed to address it. Low-level laser therapy (LLLT) is a currently available non-invasive procedure for lysing excess fat, but there is a lack of consensus exists on LLLT frequency and limited research from studies of LLLT. The purpose of this pilot study is to compare the effect of three of the most common LLLT frequencies on weight, waist circumference, body fat percentage, and quality of life. Sixty overweight (body mass index (BMI) 25-29.9 kg/m²) adult participants were randomized to 12 LLLT treatments: (1) three times weekly for 4 weeks, (2) twice weekly for 6 weeks, or (3) once weekly for 12 weeks. All participants attended an in-person visit at baseline and at weeks 4, 6, 12, and 26. Participants were recruited September 30, 2016 through to August 27, 2017. The majority of the 60 participants were female (90%) with an average age of 43.7 years (± 9.2 years). Most participants (98%) completed 10 or more of the 12 LLLT treatments. When comparing across treatment groups, the greatest reductions from baseline were observed in those assigned to twice weekly for 6 weeks in weight (1 ± 1.7 (±SD) kg by week 6), waist circumference (- 2.0 ± 3.2 in. by week 6 and - 1.5 ± 3.2 in. by week 26), body mass index (- 0.4 ± 0.6 kg/m²), and body fat mass (- 1.1 ± 1.6 kg). This group also had the most significant improvement from baseline in quality of life (+ 0.5 ± 0.8 by week 6), body satisfaction (+ 0.2 ± 0.4 by week 6 and week 26), and body appreciation (+ 0.2 ± 0.3 by week 6 and + 0.3 ± 0.3 by week 26). LLLT twice weekly for 6 weeks could be proposed as the optimal frequency and duration for the management of body weight. Trial registration: https://clinicaltrials.gov/ct2/show/NCT02877004. Registered August 24, 2016.

Low-power laser irradiation decreases lipid droplet accumulation in the parotid glands of diabetic rats

Lipid droplet accumulation has been related to salivary gland hypofunction in diabetes. In this study, the effect of laser irradiation on the parotid glands (PGs) of diabetic rats was analyzed with regard to its effect on lipid droplet accumulation, intracellular calcium concentration and calmodulin expression. The animals were distributed into 6 groups: D0, D5, D20 and C0, C5, C20, for diabetic (D) and control animals (C), respectively. Twenty-nine days following diabetes induction, PGs of groups D5 and C5; D20 and C20 were irradiated with 5 and 20 J/cm² of a red diode laser at 100 mW, respectively. After 24 hours, PGs were removed for histological, biochemical, and western blotting analysis. The diabetic animals showed lipid droplet accumulation, which was decreased after irradiation. Ultrastructurally, the droplets were nonmembrane bound and appeared irregularly located in the cytoplasm. Moreover, diabetic animals showed an increased intracellular calcium concentration. In contrast, after laser irradiation a progressive decrease in the concentration of this ion was observed, which would be in agreement with the results found in the increased expression of calmodulin in D20. These data are promising for using laser to decrease lipid droplet accumulation in PGs, however, more studies are necessary to better understand its mechanisms. Micrographs showing decreased lipid accumulation after laser irradiation in light micrographs (LM), and morphology of lipid droplet in transmission electron microscopic (TEM). LM: (A) PGs from nondiabetic rats that did not receive Laser irradiation (LI), (B) PGs from nondiabetic rats that received a dose of 20 J/cm² , (C) lipid accumulation (arrows) in the secretory cells from diabetic rats that did not receive irradiation, (D) reduction of lipid accumulation in the secretory cells from diabetic rats that received a dose of 20 J/cm² and TEM: (E) scale bar = 5 μm, (F) scale bar = 1 μm, and (G) scale bar = 0.5 μm.

Perspective on Broad-Acting Clinical Physiological Effects of Photobiomodulation

Research into photobiomodulation reveals beneficial effects of light therapy for a rapidly expanding list of medical conditions and illnesses. Although it has become more widely accepted by the mainstream medicine, the effects and mechanisms of action appear to be poorly understood. The therapeutic benefits of photobiomodulation using low-energy red lasers extend far beyond superficial applications, with a well-described physics allowing an understanding of how red lasers of certain optimum intensities may cross the cranium. We now have a model for explaining potential therapeusis for applications in functional neurology that include stroke, traumatic brain injury, and neurodegenerative conditions in addition to the currently approved functions in lipolysis, in onychomycosis treatment, and in pain management.

Photobiomodulation with non-thermal lasers: Mechanisms of action and therapeutic uses in dermatology and aesthetic medicine

BACKGROUND

Non-thermal laser therapy in dermatology, is a growing field in medical technology by which therapeutic effects are achieved by exposing tissues to specific wavelengths of light.

OBJECTIVES

The purpose of this review was to gain a better understanding of the science behind non-thermal laser and the evidence supporting its use in dermatology.

METHODS

A group of dermatologists and surgeons recently convened to review the evidence supporting the use of non-thermal laser for body sculpting, improving the appearance of cellulite, and treating onychomycosis.

RESULTS

The use of non-thermal laser for body sculpting is supported by three randomized, double-blind, sham-controlled studies (N = 161), one prospective open-label study (N = 54), and two retrospective studies (N = 775). Non-thermal laser application for improving the appearance of cellulite is supported by one randomized, double-blind, sham-controlled study (N = 38). The use of non-thermal laser for the treatment of onychomycosis is supported by an analysis of three non-randomized, open-label studies demonstrating clinical improvement of nails (N = 292).

CONCLUSIONS

Non-thermal laser is steadily moving into mainstream medical practice, such as dermatology. Although present studies have demonstrated the safety and efficacy of non-thermal laser for body sculpting, cellulite reduction and onychomycosis treatment, studies demonstrating the efficacy of non-thermal laser as a stand-alone procedure are still inadequate.

Low-Level Laser Therapy for Reducing the Hip, Waist, and Upper Abdomen Circumference of Individuals with Obesity

OBJECTIVE

To assess the effectiveness of low-level laser therapy (LLLT) for reducing hip, thigh, and abdomen circumference of individuals with body-mass index (BMI) between 30 and 40 kg/m².

BACKGROUND

Previous studies demonstrated the effectiveness of LLLT for reducing body circumference in the hips, thighs, and abdomen of nonobese individuals with a BMI <30 kg/m².

METHODS

In this randomized, double-blind sham-controlled study, obese, but otherwise healthy, individuals were randomized to undergo 30-min LLLT (n = 28) or sham treatments (n = 25) three times weekly for 4 weeks. Body measurements were obtained after 2 and 4 weeks of treatment and 2 weeks post-treatment ( ClinicalTrials.gov Identifier: NCT01821352).

RESULTS

After 4 weeks, 20 LLLT-treated subjects (71.43%) achieved ≥7.2 cm decrease in combined measurements versus three sham-treated subjects (12%; p < 0.00005). The mean (standard deviation) decrease in combined measurement for LLLT-treated subjects was 10.52 (7.59) cm (p < 0.0001 vs. baseline) versus 1.80 (3.20) cm for sham-treated subjects. Among subjects with a combined ≥7.2 cm decrease, the mean total decrease 2 weeks post-treatment was 15.21 cm. There were no adverse events.

CONCLUSIONS

Based on these results, the device was cleared by the U.S. Food and Drug Administration as a noninvasive esthetic treatment for reduction of circumference of hips, waist, and upper abdomen when applied to individuals with a BMI between 30 and 40 kg/m².

Review of the Mechanisms and Effects of Noninvasive Body Contouring Devices on Cellulite and Subcutaneous Fat

CONTEXT

Today, different kinds of non-invasive body contouring modalities, including cryolipolysis, radiofrequency (RF), low-level laser therapy (LLLT), and high-intensity focused ultrasound (HIFU) are available for reducing the volume of subcutaneous adipose tissue or cellulite. Each procedure has distinct mechanisms for stimulating apoptosis or necrosis adipose tissue. In addition to the mentioned techniques, some investigations are underway for analyzing the efficacy of other techniques such as whole body vibration (WBV) and extracorporeal shockwave therapy (ESWT). In the present review the mechanisms, effects and side effects of the mentioned methods have been discussed. The effect of these devices on cellulite or subcutaneous fat reduction has been assessed.

EVIDENCE ACQUISITION

We searched pubmed, google scholar and the cochrane databases for systemic reviews, review articles, meta-analysis and randomized clinical trials up to February 2015. The keywords were subcutaneous fat, cellulite, obesity, noninvasive body contouring, cryolipolysis, RF, LLLT, HIFU, ESWT and WBV with full names and abbreviations.

RESULTS

We included seven reviews and 66 original articles in the present narrative review. Most of them were applied on normal weight or overweight participants (body mass index < 30 kg/m2) in both genders with broad range of ages (18 to 50 years on average). In the original articles, the numbers of included methods were: 10 HIFU, 13 RF, 22 cryolipolysis, 11 LLLT, 5 ESWT and 4 WBV therapies. Six of the articles evaluated combination therapies and seven compared the effects of different devices.

CONCLUSIONS

Some of the noninvasive body contouring devices in animal and human studies such as cryolipolysis, RF, LLLT and HIFU showed statistical significant effects on body contouring, removing unwanted fat and cellulite in some body areas. However, the clinical effects are mild to moderate, for example 2 - 4 cm circumference reduction as a sign of subcutaneous fat reduction during total treatment sessions. Overall, there is no definitive noninvasive treatment method for cellulite. Additionally, due to the methodological differences in the existing evidence, comparing the techniques is difficult.

A randomized, open-label pilot of the combination of low-level laser therapy and lorcaserin for weight loss

Background

Obesity is a significant public health problem and innovative treatments are needed. The purpose of this pilot study was to assess the preliminary efficacy and safety of a combined treatment of low-level laser therapy (LLLT) and lorcaserin on weight loss, health quality of life (QOL) measures, and cardiovascular risk factors.

Methods

Forty-five overweight and obese adult participants with a body mass index (BMI) >26.9 and <40 were randomized to receive LLLT, lorcaserin, or a combination of the two therapies. All study participants received treatment for 3 months and were followed for 3 months post-treatment. Participants were recruited from June 2014 through September 2014.

Results

The majority of the 44 participants accrued to this study were female (84 %) with an average age of 43.9 years (range 22 to 64 years). Most participants (93 % LLLT alone, 87 % LLLT + lorcaserin) completed at least 80 % of the LLLT treatments. From baseline to end of treatment, significant reductions in waist circumference were noted for each treatment group (-2.3 ± 4.1 cm, -6.0 ± 7.3 cm, and -4.0 ± 5.5 cm for LLLT, lorcaserin and combination respectively); however, the reduction in body weight was only significant in those receiving lorcaserin and combination treatment (-0.4 ± 1.5 kg, -1.3 ± 1.2 kg and -1.3 ± 1.3 kg). No significant differences were noted between the groups. Self-reported satisfaction was higher in the lorcaserin versus the LLLT group.

Conclusion

This small pilot demonstrates that when combined with behavioral intervention, Lorcaserin and LLLT may be effective components of a comprehensive approach to the treatment of overweight and obesity in the clinical setting. Further studies with larger sample size and longer duration of treatment and follow-up are needed to further address efficacy.

Trial Registry Information

Trial registration: NCT02129608. Registered June 15, 2014.

Low-level laser therapy (LLLT) does not reduce subcutaneous adipose tissue by local adipocyte injury but rather by modulation of systemic lipid metabolism

Low-level laser (light) therapy (LLLT) has been applied recently to body contouring. However the mechanism of LLLT-induced reduction of subcutaneous adipose tissue thickness has not been elucidated and proposed hypotheses are highly controversial. Non-obese volunteers were subject to 650nm LLLT therapy. Each patient received 6 treatments 2-3 days apart to one side of the abdomen. The contralateral side was left untreated and served as control. Subjects' abdominal adipose tissue thickness was measured by ultrasound imaging at baseline and 2 weeks post-treatment. Our study is to the best of our knowledge, the largest split-abdomen study employing subcutaneous abdominal fat imaging. We could not show a statistically significant reduction of abdominal subcutaneous adipose tissue by LLLT therapy. Paradoxically when the measurements of the loss of fat thickness on treated side was corrected for change in thickness on non treated side, we have observed that in 8 out of 17 patients LLLT increased adipose tissue thickness. In two patients severe side effect occurred as a result of treatment: one patient developed ulceration within appendectomy scar, the other over the posterior superior iliac spine. The paradoxical net increase in subcutaneous fat thickness observed in some of our patients is a rationale against liquefactive and transitory pore models of LLLT-induced adipose tissue reduction. LLLT devices with laser diode panels applied directly on the skin are not as safe as devices with treatment panels separated from the patient's skin.

Complementary and alternative medicine for the treatment of obesity: a critical review

CONTEXT

Obesity and its associated morbidities pose a major health hazard to the public. Despite a multiplex of available diet and exercise programs for losing and maintaining weight, over the past years, interest in the use of complementary and alternative medicine (CAM) for obesity treatment has greatly increased.

EVIDENCE ACQUISITION

We searched PubMed, Google scholar and the Cochrane databases for systemic reviews, review articles, meta-analysis and randomized clinical trials up to December 2013.

RESULTS

In this review, the efficacy and safety of the more commonly used CAM methods for the treatment of obesity, namely herbal supplements, acupuncture, and non-invasive body-contouring, are briefly discussed. The evidence supporting the effectiveness and safety of these methods is either lacking or point to a negligible clinical benefit, barely surpassing that of the placebo. Furthermore, several limitations are observed in the available scientific literature. These shortcomings include, without being limited to, uncontrolled trial designs, non-random allocation of subjects to treatment arms, small number of patients enrolled, short durations of follow-up, and ambiguous clinical and laboratory endpoints.

CONCLUSIONS

Further investigations are necessary to accurately determine the efficacy, safety, standard dosage/procedure, and potential side effects of the various CAM methods currently in use.

The evidence behind noninvasive body contouring devices

The demand for body contouring is rapidly increasing, and interest in noninvasive approaches has also grown. The author reviewed the evidence base behind the currently available devices and methods for nonsurgical body contouring. There is little high-level evidence in the present literature to support the effectiveness of any of these devices.

An evaluation of the patient population for aesthetic treatments targeting abdominal subcutaneous adipose tissue

A large and growing population of patients currently seeks minimally invasive therapeutic options for the aesthetic treatment of localized, central abdominal subcutaneous adipose tissue (SAT). We sought to evaluate the ideal population for aesthetic treatment of central abdominal SAT, highlight the existing disparities between SAT in obese (body mass index [BMI] ≥ 30; BMI) and nonobese (BMI < 30) patients, and review the available FDA-cleared, minimally invasive treatment options for central abdominal adiposity. The cosmetic issue of localized, central (periumbilical) abdominal adiposity in nonobese individuals is quite distinct from abdominal bulging secondary to obesity. Given the recognized clinical and physiologic differences between obese and nonobese counterparts, the exclusion of obese patients from clinical study by currently available FDA-cleared devices targeting abdominal fat, and the status of obesity as a chronic, systemic disease requiring medical, surgical, and/or lifestyle-altering therapies, minimally invasive therapeutic options for aesthetic reductions in central abdominal SAT must be limited to the nonobese population.

Non-invasive subcutaneous fat reduction: a review

The risks, financial costs and lengthy downtime associated with surgical procedures for fat reduction have led to the development of a number of non-invasive techniques. Non-invasive body contouring now represents the fastest growing area of aesthetic medicine. There are currently four leading non-invasive techniques for reducing localized subcutaneous adipose tissue: low-level laser therapy (LLLT), cryolipolysis, radio frequency (RF) and high-intensity focused ultrasound (HIFU). To review and compare leading techniques and clinical outcomes of non-invasive subcutaneous fat reduction. The terms 'non-invasive', 'low-level laser', 'cryolipolysis', 'ultrasound' and 'radio frequency' were combined with 'lipolysis', 'fat reduction' or 'body contour' during separate searches in the PubMed database. We identified 31 studies (27 prospective clinical studies and four retrospective chart reviews) with a total of 2937 patients that had been treated with LLLT (n = 1114), cryolipolysis (n = 706), HIFU (n = 843) or RF (n = 116) or other techniques (n = 158) for fat reduction or body contouring. A majority of these patients experienced significant and satisfying results without any serious adverse effects. The studies investigating these devices have all varied in treatment regimen, body locations, follow-up times or outcome operationalization. Each technique differs in offered advantages and severity of adverse effects. However, multiple non-invasive devices are safe and effective for circumferential reduction in local fat tissue by 2 cm or more across the abdomen, hips and thighs. Results are consistent and reproducible for each device and none are associated with any serious or permanent adverse effects.

Independent evaluation of low-level laser therapy at 635 nm for non-invasive body contouring of the waist, hips, and thighs

INTRODUCTION

The non-invasive body-contouring segment continues to exhibit uninhibited growth, a trend that has provoked the emergence of numerous body-contouring devices. One particular device, low-level laser therapy at 635 nm (LLLT-635), has exhibited promising clinical results. We performed an independent, physician-led trial to evaluate the utility of LLLT-635 nm for non-invasive body contouring of the waist, hips, and thighs.

METHODS

Eighty-six participants were retrospectively assessed at an individual clinic in the United States. A multi-head laser device was administered every-other-day for 2 weeks. Each treatment consisted of 20 minutes of anterior and posterior treatment. Patients received concurrent treatment of the waist, hips, and bilateral thighs. Circumferential measurements were evaluated at baseline and one week following the 2-week treatment administration phase.

RESULTS

Compared with baseline, a statistically significant 2.99 in. (7.59 cm) mean loss was observed at the post-procedure evaluation point (P < 0.0001). When analyzed individually, the waist, hips, and thighs each reported a statistically significant reduction of -1.12, -0.769, and -1.17, respectively. Furthermore, linear regression analysis revealed a weak linear dependence (r = 0.179) between the reported weight and circumference change.

CONCLUSION

These data further validate the clinical efficacy and safety of LLLT at 635 nm.

Low-level laser therapy for fat layer reduction: a comprehensive review

BACKGROUND AND OBJECTIVE

Low-level laser (light) therapy (LLLT) is a noninvasive, nonthermal approach to disorders requiring reduction of pain and inflammation and stimulation of healing and tissue regeneration. Within the last decade, LLLT started being investigated as an adjuvant to liposuction, for noninvasive body contouring, reduction of cellulite, and improvement of blood lipid profile. LLLT may also aid autologous fat transfer procedures by enhancing the viability of adipocytes. However the underlying mechanism of actions for such effects still seems to be unclear. It is important, therefore, to understand the potential efficacy and proposed mechanism of actions of this new procedure for fat reduction.

MATERIALS AND METHODS

A review of the literature associated with applications of LLLT related to fat layer reduction was performed to evaluate the findings from pre-clinical and clinical studies with respect to the mechanism of action, efficacy, and safety.

RESULTS

The studies as of today suggest that LLLT has a potential to be used in fat and cellulite reduction as well as in improvement of blood lipid profile without any significant side effects. One of the main proposed mechanism of actions is based upon production of transient pores in adipocytes, allowing lipids to leak out. Another is through activation of the complement cascade which could cause induction of adipocyte apoptosis and subsequent release of lipids.

CONCLUSION

Although the present studies have demonstrated safety and efficacy of LLLT in fat layer reduction, studies demonstrating the efficacy of LLLT as a stand-alone procedure are still inadequate. Moreover, further studies are necessary to identify the mechanism of action.

Ultrastructural assessment of cellulite morphology: clues to a therapeutic strategy?

INTRODUCTION AND AIMS

Cellulite is a problematic condition affecting mostly women, characterized by a bumpy or nodular skin surface. Recent approaches with laser treatment have offered some promise. The present study sought to identify possible targets for laser treatment or light therapy through an ultrastructural investigation of the condition.

SUBJECTS AND METHODS

Study subjects comprised 7 healthy Japanese female volunteers (Age range 37-46 yr, average 38.4) with cellulite, graded on the 4-point Nurnberger-Muller cellulite severity scale. Four patients were at grade 2 and 3 at grade 3. Three millimeter punch biopsies were obtained and routinely processed for light and transmission electron microscopy.

RESULTS

Microphotography of specimens from cellulite patients demonstrated the presence of fibrotic septa which divided up larger clusters of adipose tissue into smaller packets, with the septa acting as a tethering system, thus producing the typical dimpling pattern. Ultrastructural findings showed proliferation of collagen and elastic fibers down into the cellulite tissue with compression of capillaries and congestion of arterioles, resulting in poor blood flow.

CONCLUSIONS

The histological and ultrastructural findings of cellulite clearly distinguish the condition from simple fat deposition. The remodeling of the fat layer into lobulated packets of lipocytes sequestered by fibrotic septa with a high proportion of elastic fibers would suggest the use of a fiber-based interstitial laser-assisted lipolysis system at an appropriate wavelength which might offer benefits through disruption of the septae through a photomechanical effect and lipolysis of the sequestered lipocytes. This could be followed by a course of near-infrared phototherapy to accelerate clearance of freed lipid and debris and reestablish the vascular system.

Ultrastructural assessment of cellulite morphology: clues to a therapeutic strategy?

INTRODUCTION AND AIMS

Cellulite is a problematic condition affecting mostly women, characterized by a bumpy or nodular skin surface. Recent approaches with laser treatment have offered some promise. The present study sought to identify possible targets for laser treatment or light therapy through an ultrastructural investigation of the condition.

SUBJECTS AND METHODS

Study subjects comprised 7 healthy Japanese female volunteers (Age range 37-46 yr, average 38.4) with cellulite, graded on the 4-point Nurnberger-Muller cellulite severity scale. Four patients were at grade 2 and 3 at grade 3. Three millimeter punch biopsies were obtained and routinely processed for light and transmission electron microscopy.

RESULTS

Microphotography of specimens from cellulite patients demonstrated the presence of fibrotic septa which divided up larger clusters of adipose tissue into smaller packets, with the septa acting as a tethering system, thus producing the typical dimpling pattern. Ultrastructural findings showed proliferation of collagen and elastic fibers down into the cellulite tissue with compression of capillaries and congestion of arterioles, resulting in poor blood flow.

CONCLUSIONS

The histological and ultrastructural findings of cellulite clearly distinguish the condition from simple fat deposition. The remodeling of the fat layer into lobulated packets of lipocytes sequestered by fibrotic septa with a high proportion of elastic fibers would suggest the use of a fiber-based interstitial laser-assisted lipolysis system at an appropriate wavelength which might offer benefits through disruption of the septae through a photomechanical effect and lipolysis of the sequestered lipocytes. This could be followed by a course of near-infrared phototherapy to accelerate clearance of freed lipid and debris and reestablish the vascular system.

Low-level laser therapy (LLLT) combined with swimming training improved the lipid profile in rats fed with high-fat diet

Obesity and associated dyslipidemia is the fastest growing health problem throughout the world. The combination of exercise and low-level laser therapy (LLLT) could be a new approach to the treatment of obesity and associated disease. In this work, the effects of LLLT associated with exercises on the lipid metabolism in regular and high-fat diet rats were verified. We used 64 rats divided in eight groups with eight rats each, designed: SC, sedentary chow diet; SCL, sedentary chow diet laser, TC, trained chow diet; TCL, trained chow diet laser; SH, sedentary high-fat diet; SHL, sedentary high-fat diet laser; TH, trained high-fat diet; and THL, trained high-fat diet laser. The exercise used was swimming during 8 weeks/90 min daily and LLLT (GA-Al-As, 830 nm) dose of 4.7 J/point and total energy 9.4 J per animal, applied to both gastrocnemius muscles after exercise. We analyzed biochemical parameters, percentage of fat, hepatic and muscular glycogen and relative mass of tissue, and weight percentage gain. The statistical test used was ANOVA, with post hoc Tukey-Kramer for multiple analysis between groups, and the significant level was p < 0.001, p < 0.01, and p < 0.05. LLLT decreased the total cholesterol (p < 0.05), triglycerides (p < 0.01), low-density lipoprotein cholesterol (p < 0.05), and relative mass of fat tissue (p < 0.05), suggesting increased metabolic activity and altered lipid pathways. The combination of exercise and LLLT increased the benefits of exercise alone. However, LLLT without exercise tended to increase body weight and fat content. LLLT may be a valuable addition to a regimen of diet and exercise for weight reduction and dyslipidemic control.