Can low-level laser therapy (LLLT) associated with an aerobic plus resistance training change the cardiometabolic risk in obese women? A placebo-controlled clinical trial

Loss of subcutaneous fat in 20 patients, both sexes, using a second-generation TECAR device of 1.240 Watts and results analyzed with magnetic resonance

BACKGROUND

Body contouring and abdominal fat loss without surgery are increasingly used technique. In a study in pigs, it is noted that both capacitive and resistive radiofrequency stimulation reduced subcutaneous fat. One human study demonstrated a loss of 2.90 cm in waist diameter. Second-generation TECAR (Acronym for Transfer Electric Capacitive and Resistive) device with 4 channels, 200 cm2 work area per channel, and high power (1240 W), regulates body energy input by measuring absorption in the body and adjusting the power for 80 min at 50°C.

AIMS

To evaluate the loss of subcutaneous fat, this magnitude was measured in grams and centimeters throughout the abdomen by MRI before and after each treatment.

SUBJECT AND METHODS

We have studied 25 patients, 13 women and 12 men with a mean age of 49 years. All patients had their waist diameter measured and an MRI performed before and after 10 continuous sessions except Saturday and Sunday, over 2 weeks. Additionally, a lipid profile was performed on the same day of the study and at the end of it. The study was approved by the Ethics Committee.

RESULTS

Waist diameter decreased by 5.5 cm, these differences being statistically significant (p = 0.000). Subcutaneous fat measured by MRI in cm decreased by 784 cm (p = 0.000). In grams, it decreased 808.7 g (p = 0.000). In the lipid profile, all the values decreased, but they were not statistically significant.

CONCLUSIONS

The use of this second generation of TECAR equipment at 1 MHz decreases the waist diameter by more than 5 cm and leads to the loss of more than 800 grams of subcutaneous fat in 12 days. It is a method without risks or side effects, well tolerated, and an alternative for those patients who do not want to go to the operating room.

Dose and time-response effect of photobiomodulation therapy on glycemic control in type 2 diabetic patients combined or not with hypoglycemic medicine: A randomized, crossover, double-blind, sham-controlled trial

Photobiomodulation therapy (PBMt) combined or not with oral hypoglycemic medication has not been investigated in type 2 diabetes (T2DM) patients. All 10 T2DM patients were assessed randomly at 6 different occasions (3 with and 3 without regular oral hypoglycemic medication). Capillary glycemia was assessed after overnight fast (pre-prandial), 1 h postprandially (standardized meal, 338 kcal), and 30 min, 3 h, 6 h, 12 h post-PBMt (830 nm; 25 arrays of LEDs, 80 mW/array). Three doses (0 J-sham, 100 J, 240 J per site) were applied bilaterally on quadriceps femoris muscles, hamstrings, triceps surae, ventral upper arm and forearm; and randomly combined or not with oral hypoglicemic medication, totaling six different therapies applied for all 10 TDM2 patients (PBMt sham, PBMt 100 J, PBMt 240 J, PBMt sham + medication, PBMt 100 J + medication, PBMt 240 J + medication). Cardiac autonomic control was assessed by heart rate variability (HRV) indices. Without medication, there was reduction in glycemia after all PBMt doses, with 100 J as the best dose that persisted until 12 h and presented lower area under the curve (AUC). With medication, glycemia decreased similarly among doses. No differences between 100 J and sham + medication, but AUC was significantly lower after 100 J, suggesting better glycemic control. Low frequency component of HRV increased after sham + medication and 100 J, suggesting higher sympathetic activation. PBMt showed time- and dose-response effect to reduce glycemia in T2DM patients. Effects on HRV were consistent with glycemic control.

Automated Mass Screening for Comorbidities of Vitiligo Using the National Health Insurance Database

Although the study design for identifying specific disease associations using a health insurance database has been well-established, few studies explore unknown comorbidities. We conducted a series of automated case-control studies for all International Classification of Disease, Tenth Revision, Clinical Modification diagnostic codes (A01-Z99) using the Korean National Health Insurance database from 2007 to 2017 to reveal undiscovered disease associations of vitiligo. A total of 90,297 patients with vitiligo and 90,297 age- and sex-matched controls without vitiligo were included, and disease associations for 1,265 relevant diagnostic codes were screened. A meta-analysis of the individual ORs for each International Classification of Disease, Tenth Revision code was performed to identify the possibility of selection bias. Finally, the association with vitiligo was significantly increased in 45 diseases and decreased in 6 diseases. We not only reaffirmed the positive correlation between vitiligo and other autoimmune diseases but also observed associations with obsessive-compulsive disorder and melanoma. In contrast, femur fracture showed a negative correlation. In this study, we attempted an automated mass screening and suggested a possible selection bias. In the era of large-scale databases, a systematic and comprehensive approach might be needed.

Effect of exercise training with laser phototherapy on homeostasis balance resistant to hypercoagulability in seniors with obesity: a randomized trial

The prevalence of obesity has increased the incidence of obesity-related coagulation disorders. The current study assessed the effectiveness of combined aerobic exercise and laser phototherapy on the coagulation profile and body measurements in older adults with obesity compared to aerobic exercise alone, which has not been adequately explored. We included 76 obese people (50% women and 50% men) with a mean age of 67.83 ± 4.84 years and a body mass index of 34.55 ± 2.67 kg/m². The participants were randomly assigned to the experimental group (which received aerobic training with laser phototherapy) and the control group (which received aerobic training alone) for three months. From the baseline to the final analysis, the absolute changes in specific coagulation biomarker levels (fibrinogen, fibrin fragment D, prothrombin time, Kaolin-Cephalin Coagulation Time), and contributing parameters (C-reactive protein and total cholesterol), were assessed. In comparison to the control group, the experimental group showed significant improvements in all evaluated measures (p < 0.001). So, in comparison to aerobic exercise alone, combined aerobic exercise and laser phototherapy had superior positive effects on coagulation biomarkers and decreased the risk of thromboembolism throughout a three-month intervention period in senior obese persons. Therefore, we suggest adopting laser phototherapy for individuals with a greater risk of hypercoagulability.The research was entered into the database of clinical trials under the identification NCT04503317.

Obesity Indices and Ventilatory Function Responses to High-Level Laser Therapy in Subjects with Abdominal Obesity

Objective: The aim of this study is to investigate the effectiveness of pulsed Nd:YAG high-intensity laser therapy (HILT) on body weight (Wt), body-mass index (BMI), waist circumference (WC), forced vital capacity (FVC), and forced expiratory volume in 1 sec (FEV1) in young adults with abdominal obesity (AO). Materials and methods: Thirty-seven young adult males (age 19-25 years) with BMI >30 kg/m² and WC >102 cm participated in this 12-week, randomized controlled study and were randomly allocated into either Group I [received pulsed Nd:YAG HILT plus moderate-intensity aerobic exercise training (AET) program] or Group II (received placebo pulsed Nd:YAG HILT plus the same AET program). The variables were evaluated pre- and poststudy. Results: Poststudy mean values and percentages of changes were calculated for Wt [83.7 ± 6.58 kg (-6.14%) and 88.71 ± 5.09 kg (-4.29%)], BMI [29.27 ± 1.06 kg/m² (-6.14%) and 30.09 ± 1.23 kg/m² (-4.24%)], WC [105.44 ± 5.84 cm (-3.78%) and 109.42 ± 4.9 cm (-1.74%)], FVC [4.79 ± 0.4 L (+13.6%) and 4.39 ± 0.66 L (+5.89%)], and FEV1 [4.04 ± 0.22 L (+16.4%) and 3.82 ± 0.39 L (+8.8%)] for Group I and Group II, respectively. Between groups, there were significant differences in mean values of Wt (p = 0.014), BMI (p = 0.04), WC (p = 0.03), FVC (p = 0.03), and FEV1 (p = 0.04) at the end of the study, but in favor of Group I. Conclusions: Utilizing the pulsed Nd:YAG HILT as an adjunctive therapeutic modality proved to be effective in improving the anthropometric indices and ventilatory functions in subjects with AO.

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.

Effects of the association of different volumes of strength training with photobiomodulation therapy on insulin resistance: A protocol for a randomized, triple-blind, placebo-controlled trial

Background

Insulin resistance (IR) is the main risk factor for developing type 2 diabetes. Both strength training (ST) and photobiomodulation therapy (PBMt) reduce IR, but the effect of combining different volumes of ST with PBMt is unknown.

Methods

Overweight/obese individuals will be assigned to 4 groups (n = 12/group): ST with volume following international guidelines (3 sets per exercise - high volume) or one-third of this volume (1 set per exercise - low volume), combined with PBMt or placebo. ST will be performed for 20 sessions over 10 weeks and will consist of 7 exercises. The PBMt will be applied after training sessions using blankets with light emitters (LEDs) placed over the skin on the frontal and the posterior region of the body, following the parameters recommended by the literature. The placebo group will undergo an identical procedure, but blankets will emit insignificant light. To measure plasma glucose and insulin concentrations, oral glucose tolerance tests (OGTT) will be performed before and after the training period. Thereafter, IR, the area under the curve of glucose and insulin, and OGTT-derived indices of insulin sensitivity/resistance will be calculated.

Expected impact on the field

This study will determine the effects of different ST volumes on IR and whether the addition of PBMt potentiates the effects of ST. Because previously sedentary, obese, insulin-resistant individuals might not comply with recommended volumes of exercise, the possibility that adding PBMt to low-volume ST enhances ST effects on IR bears practical significance.

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 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.

Study protocol for the use of photobiomodulation with red or infrared LED on waist circumference reduction: a randomised, double-blind clinical trial

INTRODUCTION

The search for non-invasive procedures to reduce localised adiposity in aesthetics clinics has recently been increasing. In this context, procedures, such as cryolipolysis, ultracavitation, photobiomodulation (PBM) and other techniques have been proposed. Some studies have shown that PBM can be used in body contouring. However, there is no standardisation of the protocol. More than that, as in other techniques for reducing adipose tissue, the availability of triacylglycerol may affect the lipid profile in the blood, bringing consequences to the general health of an individual. This work will aim to compare the light wavelengths when using PBM as a technique for reducing the abdominal waist circumference, while also evaluating the efficacy of the method. Changes in the lipid profile in the blood, with a long-term follow-up, will also be appraised.

METHODS AND ANALYSIS

This will be a controlled, randomised, double-blind, single-centred clinical trial. 174 patients will be recruited at the Nove de Julho University, Brazil, and then divided into three groups: Group A-RED PBM; Group B-INFRARED PBM; Group C-PLACEBO (Sham) treatment. The treatments will consist of eight sessions, two times a week, for 4 weeks. At each session, the participants will receive 30 minutes PBM (using a radiant exposure of 127 J/cm²), with an abdominal strap containing 4 LED clusters, with 72 devices each, following the indication of randomisation. All of the groups will receive 30 min of Aussie Current, at 4 kHz, modulated at 10 Hz, 40-60 mA. The main outcome of this study will be waist circumference reduction. The secondary variables will be anthropometric data, lipid profile, liver function and adipose tissue thickness, changes in the local microcirculation, and the quality of life and self-esteem. The analyses will be performed at four stages of the research, D0, end of the eighth session (D30), 15 days after the last session (FU15), 90 days after the last session (FU90) and 180 days after the last session (FU180).

ETHICS AND DISSEMINATION

The Ethics Committee of the Nove de Julho University, Brazil, approved the modified version of this project under No. 3414146 on 26 June 2019. This study is not yet recruiting. The results obtained will be published in a peer-reviewed journal in the related field.

TRIAL REGISTRATION NUMBER

Brazilian Registry of Clinical Trials-ReBec (RBR-9bwxcx).

Can photobiomodulation therapy (PBMT) control blood glucose levels and alter muscle glycogen synthesis?

Photobiomodulation therapy (PBMT) has many effects on the energy metabolism of musculoskeletal tissue, such as increased glycogen and adenosine triphosphate synthesis. In addition, these effects may be due to a systemic blood glucose control. Twenty-four Wistar rats were randomly and equally allocated into four groups: sham, PBMT 10 J/cm², PBMT 30 J/cm² and PBMT 60 J/cm². The animals were fasting for 6 h for blood glucose evaluations during pre-irradiation period, 1 h, 3 h and 6 h after PBMT. Muscle glycogen synthesis was measured 24 h after PBMT. This PBMT used a cluster of 69 LEDs (light-emitting diodes) with 35 red (630 ± 10 nm) and 34 infrared (850 ± 20 nm); 114 mW/cm² for 90s (10 J/cm²), 270 s (30 J/cm²), 540 s (60 J/cm²) applied on large muscle areas (back and hind legs) of the animals. The 10 J/cm² group showed lower blood glucose levels and glucose variability over 6 h (5.92 mg/dL) compared to the sham (13.03 mg/dL), 30 J/cm² (7.77 mg/dL) and 60 J/cm² (9.07 mg/dL) groups. The PBMT groups had the greatest increase in muscle glycogen (10 J/cm² > 60 J/cm² > 30 J/cm² > sham), characterizing a triphasic dose-response of PBMT. There was a strong negative correlation between blood glucose variability over 6 h and muscle glycogen concentration for 10 J/cm² group (r = -0.94; p < .001) followed by 30 J/cm² group (r = -0.84; p < .001) and 60 J/cm² group(r = -0.73; p < .006). These results suggest that PBMT can play a very important role in the control of blood glucose levels, and its possible mechanism of action is the induction of greater muscle glycogen synthesis independently of physical exercise.

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.

Photobiomodulation of the microbiome: implications for metabolic and inflammatory diseases

The human microbiome is intimately associated with human health, with a role in obesity, metabolic diseases such as type 2 diabetes, and divergent diseases such as cardiovascular and neurodegenerative diseases. The microbiome can be changed by diet, probiotics, and faecal transplants, which has flow-on effects to health outcomes. Photobiomodulation has a therapeutic effect on inflammation and neurological disorders (amongst others) and has been reported to influence metabolic disorders and obesity. The aim of this study was to examine the possibility that PBM could influence the microbiome of mice. Mice had their abdomen irradiated with red (660 nm) or infrared (808 nm) low-level laser, either as single or multiple doses, over a 2-week period. Genomic DNA extracted from faecal pellets was pyrosequenced for the 16S rRNA gene. There was a significant (p < 0.05) difference in microbial diversity between PBM- and sham-treated mice. One genus of bacterium (Allobaculum) significantly increased (p < 0.001) after infrared (but not red light) PBM by day 14. Despite being a preliminary trial with small experimental numbers, we have demonstrated for the first time that PBM can alter microbiome diversity in healthy mice and increase numbers of Allobaculum, a bacterium associated with a healthy microbiome. This change is most probably a result of PBMt affecting the host, which in turn influenced the microbiome. If this is confirmed in humans, the possibility exists for PBMt to be used as an adjunct therapy in treatment of obesity and other lifestyle-related disorders, as well as cardiovascular and neurodegenerative diseases. The clinical implications of altering the microbiome using PBM warrants further investigation.

The effects of exercise training associated with low-level laser therapy on biomarkers of adipose tissue transdifferentiation in obese women

Investigations suggest the benefits of low-level laser therapy (LLLT) to improve noninvasive body contouring treatments, inflammation, insulin resistance and to reduce body fat. However, the mechanism for such potential effects in association with exercise training (ET) and possible implications in browning adiposity processes remains unclear. Forty-nine obese women were involved, aged between 20 and 40 years with a body mass index (BMI) of 30-40 kg/m². The volunteers were divided into Phototherapy (808 nm) and SHAM groups. Interventions consisted of exercise training and phototherapy applications post exercise for 4 months, with three sessions/week. Body composition, lipid profile, insulin resistance, atrial natriuretic peptide (ANP), WNT5 signaling, interleukin-6 (IL-6), and fibroblast growth factor-21 (FGF-21) were measured. Improvements in body mass, BMI, body fat mass, lean mass, visceral fat, waist circumference, insulin, HOMA-IR, total cholesterol, LDL-cholesterol, triglycerides, and ANP in both groups were demonstrated. Only the Phototherapy group showed a reduction in interleukin-6 and an increase in WNT5 signaling. In addition, it was possible to observe a higher magnitude change for the fat mass, insulin, HOMA-IR, and FGF-21 variables in the Phototherapy group. In the present investigation, it was demonstrated that exercise training associated with LLLT promotes an improvement in body composition and inflammatory processes as previously demonstrated. The Phototherapy group especially presented positive modifications of WNT5 signaling, FGF-21, and ANP, possible biomarkers associated with browning adiposity processes. This suggests that this kind of intervention promotes results applicable in clinical practice to control obesity and related comorbidities.

When is the best moment to apply photobiomodulation therapy (PBMT) when associated to a treadmill endurance-training program? A randomized, triple-blinded, placebo-controlled clinical trial

Photobiomodulation therapy (PBMT) employing low-level laser therapy (LLLT) and/or light emitting diode therapy (LEDT) has emerged as an electrophysical intervention that could be associated with aerobic training to enhance beneficial effects of aerobic exercise. However, the best moment to perform irradiation with PBMT in aerobic training has not been elucidated. The aim of this study was to assess the effects of PBMT applied before and/or after each training session and to evaluate outcomes of the endurance-training program associated with PBMT. Seventy-seven healthy volunteers completed the treadmill-training protocol performed for 12 weeks, with 3 sessions per week. PBMT was performed before and/or after each training session (17 sites on each lower limb, using a cluster of 12 diodes: 4 × 905 nm super-pulsed laser diodes, 4 × 875 nm infrared LEDs, and 4 × 640 nm red LEDs, dose of 30 J per site). Volunteers were randomized in four groups according to the treatment they would receive before and after each training session: PBMT before + PBMT after, PBMT before + placebo after, placebo before + PBMT after, and placebo before + placebo after. Assessments were performed before the start of the protocol and after 4, 8, and 12 weeks of training. Primary outcome was time until exhaustion; secondary outcome measures were oxygen uptake and body fat. PBMT applied before and after aerobic exercise training sessions (PBMT before + PBMT after group) significantly increased (p < 0.05) the percentage of change of time until exhaustion and oxygen uptake compared to the group treated with placebo before and after aerobic exercise training sessions (placebo before + placebo after group) at 4th, 8th, and 12th week. PBMT applied before and after aerobic exercise training sessions (PBMT before + PBMT after group) also significantly improved (p < 0.05) the percentage of change of body fat compared to the group treated with placebo before and after aerobic exercise training sessions (placebo before + placebo after group) at 8th and 12th week. PBMT applied before and after sessions of aerobic training during 12 weeks can increase the time-to-exhaustion and oxygen uptake and also decrease the body fat in healthy volunteers when compared to placebo irradiation before and after exercise sessions. Our outcomes show that PBMT applied before and after endurance-training exercise sessions lead to improvement of endurance three times faster than exercise only.

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.