Current Indications of Low-Level Laser Therapy in Plastic Surgery: A Review

Low-level green laser promotes wound healing after carbon dioxide fractional laser therapy

BACKGROUND

The carbon dioxide (CO₂ ) fractional laser resurfacing has become one of the hottest therapies for dermatoses. However, complications such as skin swelling, prolonged erythema, post-inflammatory hyperpigmentation, and scar formation remain. Low-level laser (LLL) therapy is accepted to promote skin wound healing and regeneration, decrease inflammation and pain, and modulate immunoreaction with low-dose laser of different wavelength. 532 nm laser therapy is commonly used to remove pigmented spots and to tender skin, but not utilized in wound care.

OBJECTIVE

We aimed to determine the efficacy of the low-level 532 nm green laser in wound healing after CO₂ fractional laser.

METHODS

Six adult male mice (C57BL/6, 8 weeks old) were prepared for animal experiments. The dorsum of each mouse was divided into four parts that, respectively, received designed treatments, as controlled (group Ctrl), 532 nm LLL-treated (group GL), CO₂ fractional laser-treated (group FL), and CO₂ fractional laser followed by three times 532 nm LLL-treated (group FG). Hematoxylin-eosin staining (H&E), Masson-trichrome staining, CD31 immunohistochemical staining were performed to evaluate the efficacy of wound healing after treated by different irradiations. Western blotting was used to detect the expression of related proteins. Mouse skin fibroblasts (MSFs) were treated with LLL using a wavelength of 532 nm once. Cellular responses were observed and analyzed after 48 hours. Cell viability and migration of different groups were assessed by scratch and the Cell Counting Kit-8 (CCK8) assays, respectively.

RESULTS

Collagen remodeling and epidermis thickness were significantly enhanced in group FG than that in group FL in morphology. Besides, CD31 immunohistochemical staining indicated prominently increased angiogenesis in both groups FL and FG than non-irradiation group. The expression of extracellular matrix (ECM)-related protein (Col1, Col3 and MMP1) showed a remarkable improvement in wound healing in group FG than that in group FL. Irradiated MSFs showed a better migration ability compared with non-irradiated controls. LLL enhanced the secretion function of MSFs on Collagen I and III.

CONCLUSIONS

Low-level green laser promotes wound healing after CO₂ fractional laser by improving the integrity of skin barrier and allowing for scarless healing. Therefore, low-level green laser therapy might serve as a sequential therapy of invasive laser surgery to ensure a better wound care.

Dosimetry and Clinical Efficacy of Transcranial Photobiomodulation for Major Depression Disorder: Could they Guide Dosimetry for Alzheimer's Disease?

BACKGROUND

Major depressive disorder (MDD) is prevalent and has significant impact on individuals and society. Cognitive symptoms are frequent in MDD and insufficiently treated by antidepressant medications. Transcranial photobiomodulation (t-PBM) is a novel device therapy which shows promise as an antidepressant and pro-cognitive treatment. To date, despite the encouraging results, the optimal stimulation parameters of t-PBM to treat MDD are not established, and clinical studies are very heterogeneous in terms of these parameters. While the literature provides guidance on the appropriate fluence to achieve therapeutic results, little is known on the other parameters.

OBJECTIVE

To evaluate the relationship between different parameters and the antidepressant effect of t-PBM.

METHODS

We reviewed clinical studies on MDD and on depressive symptoms comorbid with other diseases. We calculated the standardized effect size of the change in symptoms severity before and after t-PBM and we performed a descriptive analysis of the reviewed papers.

RESULTS

The greatest effect sizes for the antidepressant effect were found in studies using pulse-wave t-PBM with high peak irradiance (but low average irradiance) over large skin surface. One well-designed and sufficiently powered, double-blind, sham-controlled trial indicated that t-PBM with low irradiance over a small skin surface is ineffective to treat depression.

CONCLUSION

The use of t-PBM for Alzheimer's disease and for dementia is still at its inception; these dosimetry lessons from the use of t-PBM for depression might serve as guidance.

Photobiomodulation of acute pain syndrome after septoplasty

The paper evaluates the effectiveness of the use of therapeutic laser exposure (photobiomodulation therapy – PBMT) to minimize acute pain in the early postoperative period in patients after septoplasty. The study included two groups of patients. Patients of the first group (31 patients) underwent septoplasty with standard management in the postoperative period. Patients of the second group (31 patients) also underwent septoplasty, and then added PBMT to the standard measures of the postoperative period at 3, 6 and 24 h after septoplasty (λ = 0.890 μm, P = 10 W, 2 min) and then intranasally 48 h after septoplasty (λ = 0.630 μm, P = 8 W, 2 min). In patients of both groups, heart rate variability and pain were assessed using a visual analog scale within 48 hours after septoplasty. In patients of the second group, after the use of PBMT, the indicators of heart rate variability had a significantly lower total power, compared with patients of the first group. So, after PBMT, the ultra-low-frequency component of the spectral analysis of heart rate variability in the first group was 18580 ± 2067 ms2, which is significantly higher than in the second group (8086 ± 3003 ms2) (p <0.001). The low-frequency component of heart rate variability was also significantly higher in the first group (1871 ± 405 ms2) compared to the second (1095 ± 190 ms2) (p <0.005), which indicates an increase in the tension of the sympathetic part of the autonomic nervous system in the group without the use of PBMT. In the first 3 hours after surgery, the severity of pain between the groups did not differ significantly (p = 0.07). In the period from 6 to 24 hours after surgery, patients who did not undergo PBMT experienced significantly higher pain than patients with PBMT (p <0.001). Thus, in our study, the group of patients with PBMT showed better results in pain and heart rate variability compared to the classical rehabilitation of patients after septoplasty.

Effect of Photobiomodulation on Ecchymosis after Rhinoplasty: A Randomized Single-Blind Controlled Trial

BACKGROUND

This study was conducted to compare the effect of photobiomodulation therapy (low-level laser therapy) on ecchymosis after rhinoplasty.

SUBJECTS AND METHODS

Sixty rhinoplasty candidates were randomly divided into two groups. Photobiomodulation, including red light (660 nm), infrared light (840 nm), and infrared laser, was used in the first group on the first postoperative day, and its effect on periorbital ecchymosis was evaluated.

RESULTS

The findings showed that low-power laser reduced ecchymosis significantly (p = 0.005^*).

CONCLUSION

Photobiomodulation may be effectively used for reducing ecchymosis after rhinoplasty.

LEVEL OF EVIDENCE II

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 . RCT registration number is IRCT20080820001056N3.

Effects of photobiomodulation therapy in the integration of skin graft in rats

Skin graft is one of the most common techniques used in plastic surgery and repair. However, there are some complications that can lead to loss of the skin graft. Thus, several features have been studied with the aim of promoting the integration of skin grafts. Among these resources, the use of laser photobiomodulation (laser PBM) has been highlighted. The present study aimed to investigate the effects of laser PBM on the viability and integration of skin grafts in rats. Twenty male Wistar rats (± 250 g) were randomly assigned into two experimental groups with 10 animals each: control group, animals submitted to skin graft and simulation of laser PBM; laser PBM group, submitted to the skin graft and submitted to laser PBM at 660 nm, 40 mW, 60 s, 2.4 J. The animals were submitted to laser photobiomodulation immediately after the surgical procedure and each 24 h. Animal euthanasia occurred on the 7th day after surgery, 24 h after the last treatment session. The histopathological analysis revealed that the laser PBM showed better adhesion of the graft when compared to the control group. Likewise, the morphometric analysis of mast cells, blood vessels, and collagen showed a statistically significant increase in the animals irradiated with the laser PBM when compared to the control group. In addition, immunohistochemical analysis demonstrated that the laser PBM showed statistically higher immunoexpression of FGF when compared to the CG. However, IL-4 immunoexpression did not show statistical difference between the experimental groups. From the results obtained in the present study, it can be suggested that laser photobiomodulation was effective in promoting the integration and viability of total skin grafts in rats.

Non-Ionizing Radiation in Swedish Health Care-Exposure and Safety Aspects

The main aim of the study was to identify and describe methods using non-ionizing radiation (NIR) such as electromagnetic fields (EMF) and optical radiation in Swedish health care. By examining anticipated exposure levels and by identifying possible health hazards we also aimed to recognize knowledge gaps in the field. NIR is mainly used in health care for diagnosis and therapy. Three applications were identified where acute effects cannot be ruled out: magnetic resonance imaging (MRI), transcranial magnetic stimulation (TMS) and electrosurgery. When using optical radiation, such as class 3 and 4 lasers for therapy or surgical procedures and ultra-violet light for therapy, acute effects such as unintentional burns, photo reactions, erythema and effects on the eyes need to be avoided. There is a need for more knowledge regarding long-term effects of MRI as well as on the combination of different NIR exposures. Based on literature and after consulting staff we conclude that the health care professionals' knowledge about the risks and safety measures should be improved and that there is a need for clear, evidence-based information from reliable sources, and it should be obvious to the user which source to address.

Effect of 810 nm Near-Infrared Laser on Revascularization of Ischemic Flaps in Rats

OBJECTIVE

To investigate the effect of 810 nm near-infrared (NIR) laser on the revascularization of ischemic flaps.

BACKGROUND

It has long been proved that photobiomodulation therapy (PBMT) improves the blood supply of flaps. NIR laser improves the treatment of hypodermis-located lesions and of flap survival, but basic research on the use of 810 nm NIR laser for ischemic flap revascularization is still lacking.

MATERIALS AND METHODS

We prepared two symmetrical long random-pattern flaps on the backs of 60 rats. Each flap was 6 cm long, 1 cm wide, and 1 cm to the middle line. The flaps were divided into an irradiated flap group and an internal control group. The irradiated flaps underwent postoperative 810 nm laser therapy with the energy density of 11.30 J/cm² daily. The control flaps were covered by stainless steel to avoid laser irradiation. We observed the viability of the flaps. The flaps underwent Hematoxylin and Eosin (H&E) staining for the observation of histomorphology, immunohistochemical staining of factor VIII for the capillary count, α-smooth muscle actin for the small arterial count, and vascular endothelial growth factor for the integrated optical density (OD) of the positive stained color.

RESULTS

The irradiated flaps showed significantly better flap survival than the control flaps. H&E staining showed that the irradiated flaps had clear tissue structure and little inflammatory cell infiltration. The control flaps demonstrated comparatively worse results. Vascular endothelial growth factor staining showed that the difference in integrated OD between the irradiated flaps and the control flaps was not statistically significant. α-smooth muscle actin and factor VIII staining showed significantly greater numbers of arterioles and capillaries in the irradiated flaps than the control flaps after 4 days of irradiation.

CONCLUSIONS

PBMT with 810 nm NIR laser could enhance ischemic flap revascularization and increase flap viability.

Comparison of two different laser photobiomodulation protocols on the viability of random skin flap in rats

To identify the best low level laser photobiomodulation application site at the same irradiation time to increase the viability of the skin flap in rats. Eighteen male rats (Rattus norvegicus: var. Albinus, Rodentia Mammalia) were randomly distributed into three groups (n = 6). Group I (GI) was submitted to simulated laser photobiomodulation; group II (GII) was submitted to laser photobiomodulation at three points in the flap cranial base, and group III (GIII) was submitted to laser photobiomodulation at 12 points distributed along the flap. All groups were irradiated with an Indium, Galium, Aluminum, and Phosphorus diode laser (InGaAlP), 660 nm, with 50 mW power, irradiated for a total time of 240 s in continuous emission mode. The treatment started immediately after performing the cranial base random skin flap (10 × 4 cm² dimension) and reapplied every 24 h, with a total of five applications. The animals were euthanized after the evaluation of the percentage of necrosis area, and the material was collected for histological analysis on the seventh postoperative day. GII animals presented a statistically significant decrease for the necrosis area when compared to the other groups, and a statistically significant increase in the quantification of collagen when compared to the control. We did not observe a statistical difference between the TGFβ and FGF expression in the different groups evaluated. The application of laser photobiomodulation at three points of the flap cranial base was more effective than at 12 points regarding the reduction of necrosis area.

Review of transcranial photobiomodulation for major depressive disorder: targeting brain metabolism, inflammation, oxidative stress, and neurogenesis

We examined the use of near-infrared and red radiation (photobiomodulation, PBM) for treating major depressive disorder (MDD). While still experimental, preliminary data on the use of PBM for brain disorders are promising. PBM is low-cost with potential for wide dissemination; further research on PBM is sorely needed. We found clinical and preclinical studies via PubMed search (2015), using the following keywords: "near-infrared radiation," "NIR," "low-level light therapy," "low-level laser therapy," or "LLLT" plus "depression." We chose clinically focused studies and excluded studies involving near-infrared spectroscopy. In addition, we used PubMed to find articles that examine the link between PBM and relevant biological processes including metabolism, inflammation, oxidative stress, and neurogenesis. Studies suggest the processes aforementioned are potentially effective targets for PBM to treat depression. There is also clinical preliminary evidence suggesting the efficacy of PBM in treating MDD, and comorbid anxiety disorders, suicidal ideation, and traumatic brain injury. Based on the data collected to date, PBM appears to be a promising treatment for depression that is safe and well-tolerated. However, large randomized controlled trials are still needed to establish the safety and effectiveness of this new treatment for MDD.