Laser lipolysis is a body contouring procedure designed to remove excess fat from specific areas of the body using laser energy. It's also referred to as laser liposuction, laser lipo, and liposculpture. This article delves into the effectiveness of laser lipolysis, the different types, the procedure itself, candidacy, potential side effects, and a comparison with other fat reduction methods like CoolSculpting.
What is Laser Lipolysis?
Laser lipolysis is a body contouring procedure that utilizes laser energy to eliminate excess fat from areas such as the abdomen, back, neck, calves, hips, buttocks, obliques (love handles), thighs, and upper arms.
Types of Laser Lipolysis
Plastic surgeons may perform two primary types of laser lipolysis:
- Minimally Invasive Laser Lipolysis: This involves making a small incision in the skin to insert the laser applicator.
- Noninvasive Laser Lipolysis: This type doesn't require any incisions, as the laser applicator is applied directly to the skin's surface.
Does Laser Lipolysis Really Work?
Both minimally invasive and noninvasive laser lipolysis have demonstrated effectiveness in reducing fat cells. However, it can take up to three months to observe noticeable results.
How Many Sessions Are Needed?
The number of laser lipolysis sessions required varies depending on individual circumstances. On average, people may need one to two treatments for each body part.
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Who is a Good Candidate?
Ideal candidates for laser lipolysis are individuals who:
- Are in good overall health.
- Don’t smoke or can quit smoking weeks before treatment.
- Have realistic expectations regarding the outcomes.
Who Isn't a Good Candidate?
Laser lipolysis may not be suitable for individuals who have:
- Excess weight (obesity).
- Loose skin.
- Medical conditions, such as diabetes, cardiovascular diseases, or liver disease.
Furthermore, laser lipolysis is not recommended for women who are pregnant or trying to conceive. A consultation with a plastic surgeon can help determine if minimally invasive or noninvasive laser lipolysis, or another body contouring method, is appropriate.
Is Laser Lipolysis Permanent?
Laser lipolysis results are generally long-lasting.
Low-Level Laser Therapy (LLLT) and Fat Reduction
Low-level laser therapy (LLLT) is frequently employed in medical applications but lacks extensive scientific studies regarding its efficacy and the mechanism by which it causes fat loss from fat cells for body contouring.
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A study involving forty healthy men and women with a BMI <30 kg/m2 were randomized to either laser or control treatment. Subjects' waistlines were treated for 30 minutes twice a week for four weeks. Standardized waist circumference measurements and photographs were taken before and after treatments. Subjects were asked not to change their diet or exercise habits. The data showed that each treatment resulted in a 0.4-0.5 cm loss in waist girth. Cumulative girth loss after four weeks was −2.15 cm (−0.78 ± 2.82 vs. 1.35 ± 2.64 cm for the control group, p < 0.05). A blinded evaluation of standardized pictures showed statistically significant cosmetic improvement after four weeks of laser treatment. LLLT achieved safe and significant girth loss sustained over repeated treatments and cumulative over eight treatments in four weeks.
The Science Behind LLLT
Laser-based devices have been used in various medical and surgical applications, with their biological effects documented for over 20 years. Low-level laser (LLL) devices have been used to facilitate tissue repair and healing processes. Although the physiological methods responsible for augmented cell proliferation and pain relief are unknown, well-controlled clinical trials have demonstrated that low-level lasers provide therapeutic relief of pain. Low-level laser therapy is defined as management with a dose rate that causes no immediate demonstrable temperature rise of the treated tissue and no macroscopically visible change in tissue structure.
The Meridian LAPEX 2000 LipoLaser System is a semiconductor-based, low-level laser therapy device (LLLD). Originally developed and approved for the treatment of pain due to carpal tunnel syndrome, it has been modified and is now being evaluated for its effectiveness in reducing areas of local fat accumulation for cosmetic purposes. The LAPEX 2000 LipoLaser emits light at 635-680 nm, is non-thermal, and does not heat the tissues.
How LLLT Affects Fat Cells
Neira et al. evaluated the effect of a 635-680 nm, 10-mW diode laser radiation with exclusive energy optics on treated fat cells in biopsy specimens. Fat cells were treated in vivo with 1.2-3.6 J/cm2 of energy from the laser for 2 to 6 minutes. The cells were then removed by lipectomy, examined by electron microscopy, and compared to cells removed by lipectomy that were not treated with the laser. Untreated fat cells looked like round grapes. Eighty percent of the fat was released from the fat cells after 4 minutes of laser light exposure, and 99% was released after 6 minutes of exposure. After exposure to the laser light, pores in fat cells were visible by scanning electron microscope.
Several studies have recognized that LLL accelerates repair processes, stimulates cell proliferation, and promotes vascularization in injured tissues. However, clinical application to body fat reduction as a minimally invasive option is an evolving field that is not well-studied.
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Clinical Trial on LLLT for Fat Reduction
A blinded clinical trial was conducted to describe the application of low-level laser therapy to local fat reduction for cosmetic purposes. As a secondary objective, the study investigated the mechanism by which the laser causes fat loss from fat cells, specifically whether the fat loss induced by the laser is due to (1) the activation of the complement cascade lysing adipocytes, (2) adipocyte death, or (3) release of intact triglycerides from cells.
Forty healthy men and women between the ages of 18-65 years, inclusive, and body mass index (BMI) no greater than 29.9 kg/m2 were randomized in a 1:1 ratio to an experimental laser treatment or to a control laser treatment. Subjects could not be using light sensitizing agents, diuretics, or undergoing photodynamic therapy. Subjects were required to have a stable weight, gaining or losing no more than 2.5 kg in 6 months prior to the trial. Subjects could not be on a weight reduction regimen and were asked not to change their diet or exercise habits during the trial.
The laser therapy device consisted of a console housing most electronics, the controls for the device, and two multiprobes that housed four lasers emitting visible laser light at a wavelength of 635-680 nm. Each subject had two treatments per week for a total of eight treatments over four weeks. Each treatment session lasted approximately 30 minutes. The two multiprobes were placed over the waist bilaterally in three positions, as well as two enhancement probes that were placed to both sides of the inguinal region, and the laser was activated for 10 minutes in each of these positions to encompass the waist from the back to the front.
Measurements and Analysis
All subjects had photographs taken at a standardized distance with a standard background and lighting. Girth measurements of the waist were obtained in the manner recommended by the United States National Institutes of Health (NIH) guidance at the iliac crest using a tape measure with standardized tension and oriented parallel to the floor. Standardized waist measurements were taken at baseline, treatment 3, and treatment 8. Standardized photographs were taken before and after the initial treatment, treatment 3, and treatment 8. Weight was measured, and BMI was calculated at baseline and at treatment 8 (week 4). Blood pressure was measured at baseline, treatment 3, and treatment 8.
The waist circumference measurements were compared between the control and laser-treated group using a t-test. The data were analyzed using completers and the more conservative intent-to-treat analysis. The blinded observers judged improvement on a 0-3 scale.
Results of the Clinical Trial
Forty subjects participated in the clinical trial; twenty were treated with the LAPEX 2000 LipoLaser, and twenty were treated with an inactive version of the device. One subject in the treatment group did not complete the study due to scheduling conflicts. There were no adverse events in either group during the trial.
The mean placebo-subtracted reductions in waist girth at treatments 1, 3, and 8 with the LAPEX 2000 LipoLaser were 0.49, 0.41, and 0.40 cm, respectively. This single treatment difference, 0.41 cm (laser −0.59 ± 0.71 cm vs. placebo −0.19 ± 0.47 cm) (mean±SD), was significant (p < 0.05) on the third treatment done during week 2 in the completers' analysis but was not statistically significant by the intent-to-treat analysis. The cumulative girth loss at treatment 3 on week 2 was a significant 1.74 cm (laser −1.89 ± 2.97 cm vs. placebo −0.16 ± 2.46 cm, p < 0.05) on both the completers' analysis and by intent-to-treat analysis. Cumulative girth loss at treatment 8 (4 weeks of treatment) was 2.15 cm with 15 subjects in the laser group and 16 subjects in the placebo group (laser −0.78 ± 2.82 cm vs. placebo 1.35 ± 2.64 cm) in those who maintained their weight within 1.5 kg of their baseline weight (p < 0.05).
The standardized pictures of the participants showed a significant 1.21 difference (laser 1.21 ± 0.42 vs. placebo 0 ± 0) in appearance on a 0-3 scale favoring the LAPEX 2000 LipoLaser group comparing baseline to week 4 (treatment 8) pictures (p < 0.001).
Cellular Mechanisms
The fat cells that came into contact with plasma or plasma with white blood cells were lysed in both the laser-treated and the control plate, but cells in the control wells or in wells with heat-inactivated plasma were not lysed. This indicates that serum complement does lyse fat cells, but that the laser does not activate complement. The number of viable cells in the laser-treated or untreated group as determined by the propidium iodide assay were similar, but calcein levels were lower in the laser-treated cells.
Baseline triglycerides in the control wells were undetectable and were increased, as expected, in the wells with serum. The laser-irradiated wells containing serum had significantly greater increases in triglycerides than the non-irradiated wells containing serum (69 ± 1.7 vs. 66.7 ± 1.5 mg/dL, p = 0.004). The laser-irradiated wells containing heat-inactivated serum had a significantly greater increase in triglycerides than the non-irradiated wells containing heat-inactivated serum (72.6 ± 1.8 vs. 70.1 ± 1.6 mg/dL, p = 0.008).
Six-Week LLLT Protocol Study
Another study aimed to determine if the same aesthetic benefit can be achieved following one weekly low-level laser therapy treatment for six weeks, compared to the previous two-week treatment protocol.
Study Design and Methods
Healthy adults with a body mass index of 25 to 40kg/m2 (N=54) underwent one weekly low-level laser therapy procedure for six consecutive weeks using a device consisting of six 17mW, 635nm red diodes. Waist, hip, thigh, and upper abdomen circumference were measured weekly. The study's success criteria was a 4.5-inch mean decrease in combined body circumference.
Results
The mean decrease in combined circumference reduction at six weeks was 5.4 inches (p<0.001), and most subjects (72.2%) achieved a ?4.5-inch decrease. Most subjects (81.0%) were Satisfied (27%) or Very Satisfied (54%) with the aesthetic results they achieved. There were no adverse events.
Conclusion
The study concluded that one weekly low-level laser therapy treatment for six weeks is clinically effective for reducing waist, hip, thigh, and upper abdomen circumference and may be more effective than the previous two-week treatment protocol.
Device and Procedure Details
The device used in this study comprises six independent 17mW, 635nm red laser diodes (Erchonia® Zerona 6-Headed Scanner (EZ6); Erchonia Corporation, McKinney, Texas). The device utilizes internal mechanics, which collects the light emitted from each laser diodes and processes it through a proprietary lens system that redirects the beam with a line refractor. The refracted light is then bent into a circular pattern that is completely random and independent of other individual diodes.
The first LLLT treatment was performed during clinic Visit 1 after baseline body measurements were obtained. With subjects laying on their back on a procedure table, the device was positioned 6 inches (15.2cm) above their lower and upper abdomen, stomach, hips, and bilateral thighs area and centered along the body midline, and was activated for exactly 30 minutes. The subjects were then asked to lay on their stomach and the corresponding dorsal areas were treated for an additional 30 minutes. The procedure was repeated weekly for six weeks.
Outcome Measures and Satisfaction
The primary outcome measure was the change in combined bilateral thigh, hip, waist, and upper abdomen circumference from baseline to completion of the sixth and final procedure and two weeks after completing the final procedure. The pre-established study success criteria was a minimum mean decrease in combined circumference of 4.5 inches (11.4cm). At six weeks, subjects were asked to rate their satisfaction with the aesthetic results they achieved using a 5-point Likert scale.
Study Results: Circumference Reduction and Satisfaction
The mean combined decrease in circumference measurement at six weeks was 5.4 inches (13.7cm; p<0.0001). The maximum decrease in total mean circumference was achieved at the two-week post-treatment evaluation for the hips (1.2 inches; 3.0cm), waist (1.8 inches; 4.6cm), upper abdomen (1.3 inches; 3.3cm), right thigh (1.1 inches; 2.8cm), and left thigh (0.9 inches; 2.3cm) (for each, p<0.01 vs. Baseline). An overall positive satisfaction rating following the final LLLT procedure was given by 81 percent of subjects.
Comparison to Other Non-Invasive Techniques
Although tumescent liposuction remains the gold standard for the removal of unwanted adipose tissue, there is a strong public demand for less invasive techniques. In addition to LLLT, several marketed devices are currently available that utilize thermal and mechanical ultrasound, cryotherapy, and various forms of radiofrequency for noninvasive body sculpting.
Subjects undergoing treatment with thermal ultrasound commonly experience adverse events, including mild or moderate procedural pain and ecchymosis. Cryotherapy is better tolerated, although most subjects in one study reported minimal to tolerable procedural discomfort. In contrast, subjects undergoing LLLT experienced no treatment-related discomfort or other post-treatment adverse effects.
Laser Liposuction vs. CoolSculpting
Laser liposuction and CoolSculpting are both fat-reduction procedures performed to remove fat from specific areas of the body, such as the arms, thighs, stomach, and chin. CoolSculpting is noninvasive, while laser lipo is a minor surgical procedure. Laser lipo carries many of the same risks and side effects as traditional liposuction, but on a smaller scale.
Key Differences
- Procedure: Laser lipo is minimally invasive, using a laser to melt away fat under the skin. CoolSculpting is noninvasive, using a cooling applicator to freeze away fat beneath the skin.
- Downtime: Laser lipo might require a few days of downtime. After a CoolSculpting procedure, you may return to your normal activities the same day.
- Cost: Laser liposuction costs an average of $2,500 to $5,450. CoolSculpting averages $2,000 to $4,000.
- Efficacy: Both procedures are effective. Results are permanent when a healthy weight, diet, and lifestyle are maintained.
- Results Timeline: While laser lipo results are immediate, CoolSculpting results take several weeks (and up to two months) to be noticeable.
Laser Liposuction Procedure
Laser lipo can be performed in your doctor’s office under local anesthesia, without the need for general anesthesia. A small incision is made, and a tiny laser is inserted under the skin to liquefy the fat. A cannula then sucks the melted fat out from beneath the skin.
CoolSculpting Procedure
CoolSculpting involves placing an applicator on the area to be treated, which freezes the fat cells. The frozen fat cells die and are processed away and absorbed by your body over several weeks to two months.
Ideal Candidates
- Laser Liposuction: People who are healthy and near their ideal weight. It's not a weight loss treatment for individuals with excessive body weight.
- CoolSculpting: Individuals of a healthy weight with stubborn pockets of fat on their bodies that aren’t affected by diet and exercise.
Duration of Procedures
- Laser Liposuction: Sessions take about one hour per area.
- CoolSculpting: Sessions take about 35 to 60 minutes per area.
Results Timeline
- Laser Liposuction: Results within about a week, with full results over two to six months.
- CoolSculpting: Results in as few as three weeks, with best results two months afterward.
Contraindications
- Laser Liposuction: Pregnancy, breastfeeding, heavy menstruation, a pacemaker or defibrillator, abnormal tissue growth, blood clots, cancer, heart disease, insulin-dependent diabetes, liver disease, multiple sclerosis, implants, or a vascular condition.
- CoolSculpting: Pregnancy, breastfeeding, a clotting disorder, cold urticaria, cryoglobulinemia, a current or past hernia in or near the treatment area, infected or open wounds, a neuropathic condition, numbness or lack of feeling in the skin, a pacemaker or defibrillator, paroxysmal cold hemoglobinuria, poor circulation, Raynaud’s disease, scar tissue in the treatment area, or skin conditions like rashes, psoriasis, dermatitis, eczema.
Cost Breakdown
The Consumer Guide to Plastic Surgery estimates laser lipo can cost an average of $2,500 to $4,500 per area, depending on the body area receiving treatment. Smaller applicators for CoolSculpting cost around $750 per one-hour session, while the largest applicator costs around $1,500.
Possible Side Effects
- Laser Liposuction: Pain or numbness, discomfort, loose or discolored skin, burning under the skin, dimpled or lumpy tissue, scar tissue, infection, blood clots, or skin necrosis.
- CoolSculpting: Pinching or tugging sensation, stinging, pain, aching, temporary skin sensitivity, swelling, redness, bruising, or paradoxical adipose hyperplasia.
Laser Lipolysis: Answering Key Questions
Laser lipolysis is a highly effective treatment, destroying between 20 and 26% of fat cells in a large targeted area and approximately 80% of localized fat cells when treating a small area. Typically, only one treatment session will be necessary if you are targeting a small region of your body. If you are targeting a large area for treatment, you may need two or three treatment sessions.
How Does Laser Lipolysis Work?
Laser lipolysis destroys excess fat cells in a targeted area by using the heat emitted from the laser light energy to melt the cell walls of adipose tissue. Once these cell walls get hot enough, they liquefy, release the stored fat, and die. These liquefied fat cells are swept up by your lymphatic system and travel through your body. Eventually, the deoxycholic acid in your gut processes these dead fat cells and has them excreted from your body just like dietary fat.
Treatment Session Duration and Targeted Areas
The average laser liposuction session takes an hour per treatment area. The length of your session will depend on factors such as the size of the areas being targeted, the number of areas being targeted for treatment, your body fat distribution, and how much excess fat you would like eliminated.
You can use laser lipo to target virtually any region of your body, most commonly larger areas of the body, such as the hips, sides, buttocks, back, and upper or lower abdomen. Nevertheless, it is also effective for the treatment of smaller regions, like the chin, calves, neck, upper arms, underarms, and the backs of the knees.
Pain and Recovery
Laser lipolysis is not painful; it targets fat cells precisely and heats them to death effectively. The muscle tissues surrounding your adipose tissue will feel as if they are being warmed deeply and comfortably by a hot stone massage.
You can enjoy the final results of laser lipo within four to six weeks. Since your lymphatic system flushes out the liquefied fat cells gradually, your skin has time to adjust to your new contours, and you won’t need a skin tightening treatment or procedure to get the look you want. Additionally, the heat used to liquefy the fat cells also encourages cellular turnover, so your skin will become tighter as a result of treatment.
Maintaining Results
The results of laser lipo are considered permanent because the adult human body cannot grow new fat cells. However, it is possible to gain weight after this treatment is over.
Is Laser Lipolysis Right for You?
To determine whether laser lipo will help you, it is important to discuss your health history and current health status and assess your areas of concern with a qualified professional.
Ideal candidates include individuals with decent skin elasticity and women who don’t plan to become pregnant in the future.
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