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Avci et al. Page 5 illustrated the clinical utility of the Zerona and set the precedent on how aesthetic devices should be evaluated. In a randomized study, Caruso-Davis used 635–680 nm LLLT device (Meridian LAPEX 2000 LipoLaser System, Meridian Medical Inc. Anyang, Korea) for 30 minutes twice a week for 4 weeks on 40 healthy young men and women and subjects were asked not to change their diet nor exercise habits [29]. Results demonstrated that LLLT achieved safe and significant girth loss at the end of the treatment period. However it is worthwhile to note that this device is currently approved by the FDA for hand and wrist pain associated with carpal tunnel syndrome only. Another study by Jackson et al. demonstrated a significant reduction (overall mean reduction of 5.17 inches across all measurement points) in circumferential measurements across waist, hips, and thighs of 689 patients following LLLT with Zerona LipoLaser (Erchonia Medical, Inc.). Treatment period was for two consecutive weeks, with each patient receiving three treatments per week every other day for a total of 40 minutes. The authors also noted that circumferential reduction exhibited following LLLT was not attributable to fluid nor fat relocation since all the measurement points including nontreated regions reported an inch loss. Moreover, a double-blind, controlled, randomized study designed to assess the efficacy of 635 nm LLLT (3.94 J/cm2, 17 mW) in reducing upper arm circumference, LLLT group (n = 20) demonstrated a significant progressive and cumulative treatment effect compared to sham treated group (n = 20) following six treatments with no side effects [30]. A recent study investigated the efficacy of LLLT –635 nm device that consists of 5 diodes generating an output intensity of ~0.95 J/cm2 each and the group demonstrated an average of 2.99 inches reduction in waist, hips, and thigh at the end of the treatment period. However, the study had several limitations such as lack of control group as well as administration of dietary supplements (niacin, niacinamide, L-carnitine, omega-3 fish oil, ginko biloba, and decaffeinated green tea) in the study subjects [68]. LLLT FOR CELLULITE REDUCTION Even though etiology of cellulite remains controversial, it manifests itself at the histological level not only by the presence of thinner, more radially oriented supporting fibrous septae in the deep subcutis [69], but also by an irregular dermohypo-dermal interface produced by herniation of subdermal fat into the reticular and papillary dermis [21]. Sasaki et al. [20] conducted a double-blinded study among nine female volunteers to evaluate the efficacy of phosphatidylcholine-based anticellulite gel (active gel) in combination with a LED at wavelengths of red (660 nm) and near-infrared (950 nm), a deeper penetrating wavelength, for treatment of cellulite [26]. Study subjects were treated twice daily for 3 months with an active gel on one thigh and placebo gel on the other thigh. Twice a week, each thigh was exposed to 15 minutes of LED with a total of 24 treatments. Digital ultrasound at the dermal–adiposal interface revealed not only a signifi-cant reduction of subcutaneous fat immediately below the dermis but also less echo-like intrusions were observed in the dermal layer of active gel and LED treated thighs. Among three of six biopsies taken from thighs that were treated for 3 months, with the active gel in combination with LED, less intrusion of subcutaneous fat into the papillary and reticular dermis have been noted upon histologic analysis. However, in nine placebo and LED only treated thighs minimal changes were observed. One of the limitations of this study was the lack of active gel treated only group, which leaves a possibility of LED having no enhancing effect in the combination therapy. Lastly, it is worthwhile to note that at the 18th month of evaluation period, five responsive thighs reverted back to their original cellulite grading. Some of the gels used in this study contained methylxanthine caffeine that inhibits the action of cyclic 3′,5′-phosphadiesterase, the enzyme that causes degradation of cAMP into 5′-AMP [26]. As mentioned earlier, Lasers Surg Med. Author manuscript; available in PMC 2014 August 01. NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author ManuscriptPDF Image | Low-Level Laser Therapy for Fat Layer Reduction
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