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Effect of Low-Level Laser Therapy on

Abdominal Adipocytes before Lipoplasty
Spencer A. Brown, Ph.D., Rod J. Rohrich, M.D., Jeffrey Kenkel, M.D., V. Leroy Young, M.D.,
John Hoopman, L.S.O., and Maria Coimbra, M.D.
Dallas, Texas; and St. Louis, Mo.

tron microscopy photographs. These data do not support the belief that low-level laser therapy treatment
before lipoplasty procedures disrupts tissue adipocyte
structure. (Plast. Reconstr. Surg. 113: 1796, 2004.)

Low-level laser therapy is a new subspecialty for the

medical application of lasers that provides therapeutic
rather than surgical outcomes for many medical indications. Recently, low-level laser therapy was reported to
liquefy or release stored fat in adipocytes by the opening
of specialized yet not identified cell membraneassociated
pores after a brief treatment. Currently, low-level laser
therapy is a U.S. Food and Drug Administrationapproved
technology for improving pain alleviation. To explore
these data further, a series of in vitro studies on human
preadipocytes and institutional animal care and use committeeapproved protocols in a porcine Yucatan model
and an institutional review boardapproved clinical study
were performed. Using a 635-nm low-level laser of 1.0
J/cm2 supplied to the authors by the vendor, these studies
were designed to determine whether alteration in adipocyte structure or function was modulated after low-level
laser therapy. Cultured human preadipocytes after 60
minutes of laser therapy did not change appearance compared with nonirradiated control cells. In the porcine
model, low-level laser therapy (30 minutes) was compared
with traditional lipoplasty (suction-assisted lipoplasty) and
ultrasound-assisted lipoplasty. From histologic and scanning electron microscopic evaluations of the lipoaspirates,
no differences were observed between low-level laser therapy derived and suction-assisted lipoplasty derived specimens. Using exposure times of 0, 15, 30, and 60 minutes
in the presence or absence of superwet wetting solution
and in the absence of lipoplasty, total energy values of 0.9
mW were delivered to tissue samples at three increasing
depths from each experimental site. No histologic tissue
changes or specifically in adipocyte structure were observed at any depth with the longest low-level laser therapy
(60 minutes with superwet fluid). Three subjects undergoing large-volume lipoplasty were exposed to superwet
wetting fluid infiltration 14 minutes before and 12 minutes after, according to vendor instructions. Tissue samples from infiltrated areas were collected before suctionassisted lipoplasty and lipoaspirates from suction-assisted
lipoplasty. No consistent observations of adipocyte disruptions were observed in the histologic or scanning elec-

Low-level laser therapy has emerged as a

medical application for the treatment of several medical indications.15 These include leg
ulcers, arthritis, wound healing, and scars.
Low-level laser therapy is generally defined as
exposure of tissue to a laser that does not
generate an immediate detectable temperature increase or, most importantly, any macroscopically visible changes in cell or tissue structure.6 The biological mechanisms responsible
for increased cell proliferation and pain relief
are still not known, although well-controlled
clinical trials have demonstrated that low-level
laser therapy provides clinical relief of pain. In
January of 2002, the Food and Drug Administration granted 501(k) clearance for one device for the specific indication of adjunctive
use in providing temporary relief of minor
chronic neck and shoulder pain of musculoskeletal origin.
Low-level laser therapy has recently been applied in conjunction with another medical indicationlipoplasty.7,8 In vitro and ex vivo approaches were applied to examining adipocyte
structure changes associated with low-level laser therapy. Human adipose tissue specimens
from lipectomy samples were irradiated (2 to 6
minutes) at 1.2 to 3.6 J/cm2. With increasing

From the Nancy Lee and Perry Bass Advanced Wound Healing and Tissue Regeneration Laboratory, Department of Plastic Surgery, University
of Texas Southwestern Medical Center. Received for publication May 21, 2003; revised September 4, 2003.
DOI: 10.1097/01.PRS.0000117302.73214.1A


Vol. 113, No. 6 /


low-level laser therapy, intracellular adipocyte

fat stores were released (80 percent by 4 minutes; 99 percent by 6 minutes) by means of a
transitory pore that deflates the adipocytes.
No other cell types were reported to have structural alterations detectable by scanning electron microscopy or transmission electron
Low-level laser therapy devices typically deliver 2 to 200 mW (0.2 to 0.02 W), with power
density ranging from 0.05 W/cm2 to greater
than 5 W/cm2. In this power range, the penetrance of red light through biological material is very low. For a 50-mW/cm2 exposure,
only 0.3 percent of the laser photons penetrate
to a depth of less than 2.0 cm.6 It was therefore
of great interest to examine and understand
how low-level laser therapy would modulate
intracellular pores of adipocytes located at
greater depths in typical abdominal
We were given the opportunity to test the
effects of low-level laser therapy on adipocytes
in isolated preadipocytes and fat tissue from a
porcine lipoplasty model and three human
subjects undergoing lipoplasty. The goal of
these studies was to examine the effects of
low-level laser therapy on human adipocytes in
these model systems. Using a variety of exposure times and in the presence and absence of
superwet fluid, isolated fat tissue was evaluated
by histologic and scanning electron microscopy analyses.




Three female subjects were recruited

through the Plastic Surgery Clinic in Aston
over a 3-month period. All subjects gave informed consent for the University of Texas
Southwestern Medical Center Institutional Review Boardapproved protocol and were
screened through an initial office visit consisting of an evaluation of their general medical
condition, body habitus, and lifestyle. All patients in this series had localized fat collections.
Morbidly obese patients or those with systemic
medical problems were not considered candidates for body contouring. All procedures were
performed with preoperative uniform subcutaneous infiltration of the wetting solution in the
intermediate surgical plane using a standard
subcutaneous infiltration pump and cannula.
The infiltrate was delivered in a superwet tech-


nique with a 1:1 ratio of infiltrate to estimated

aspirate.9 The solution consisted of 30 cc of 1%
lidocaine and 1 cc of epinephrine 1:1000 per
liter of room temperature lactated Ringers solution. Lidocaine was withheld from any infiltration fluid given beyond the first 4 liters to
avoid toxicity. Seven to 10 minutes was allowed
between infiltration and treatment of each
area. Patients in our series had uneventful hospital courses.
Two experimental approaches were used for
tissue collection. In one patient, lipoaspirate
samples were taken from body areas that were
exposed or not exposed to low-level laser therapy. In the next patients, fat tissue was collected slowly subsequent to low-level laser therapy but preceding any lipoplasty procedure.

The Erchonia Laser PL3000 is a single-diode,

variable-hertz, 635-nm, 10-mW laser that was
generously provided to these investigators by
Majes-Tec Innovations, Inc. (Mesa, Ariz.). The
635-nm pulsed laser light was used for all cellbased, porcine lipoplasty and human lipoplasty
subjects. Before each experiment, the power
output of the laser was determined and found
to be at the recommended specifications (0.9
to 1 mW/second). The power output was confirmed before each experiment by a certified
laser safety engineer (J.H.). The laser light was
applied to the cells or tissue in a sweeping
motion approximately 6 to 12 inches above the
targeted area, as suggested by the representatives during the first surgical procedures. The
adipose tissue was externally irradiated
through the skin in porcine and human studies, immediately after infiltration of superwet
fluid. Target areas received low-level laser therapy for 12 minutes each before superwet fluid
introduction and then a second treatment for
14 minutes. The laser light has a dual linegenerated beam, at a 60-degree angle, with a
maximum width of 3 mm. The double 15-mW
diode emits 1 mW of energy at any given point
along the beam. The length of the line generated was factored at an average of 23.7 mm/
inch of generated line for each 25 mm of
distance from the patient. The laser was held
perpendicular to the skin at approximately 6 to
12 inches and passed slowly and evenly across
the entirety of the skin area that was to be
treated throughout the duration of the procedure. The laser was either attached to a robotic
movement arm to ensure a steady and even


distribution by the laser beam or hand held

(Fig. 1). The fluence is considered to be 14.4 J
per area treated. This diode is manufactured
by Coherent (Santa Clara, Calif.), classified by
the Center for Devices and Radiological Health
as a class II laser diode (accession no. 91R025245). It is a hand-held device that uses rechargeable batteries or a separate alternating current
power adapter.

Human lipoaspirates from consenting patients at the University of Texas Southwestern

Medical Center Institutional Review Board
approved protocol were obtained during surgery. Preadipocytes from collagenase-treated lipoaspirates were isolated and cultured.10 Cells
were transferred to a tissue culture dish and
grown in Dulbeccos Modified Eagle Medium/
Hams-10 with bovine calf serum (10%, v/v) in
a humidified incubator. In a hood, the covers
were removed for 60 minutes from duplicate
dishes and exposed to air (control) or low-level
laser therapy (height, 6 inches). Microscopic
photographs were recorded before and after
laser therapy.
Porcine Model

Two different experimental protocols were

Protocol I: lipoplasty. A Yucatan pig weighing
300 pounds was fasted for 24 hours before surgery. On the day of the surgery, the animal was
injected with Telazol (Fort Dodge Animal

FIG. 1. Intraoperative clinical application of Erchonia

low-level laser therapy. The robotic arm held and moved the
laser-emitting light over the site undergoing lipoplasty. Preceding the lipoplasty, fat tissue was removed for histologic
analyses. Note the dual beams of laser light on the skin


May 2004

Health, Overland Park, Kan.) (6 mg/kg) intramuscularly for sedation, and atropine (0.04
mg/kg) was given intramuscularly. After sedation, the animal was moved to the operating
facility. An intravenous line was established
through a vein on the dorsal surface of the ear.
The animal was intubated with a 10-French endotracheal tube using a no. 11 Miller blade and
kept on isoflurane for the entire procedure.
The dose of isoflurane was adjusted to allow the
animal to breathe spontaneously. The respiratory rate of the animal was monitored during
the entire procedure.
The animal was shaved along its entire right
side. The animal was transferred to the operating suite and placed on the operating table
on its left side. The right side of the animal was
prepared with povidone-iodine solution and
70% isopropyl alcohol and draped sterilely. A
sterile marker was used to divide the right side
of the animal into three sections labeled A, B,
and C. Area A received ultrasound-assisted and
suction-assisted lipoplasty, area B received suction-assisted lipoplasty only, and area C received low-level laser therapy and was termed
laser-assisted suction-assisted lipoplasty.
All three areas were infiltrated with 1 liter of
wetting solution in each area. The superwet
solution consisted of 1 liter of lactated Ringers
solution, one ampule of epinephrine (1:1000),
and 30 ml of 1% lidocaine plain. Area A had
ultrasound-assisted lipoplasty using Mentor
Contour Genesis ultrasound system (Mentor
Corp., Santa Barbara, Calif.) at a rate of 75
percent power until the aspirate turned
bloody. The emulsified fat was then removed
by suction-assisted lipoplasty. Area B was
treated with the suction-assisted lipoplasty procedure only.
Area C was treated with the Erchonia laser.
The handpiece of the laser was attached to a
robotic arm supplied by Majes-Tec Innovations, Inc., and adjusted to a height of 12
inches above the skin. The laser was applied
over area C for 30 minutes and the suctionassisted lipoplasty procedure was used in that
exposed tissue bed. The animal was killed with
Euthasol (Delmarva Laboratories, Midlothian,
Va.) (87 mg/kg) administered intravenously.
Samples of fat were harvested from each site
and placed in 10% formalin for histologic processing and in 2% glutaraldehyde in 0.1 M
cacodylate buffer for scanning electron
The second experimental approach did not

Vol. 113, No. 6 /


involve lipoplasty. Different times of laser therapy were given to various tissue areas in the
presence or absence of superwet fluid.
Protocol II: low-level laser therapy. As shown in
Figure 2, the animal was marked for five regions
as follows: site A, superwet solution only (control wet); site B, superwet solution plus low-level
laser therapy for 15 minutes; site C, superwet
solution plus low-level laser therapy for 30 minutes; site D, superwet solution plus low-level
laser therapy for 60 minutes (Fig. 3); and site E,
no superwet fluid and low-level laser therapy for
30 minutes. Tissue samples were surgically obtained from each irradiated or nonirradiated
site. From each site, three specimens were removed at increasing depths (0 to 1.5, 1.6 to 3.0,
and 3.1 to 4.5 cm) to examine the effect of
low-level laser therapy at different tissue depths.
Histologic and Scanning Electron Microscopy Determinations

All tissue samples were fixed in individually

labeled cassettes in 10% neutral buffered formalin. Tissues were processed, embedded, sectioned, and stained with hematoxylin and eosin using standard procedures. Samples were
also processed for scanning electron microscopy by the Molecular Imaging Core Laboratory at the University of Texas Southwestern


FIG. 3. Low-level laser therapy treatment of the porcine

lipoplasty model. Site D is shown receiving low-level laser
therapy. The robotic arm provides the uniform delivery of
low-level laser therapy.

Medical Center. Scanning electron microscopy

samples had three or four different photomicrographs of different views of the fixed sample. All tissue and lipoaspirate specimens were
coded and forwarded to the respective core
facilities. The staff at each facility chose the
portions used for analyses in the absence of any
investigator from this study.
Low-Level Laser Therapy Using the Porcine Model

FIG. 2. Low-level laser therapy in a porcine model; no

lipoplasty. An animal was prepared for surgery, and five areas
were designated for the following treatments: site A, superwet
solution only (control wet); site B, superwet solution plus
low-level laser therapy for 15 minutes with suction-assisted
liposuction; site C, superwet solution plus low-level laser therapy for 30 minutes with suction-assisted liposuction; site D,
superwet solution plus low-level laser therapy for 60 minutes
with suction-assisted liposuction; and site E, low-level laser
therapy for 30 minutes with suction-assisted liposuction (control dry).

Scanning electron microscopy and histologic

results from tissue samples isolated from the
three areas of an animal in protocol I are
shown in Figures 4 and 5, respectively. Representative samples were withdrawn from lipoaspirates (one-half depth in collection container) within 15 minutes. In the absence of
low-level laser therapy, adipocytes appear to be
intact and clumped by hematoxylin and eosin
staining and scanning electron microscopy. In
contrast, adipocytes appear to be destroyed after ultrasound-assisted lipoplasty. With lowlevel laser therapy and subsequent suctionassisted lipoplasty, adipocytes were round in
appearance and not deflated.
The second experimental protocol examined the effect of low-level laser therapy in the
absence of lipoplasty, thus avoiding complications of analyzing adipocyte structures caused
by collection procedures. From surgically removed samples, representative histologic results from each site below the skin (1.5 cm) are



May 2004

FIG. 4. Histologic evaluation of low-level laser therapy on adipocytes. Representative tissue samples were
excised from each of five sites receiving various exposure times of low-level laser therapy (sites AE). Tissues were
processed, embedded, sectioned, and stained with hematoxylin and eosin using standard procedures. No
disruption of adipocytes was observed in any tissue sample, including the tissue treated for 60 minutes of low-level
laser therapy.

shown (Fig. 5). In site A (superwet fluid), normal adipocyte histology was observed as expected in the absence of low-level laser therapy. After 15 minutes of low-level laser therapy
in site B, no change in adipocyte histology was
observed with increasing tissue depth (0 to 4.5
cm). Increasing low-level laser therapy for 30
minutes (site C) had no effect on adipocyte

appearance, as cells did not appear to be deflated or necrosed. Site D samples (60 minutes
of low-level laser therapy) were processed.
From the most proximal tissue sample (0 to 1.5
cm), adipocytes appeared to be unaffected by
low-level laser therapy (Fig. 4). At a depth of
1.6 to 3.0 cm, adipocytes appeared to be largely
intact (data not shown). At the greatest depth

Vol. 113, No. 6 /



had extracellular matrix and vestiges of arterial

and venous structures adhering to the cells.
Lipoplasty Subjects on Low-Level Laser Therapy

Treatment by low-level laser therapy was performed and suction-assisted lipoplasty was used
to collect lipoaspirates from low-level laser
therapy and nonlow-level laser therapy sites.
Within 15 to 30 minutes, samples were removed at 50 percent of the depth of the surgical container for scanning electron microscopy. The photomicrographs were not
definitive, as one adipocyte sample from lowlevel laser therapy treatment appeared to be
coated, although the cells were still round
(Figs. 6 and 7). To prevent any possible collection variable, scanning electron microscopy results were performed in duplicate with specimens from collected samples in the control
and low-level laser therapy irradiated specimens. No adipocyte structural differences were
observed between low-level laser therapy irradiated and nonirradiated samples.

FIG. 5. Scanning electron microscopy of porcine specimens after suction-assisted liposuction (above); ultrasoundassisted liposuction (center), or laser-assisted lipoplasty (below). The animal was prepared for lipoplasty, and three
anatomical sites were infiltrated with superwet fluid. Lipoaspirates were collected during the suction-assisted lipoplasty procedure and the ultrasound-assisted lipoplasty. The third site
received 30 minutes of low-level laser therapy and suctionassisted liposuction or laser-assisted lipoplasty. In laser-assisted lipoplastytreated cells, no adipocyte structural
changes were observed.

of 3.1 to 4.5 cm, adipocytes were round (data

not shown). In less than 5 percent of the total
scanning electron microscopy photomicrographs, black dots on adipocyte surfaces facing
the power source were observed. All samples

An extensive series of experiments investigating the effect of low-level laser therapy on tissue-associated adipocytes or fat were performed in the porcine model. Adipocytes did
not exhibit any change in shape by histologic
and scanning electron microscopy determinations with extended low-level laser therapy (60
minutes), a time much greater than the 14
minutes reported in human subjects.8 Before
human clinical trial, the effects of low-level
laser therapy exposure were examined in
freshly isolated human preadipocytes. Under
direct exposure, the nonfat-filled cells showed
no cell shape change or cell death. Using the
same strategy in human subjects undergoing
lipoplasty as in the porcine model, no adipocyte structural changes were observed in
freshly isolated fat tissue that was previously
exposed to low-level laser therapy for 28 minutes, as recommended.
These studies were undertaken by the request of the manufacturer (Majes-Tec), who
subsequently provided the laser and robotic
arm. On receipt of the equipment, a plastic
cuff of the robotic arm was noticed to have
been damaged during shipment. After repair,
the arm was electronically grounded for use in
the surgical operating room. The medical director of Majes-Tec instructed the investigators
and applied low-level laser therapy for one pa-



May 2004

FIG. 6. Two scanning electron micrographs of one fat tissue porcine sample. The top skin
layer from a sample treated with low-level laser therapy was prepared for scanning electron
microscopy. From a single block, three micrographs were taken for analyses. In a single view (left)
from a set of three views, black spots on the adipocyte surface were observed and marked with
arrows. Adipocytes did have the prevalent black marks from a second view from the same sample.
The markings were interpreted to be artifacts of scanning times and were not representative in
any sample under any condition.

FIG. 7. Scanning electron micrograph of a human adipose tissue sample removed after low-level laser therapy but
before lipoplasty. The adipose tissue was externally irradiated
through the skin in porcine and human studies, immediately
after infiltration of superwet fluid. Target areas received lowlevel laser therapy for 12 minutes each before superwet fluid
introduction and then a second treatment for 14 minutes.
Adipocytes appear to be round and intact by scanning electron micrography after a total low-level laser therapy time of
26 minutes.

tient. An indentation on the metal case of the

laser was noted at the time. To ensure that that
performance of the laser was not compromised, power output calibrations were immediately performed before and after the surgical
procedure. Further concern was expressed
concerning the possible rotation frequency in
the repaired robotic arm by Majes-Tec. All further experiments were performed manually.

One change in the low-level laser therapy protocol was introduced. From one low-level laser
therapy irradiation of 12 minutes after superwet infiltration, an additional 12 minutes was
added before infiltration along with 12 to 14
minutes after the introduction of superwet
fluid. We have reported the results using these
irradiation times (total time, 24 to 30 minutes).
Red light (635 nm) does not penetrate effectively below the skin surface and into the subdermal tissues.11 It is well known that the depth
of penetration of laser light depends on the
lights wavelength, the power output, and the
biological parameters of the target tissue. In
laser medicine, the term greatest active
depth is the limit at which the light intensity is
so low that no biological effect of the light can
be determined. Indeed, a great number of variables such as age, pigmentation, and so forth
can have profound effects on the depth of laser
light through the skin. This would especially
seem to be logical, as only 0.3 percent of the
power of red light penetrates. From an in vitro
study, the penetration of both helium-neon
and infrared lasers was observed for only a few
millimeters, and the most important absorption was observed at the depth levels of 0.4 and
0.5 mm.11 Therefore, it would appear that only
subtle biological effects may be influenced at
deeper tissues.
Our results do not support the recent re-

Vol. 113, No. 6 /


ports of low-level laser therapy influencing adipocyte structure.8 This study focused on the
reported structural changes subsequent to lowlevel laser therapy. Deflation of fat cells with
limited low-level laser therapy (90 percent in 6
minutes) and the appearance of pores and
released fat from intracellular adipocyte stores
were the major biological endpoints. In our
hands and under all conditions of low-level
laser therapy time or presence of superwet
fluid in both porcine and clinical subjects, no
change in the round shape of the fat tissue
associated with adipocytes was observed. There
was no consistent appearance of cellular pores
in adipocytes exposed to low-level laser therapy. In addition, no changes in the appearance
of fat samples in the syringes were noted in
low-level laser therapy versus nonirradiated
conditions, suggesting that released triglycerides were not present, which may form a cloudy
appearance or fat layer. The clinical study was
terminated after three subjects, as the negative
results from the initial subjects and the porcine
studies did not justify continuation of either
study protocol. To our knowledge, no report
demonstrates that adipocytes have different
cellular properties within a species at a specific
anatomical site (i.e., fragility or susceptibility of
cellular membranes to environmental
A direct system to evaluate all adipocytes in a
lipoaspirate is not available, as collected fat
samples represent a number of conditions in
which adipocytes may be associated with other
cell types or exist alone. During the collection
and subsequent storage of lipoaspirates, distinct layers of lipids, cells, and tissue fragments
form. The supernatant layer is composed of
released lipids and some cells, and the middle
layer is composed of complexes of adipocytes
and other associated cells. Samples were obtained from the middle, or cell-rich, layer that
would potentially provide the best insight into
subtle structural changes. To eliminate the
physical forces during collection on adipocytes, tissue samples were removed using a lowsuction syringe after low-level laser therapy. To
remove selection bias, all samples were coded,
and the core lab facilities had no access to
these codes. In scanning electron microscopy,
three or four photomicrographs were provided
for each sample.
The low-level laser therapy irradiation times
used in the porcine and clinical studies were
longer than those published and those subse-


quently recommended by Majes-Tec. Histologic and scanning electron microscopy determinations were also chosen to directly
compare between data sets. To understand
these differences, duplicate sets of clinical fat
samples from one study should be analyzed by
the two different laboratories. Of specific interest was the presence of intracellular pores that
appeared only in adipocytes appearing as black
dots on scanning electron microscopy photomicrographs, subsequent to low-level laser
therapy. Several of the scanning electron microscopy photomicrographs of adipocytes in
these studies had black dots (Fig. 6). No one
sample had black dots consistently appear in
all three or four photomicrographs from one
sample. One sample was repeated and the initial black dot was not present. Furthermore,
the black dots always appeared at the outer
surface of the adipocytesthe surface facing
the power source. If low-level laser therapy influences adipocytes uniformly, pores (black
dots) would be expected to be present over the
entire surface. One interpretation of the presence of these black dots is that this may be an
artifact of exposure time.
Many theories have been proposed and discussed regarding the means by which low-level
laser therapy may influence biological processes. This study was not designed to determine the validity of whether less than 2 percent
of the penetrated photons can enhance or repress a multitude of biological pathways. Our
approach was direct and clinical in nature:
does low-level laser therapy deflate adipocytes
in fat tissue before lipoplasty? If reproducible,
low-level laser therapy pretreatment would
greatly enhance the efficacy of the lipoplasty

The use of red light based lasers is a Food

and Drug Administrationapproved device for
pain. The success of this medical application
has been well documented. This clinical study
was terminated before an assessment of pain or
wound healing after lipoplasty using the lowlevel laser therapy could be determined. A differently designed clinical trial with many more
subjects would be required to evaluate whether
low-level laser therapy may decrease pain and
increase wound healing after lipoplasty.



Spencer A. Brown, Ph.D.

Nancy Lee and Perry Bass Advanced Wound
Healing and Tissue Regeneration Laboratory
Department of Plastic Surgery
University of Texas Southwestern Medical Center
5323 Harry Hines Blvd.
Dallas, Texas 75390-9132
This study was funded by the Warren and Betty Woodward
Chair in Plastic and Reconstructive Surgery and the Crystal
Charity Ball Distinguished Chair in Plastic Surgery. We thank
Kevin Slattery, M.D., Medical Laser Division of Majes-Tec
Innovations, Inc., for use of the low-level laser therapy laser
and robotic arm and for applying low-level laser therapy to the
first clinical subject; Peter Fodor, M.D., Evan Sorokin, M.D.,
Debby Noble, and Anita Matthes for their assistance in the
cell, animal, and clinical studies; and Chris Gilpin, Ph.D.,
George Lawton, M.S., and Tom Januszewski, M.S., of the
Molecular and Cellular Imaging Facility at the University of
Texas Southwestern Medical Center for the production and
interpretation of the photomicrographs.
1. Flemming, K., and Cullum, N. Laser therapy for venous
leg ulcers. Cochrane Database Syst. Rev. 2000:
CD001182, 2000.

May 2004

2. Hendrick, D. A., and Meyers, A. Wound healing after

laser surgery. Otolaryngol. Clin. North Am. 28: 969, 1995.
3. Brosseau, L., Welch, V., Wells, G., et al. Low level laser
therapy (classes I, II and III) for the treatment of
osteoarthritis. Cochrane Database Syst. Rev. 2000:
CD002046, 2000.
4. Lucas, C., Criens-Poublon, L. J., Cockrell, C. T., and de
Haan, R. J. Wound healing in cell studies and animal
model experiments by low level laser therapy: Were
clinical studies justified? A systematic review. Lasers
Med. Sci. 17: 110, 2002.
5. Ohshiro, T., and Calderhead, R. G. Development of low
reactive-level laser therapy and its present status.
J. Clin. Laser Med. Surg. 9: 267, 1991.
6. King, P. R. Low level laser therapy: A review. Lasers Med.
Sci. 4: 41, 1989.
7. Neira, R., and Ortiz-Neira, C. Low level laser assisted
liposculpture: Clinical report in 700 cases. Aesthetic
Surg. J. 22: 451, 2002.
8. Neira, R., Arroyave, J., Ramirez, H., et al. Fat liquefaction: Effect of low-level laser energy on adipose tissue.
Plast. Reconstr. Surg. 110: 912, 2002.
9. Rohrich, R. J., Beran, S. J., and Fodor, P. B. The role of
subcutaneous infiltration in suction-assisted lipoplasty: A review. Plast. Reconstr. Surg. 99: 514, 1996.
10. Hauner, H., Skurk, T., and Wabitsch, M. Cultures of
human adipose precursor cells. Methods Mol Biol. 155:
239, 2001.
11. Kolari, P. J., and Airaksinen, O. Poor penetration of
infra-red and helium neon low power laser light into
the dermal tissue. Acupunct. Electrother. Res. 18: 17,