NONINVASIVE PROCEDURAL DERMATOLOGY
Noninvasive body contouring has become one of the fastest-growing areas of esthetic
medicine. Many patients appear to prefer nonsurgical less-invasive procedures owing to
the benefits of fewer side effects and shorter recovery times. Increasingly, 635-nm lowlevel
laser therapy (LLLT) has been used in the treatment of a variety of medical conditions
and has been shown to improve wound healing, reduce edema, and relieve acute pain.
Within the past decade, LLLT has also emerged as a new modality for noninvasive body
contouring. Research has shown that LLLT is effective in reducing overall body circumference
measurements of specifically treated regions, including the hips, waist, thighs, and
upper arms, with recent studies demonstrating the long-term effectiveness of results. The
treatment is painless, and there appears to be no adverse events associated with LLLT. The
mechanism of action of LLLT in body contouring is believed to stem from photoactivation
of cytochrome c oxidase within hypertrophic adipocytes, which, in turn, affects intracellular
secondary cascades, resulting in the formation of transitory pores within the adipocytes’
membrane. The secondary cascades involved may include, but are not limited to, activation
of cytosolic lipase and nitric oxide. Newly formed pores release intracellular lipids, which
are further metabolized. Future studies need to fully outline the cellular and systemic
effects of LLLT as well as determine optimal treatment protocols.
Semin Cutan Med Surg 32:35-40 © 2013 Frontline Medical Communications
Low-level laser (light) therapy (LLLT) is a fast-growing technology used to treat a multitude
of conditions that require stimulation of healing, relief of pain and inflammation, and
restoration of function. Although skin is naturally exposed to light more than any other
organ, it still responds well to red and near-infrared wavelengths. The photons are absorbed
by mitochondrial chromophores in skin cells. Consequently, electron transport, adenosine
triphosphate nitric oxide release, blood flow, reactive oxygen species increase, and diverse
signaling pathways are activated. Stem cells can be activated, allowing increased tissue
repair and healing. In dermatology, LLLT has beneficial effects on wrinkles, acne scars,
hypertrophic scars, and healing of burns. LLLT can reduce UV damage both as a treatment
and as a prophylactic measure. In pigmentary disorders such as vitiligo, LLLT can increase
pigmentation by stimulating melanocyte proliferation and reduce depigmentation by inhibiting
autoimmunity. Inflammatory diseases such as psoriasis and acne can also be managed.
The noninvasive nature and almost complete absence of side effects encourage
further testing in dermatology.
Semin Cutan Med Surg 32:41-52 © 2013 Frontline Medical Communications
The techniques of noninvasive facial rejuvenation are forever being redefined and improved.
This article will review historical as well as present approaches to resurfacing, discussing
the nonablative tools that can complement resurfacing procedures. Current thoughts on the
pre- and postoperative care of resurfacing patients are also considered.
Semin Cutan Med Surg 32:53-58 © 2013 Frontline Medical Communications
Noninvasive procedural dermatology has evolved rapidly during the past decade. An array
of skin tightening, resurfacing, and fat-reducing energy devices can now be combined with
filler and neurotoxin injectables to reduce the visible signs of aging with minimal downtime
and risk. In the future, such advances will likely continue, although the pace of technological
breakthroughs is difficult to predict. Complex feedback devices, nanotechnology, and
cell-based therapies will eventually begin to fulfill the promise of scar removal, pigmentation
correction, and replacement of aged skin with skin that is new and completely
functional. Dermatologists are well equipped to retain their leadership in noninvasive
esthetic medicine, and they will, to the extent that they continue to pioneer outstanding
therapies that are effective, affordable, and safe.
Semin Cutan Med Surg 32:59-61 © 2013 Frontline Medical Communications