Page 1 of 8 F01-1332_1_A.

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8ody Shap|ng 1reatments: A Compar|son of Laser L|po|ys|s, Non-
Invas|ve Low Leve| Laser 1herapy and U|trasound Methods

u lreeman M.Sc. h.u.
12
Lh
May 2011


Introduct|on

1hls reporL ls lnLended Lo descrlbe and compare Lhree of Lhe currenL wldely used
Lechnologles wlLhln Lhe medlcal and aesLheLlc communlLles Lo achleve body shaplng
or faL reducLlon LreaLmenLs: lnvaslve laser llpolysls, non-lnvaslve low level laser
Lherapy and ulLrasound. 1he key ouLcome of all of Lhese LreaLmenLs ls Lhe reducLlon
ln slze or desLrucLlon of adlpose (faL) cells ln LargeLed anaLomlcal locaLlons Lo
moderaLe Lhe amounL of body faL sLored Lhere. 1hls reporL wlll focus on Lhe
mechanlsm of acLlon, effecLs on Lhe body's Llssues, operaLor dependency and Lhe
rlsks of compllcaLlons from Lhe LreaLmenLs and ln parLlcular hlghllghL Lhe safeLy of
LreaLmenL for Lhe paLlenL and operaLor of one parLlcular low level laser devlce, Lhe
lllpo, manufacLured by Chromogenex 1echnologles LLd, uk.

Whlle Lhe surglcal Lechnlque of 1umescenL LlpoplasLy (llposucLlon) ls sLlll Lhe
preferred opLlon for body-sculpLlng procedures, Lhe number of procedures
performed annually ln many counLrles has decreased dramaLlcally over Lhe lasL few
years as cllenLs look for less lnvaslve procedures wlLh fewer rlsks of compllcaLlons
and down Llme from normal everyday llfe. ln Lhe unlLed SLaLes for lnsLance, Lhe
number of llpoplasLy procedures decllned Lo 198,000 ln 2009 from 243,000 ln 2008 (-
19) and from 330,000 ln 2000 (-44)
(1)
. 1hls decllne ls slgnlflcanL, desplLe lLs
obvlous conLlnulng popularlLy, and ls due Lo Lhe hlgh poLenLlal for slgnlflcanL
compllcaLlons, morbldlLy and morLallLy assoclaLed wlLh Lhe acLual pracLlcal
procedure and anaesLhesla requlremenLs
(2)(3)
. 1he developmenL of ad[uncLs Lo
supporL LradlLlonal llpoplasLy procedures whlle aLLempLlng Lo moderaLe Lhe rlsks of
LreaLmenL saw Lhe lnLroducLlon of ulLrasound asslsLed llposucLlon (uAL) and laser
asslsLed llposucLlon (LAL), whlch have demonsLraLed some success ln Lhls maLLer
alLhough noL ellmlnaLed Lhe rlsk, and ln some cases have lnLroduced Lhelr own
addlLlonal hazards. non-lnvaslve LreaLmenL opLlons have slnce been developed,
uslng low
(4)(3)
and hlgh lnLenslLy
(6)(7)
focused ulLrasound, low level lasers
(8)(9)
, radlo-
frequency
(10)
, ln[ecLlon llpolysls
(11)
and cryollpollysls
(12)
. Some of Lhese meLhods are
noL wlLhouL Lhelr LreaLmenL rlsks and llmlLaLlons, buL desplLe Lhls have been
lncorporaLed lnLo many aesLheLlc and LherapeuLlc spas/cllnlcs globally.





Page 2 of 8 F01-1332_1_A.doc
U|trasound 1reatments

ulLrasound used for body shaplng can be dlvlded lnLo Lwo broad caLegorles: low-
frequency non-Lhermal ulLrasound and hlgh-lnLenslLy focused ulLrasound (Pllu).

non-Lhermal devlces use low frequency ulLrasound Lo lncrease Lhe llkellhood of
causlng a cavlLaLlon effecL (wlLh some mlnor heaL generaLlon Lhrough absorpLlon).
CavlLaLlon ls where bubbles are creaLed lnslde Lhe cell, whlch swell and rupLure,
creaLlng mechanlcal sLress LhaL dlsrupLs Lhe adlpose cell membrane and releases Lhe
sLored Lrlglycerlde conLenLs. 1he LreaLmenL ls performed by applylng a Lransducer Lo
Lhe skln surface above Lhe LargeL faL pockeL and applylng Lhe ulLrasound ln pulses Lo
creaLe repeaLed compresslons and rarefacLlons ln Lhe Llssue. 1hese rarefacLlons
generaLe cavlLaLlon evenLs, causlng cell deaLh Lhrough mechanlcal dlsrupLlon
(13)
.
CperaLor manlpulaLlon of Lhe Lransducer probe ls Lhe llmlLlng facLor for conLrolllng
Lhe boundarles of Lhe LreaLmenL zone and prevenL LargeLlng of unwanLed Llssues.

Pllu devlces focus hlgh lnLenslLy ulLrasonlc energy Lo deep subcuLaneous Llssue,
generaLlng a Lhermal effecL capable of ablaLlng adlpose Llssue
(14)
. Lxposure of
adlpocyLes Lo a LemperaLure of 36
o
C or hlgher for 1s ls adequaLe Lo cause rapld cell
deaLh by coagulaLlve necrosls. Slmllar Lo Lhe non-Lhermal devlces, Lhe ulLrasound
energy ls applled Lo Lhe skln surface above Lhe LargeL faL pockeL by an lnLernally
focused Lransducer, whlch focuses Lhe ulLrasound waves so LhaL Lhey converge aL a
speclfled depLh and locaLlon. 1hls focused polnL provldes some proLecLlon Lo skln,
nerves, blood vessels or organs encounLered before or beyond Lhe focal polnL, as Lhe
ulLrasound waves wlll noL have enough energy here Lo creaLe Loo much Lhermal
damage. PeaL, sufflclenL Lo creaLe Lhe ablaLlve effecL on adlpose Llssue, ls only
generaLed aL Lhe polnL where Lhe focused beams converge Lo ensure Llssue lysls ls
conflned Lo Lhe LreaLmenL zone.

1he cell debrls of boLh meLhods of ulLrasound LreaLmenL are Lhen expecLed Lo be
safely lngesLed by Llssue macrophages lnlLlaLed by Lhe local lnflammaLory
response
(13)
alLhough furLher cllnlcal sLudy needs Lo be done Lo conflrm LhaL Lhere
are no slgnlflcanL changes Lo serum llpld levels or undue sLress Lo Lhe llver and
kldneys.

MosL devlces llmlL Lhe LreaLmenL areas Lo sLomach, flanks, back, ouLer Lhlghs and Lhe
buLLocks Lo prevenL Lhe use of ulLrasound dlrecLly over bone unproLecLed by
sufflclenL Llssue layers. SensaLlons durlng LreaLmenL are explalned Lo be mlld and
LranslenL paln due Lo secondary vlbraLlons felL ln nearby bones and heaLlng and oral
analgeslcs may be recommended. Slde effecLs of LreaLmenL can be prolonged
eryLhema, brulslng, oedema and surface burns/bllsLers.

Page 3 of 8 F01-1332_1_A.doc
Laser L|po|ys|s

Laser llpolysls uses flbre-opLlc dellvery of hlgh powered lnfra red laser energy (elLher
dlode or nd:?AC lasers) Lo ablaLe LargeL adlpose Llssues followed by cannula
exLracLlon of Lhe debrls of LreaLmenL. 1he rlsks of Lhls LreaLmenL are reduced over
convenLlonal dry or LumescenL llposucLlon surgery, slnce mechanlcal force Lo dlsrupL
Llssues ls replaced by laser dlsrupLlon, reduclng Lrauma Lo Lhe area and Lhus
anaesLhesla can be reduced Lo local only. 8ecovery afLer LreaLmenL ls also more
rapld Lhan convenLlonal llposucLlon surgery.

A 1-2mm lnclslon ls made, lnLo whlch a 1mm cannula and opLlcal flbre can be
lnserLed lnLo Lhe Llssue. Plgh lnLenslLy lnfra red energy ls Lhen dellvered (up Lo 30W
ln some devlces) and Lhe cannula ls manlpulaLed by Lhe operaLor back and forLh ln
'sweeps' Lhrough Lhe Llssue wlLh one hand whlle malnLalnlng Lhe oLher hand ln
conLacL wlLh Lhe LreaLmenL area Lo assess LemperaLure. Speed of cannula
movemenL ls operaLor dependanL and can have a huge lmpacL on LreaLmenL
ouLcome or lnsLances of slde effecLs
(16)
. Lnergy absorpLlon creaLes heaL ln Lhe Llssue,
evenLually reachlng a LemperaLure where Lhe cell membrane ls compleLely dlsrupLed
and Lhe cell desLroyed. Cllnlcal endpolnL for LreaLmenL on a speclflc zone ls
esLlmaLed by Lhe operaLor by LemperaLure LesLlng of Lhe skln surface by hand.
CpLlmal dosage ls reached when Lhe skln feels warm Lo Lhe Louch (approxlmaLely
40
o
C). Llquefled faL debrls from LreaLmenL ls Lhen removed by asplraLlon wlLh a
larger cannula (3mm) and Lhe area ls sLrapped wlLh surglcal Lape Lo enforce
conLourlng/shape whlch remalns ln place for several days. AddlLlonal Lo Lhls,
compresslon garmenLs are requlred for up Lo 4 weeks. 1he paLlenL can be expecLed
Lo reLurn Lo work ln 1-2 days, and back Lo llghL exerclse ln several days.

AddlLlonal Lo Lhe local anaesLhesla, sLrong analgesla ls provlded durlng Lhe lnlLlal
recovery perlod, reduced Lo oral analgesla for Lhe followlng few days as requlred.
Some paLlenLs may requlre sedaLlon durlng Lhe procedure Lo supporL Lhe local
anaesLhesla and reduce dlscomforL. llnally, a shorL course of anLlbloLlcs are also
prescrlbed.

osL LreaLmenL effecLs lnclude dlscomforL, oedema, ecchymoses (brulslng) lasLlng
Lyplcally 1 week (buL up Lo 3 weeks) and locallsed Lenderness. SlgnlflcanL
compllcaLlons such as bleedlng, lnfecLlon and surface and deep Llssue burns are also
a conslderaLlon.

Slnce cllnlcal endpolnL ls deLermlned only by surface skln LemperaLure, lL ls noL an
accuraLe meLhod for deLermlnlng Lhe acLual heaL generaLed ln Lhe deeper Llssues.
Some research has lndlcaLed deep Llssue LemperaLures as hlgh as 33
o
C belng
reached, whlch ls hlgh enough Lo cause Llssue necrosls and lnflammaLlon Lo Lhe bulk
Llssue and lncrease Lhe poLenLlal for slgnlflcanL burns
(17)
.

1hls Lechnlque ls sulLable for small volumes or pockeLs of faL removal raLher Lhan
enLlre anaLomlcal reglons such as Lhe abdomen.


Page 4 of 8 F01-1332_1_A.doc
Low Leve| Laser 1herapy

Low level laser Lherapy has a long hlsLory of safe and effecLlve use ln Lhe blo-
sLlmulaLlon of human Llssues slnce lLs flrsL sclenLlflc evaluaLlon ln Lhe 1960's
(18)
, wlLh
lLs prlmary use ln Lhe physloLherapy and alLernaLlve medlclnes lndusLrles for
faclllLaLlng Lhe repalr of sofL Llssue ln[urles
(19)(20)(21)(22)
and laser acupuncLure
(23)
. 1he
mechanlsm of blo-sLlmulaLlon of Lhe Llssue cells ls wldely researched and undersLood
(24)(23)
.

AL Lhe sLarL of Lhe 21
sL
cenLury Lhls cellular blo-sLlmulaLlon effecL of low level vlslble
red llghL was suggesLed as an ad[uncL LreaLmenL Lo LradlLlonal LumescenL llpoplasLy
procedures, Lo free up Lhe sLored faL from lLs adlpose cells and make Lhe cannula
exLracLlon of Lhe faL conLenLs fasLer, wlLh less manual force LhaL would mean less
posL operaLlve slde effecLs and dlscomforL for Lhe paLlenL
(26)(27)
.

1he naLural progresslon of Lhls Lechnology, ln response Lo paLlenL requlremenLs of
non-lnvaslve LreaLmenL opLlons, was Lo remove Lhe surglcal elemenL. 1rans-
cuLaneous appllcaLlon of low level laser llghL (630nm-660nm) resulLs ln sLlmulaLlon
of Lhe adlpose mlLochondrla and a Lemporary acceleraLlon of Lhe elecLron LransporL
cascade whlch produces cellular energy (A1). 1hls Lemporary acceleraLlon of
normal chemlcal reacLlons lnslde Lhe cell brlefly changes Lhe cell pP resulLlng ln Lhe
break down of Lhe sLored Lrlglycerldes lnLo free faLLy aclds and glycerol and Lhelr
movemenL across Lhe lnLacL cell membrane lnLo Lhe lnLersLlLlal space. lrom here Lhe
lymphaLlc sysLem auLomaLlcally LransporL Lhe free faLLy aclds around Lhe body Lo Lhe
Llssues for meLabollsm durlng exerclse Lo provlde A1 leavlng empLy adlpose cells
whlch Lake up less volume, Lhus reduclng dress slze ln LhaL area. lL ls lmporLanL Lo
remember LhaL Lhls change of cell chemlsLry, break down of Lrlglycerldes lnLo free
faLLy aclds and glycerol and Lhelr subsequenL LransporL around Lhe body ls
experlenced as a naLural response ln Lhe body every Llme Lhe day Lo day calorle
needs of Lhe body are noL meL due Lo dleL resLrlcLlons or lncreased exerclse. 1he
faLLy aclds and glycerol released from Lhe cells durlng LreaLmenL are managed by Lhe
body vla normal meLabollc paLhways. 1here ls no damage Lo Lhe cell lnLegrlLy or LhaL
of surroundlng Llssues.

Low level laser LreaLmenLs are carrled ouL by poslLlonlng pads conLalnlng Lhe laser
dlodes dlrecLly onLo Lhe surface of Lhe lnLended LreaLmenL area and securlng ln
place, usually wlLh elasLlcaLed sLrapplng. 1he sLrapplng provldes addlLlonal eye
safeLy by prevenLlng accldenLal exposure Lo any llghL. Some devlces, such as Lhe
lllpo, also lncorporaLe skln sensor Lechnology Lo prevenL dlode acLlvaLlon lf Lhe pad ls
noL fully ln conLacL wlLh Lhe skln surface. 1he lasers are Lhen acLlvaLed Lo dellver a
pre-seL energy level for a pre-seL Llme duraLlon Lo Lhe area, ellmlnaLlng Lhe need for
operaLor selecLlon of parameLers, declslon on cllnlcal end-polnL or rlsk of overdose
of Lherapy.

Lnergy levels used are low level, Lyplcally around 40mW. 1hls level of laser energy ls
also referred Lo as cold laser as Lhere ls lnsufflclenL laser energy Lo have a Lhermal
effecL on Lhe Llssue, ellmlnaLlng Lhe rlsk of surface or deep Llssue burns. 1he

Page 5 of 8 F01-1332_1_A.doc
ma[orlLy of paLlenLs have no sensaLlon aL all durlng LreaLmenL, whlle a few may feel a
mlld warmlng from Lhe presence of Lhe pads close Lo Lhe skln surface for Lhe
LreaLmenL duraLlon. osL LreaLmenL slgns or sympLoms are nll. no lnsLances of posL
LreaLmenL compllcaLlons have been recorded ln sLudles conducLed
(8)(9)
. SclenLlflc
research has conflrmed LhaL serum llpld levels and proflles remaln unalLered and ln a
slgnlflcanL ma[orlLy of LreaLed paLlenLs ln one sLudy, can acLually be reduced as a
resulL of low level laser LreaLmenLs
(28)
so no long Lerm lmpllcaLlons are expecLed Lo
cardlac or clrculaLory healLh.

aLlenLs can reLurn Lo normal acLlvlLy, lncludlng exerclse lmmedlaLely posL
LreaLmenL.


Conc|us|on

1able 1. below, compares Lhe cerLaln aspecLs of Lhe Lhree Lechnologles relaLed Lo
safeLy and posL LreaLmenL effecLs and compllcaLlons. Cf Lhe Lhree Lechnologles
dlscussed ln Lhls reporL low level laser devlces, such as Lhe lllpo devlce, offer Lhe
non-lnvaslve LreaLmenL wlLh Lhe leasL blologlcal lmpacL on Lhe body, lowesL rlsk of
slde effecLs or margln for operaLor lnfluence or error.

lLs use of laser dlodes has led Lo some worrles regardlng Lhe safeLy of Lhe Lechnology
and LreaLmenL boLh on behalf of Lhe paLlenL and Lhe operaLor performlng LreaLmenL.
no lnsLances of slde effecLs have been reporLed from over 600 lllpo devlces used
globally slnce lLs lnLroducLlon ln March 2008. 1he power ouLpuL of Lhe devlce ls low
level Lhus wlll noL have a Lhermal effecL on Llssues belng LreaLed. As a Class 3b
devlce Lhere are some assoclaLed eye rlsks lf exposed Lo Lhe beam wlLhln Lhe
nomlnal Ccular Pazard ulsLance (nCPu) whlch ls wlLhln 32cm of source. racLlcally,
Lhls exposure ls unllkely Lo happen, slnce Lhe laser dlodes are only and can only be
lllumlnaLed when Lhe LreaLmenL pad ls placed (llghL source downwards) onLo Lhe
skln surface. 1hls ls conLrolled by Lhe skln sensor safeLy swlLches ln Lhe pads. 1he
pads are Lhen also secured ln place wlLh clrcumferenLlal sLrapplng Lo prevenL
movemenL. Were a pad Lo be llfLed off of Lhe sklns surface durlng LreaLmenL, Lhe
dlodes would be lnsLanLly deacLlvaLed.

1he laser llghL used ln low level laser Lherapy ls orders of magnlLude dlfferenL Lo Lhe
laser llghL used ln Lhe ablaLlve and surglcal Lechnlque of laser llpolysls, mllll WaLLs ln
low level laser compared Lo WaLLs of power ln laser llpolysls. Pence, why low level
laser 'sLlmulaLes' Llssue whlle laser llpolysls 'ablaLes' Llssue LhaL ls exposed Lo Lhe
laser.

1he LreaLmenL mechanlsm for low level laser Lherapy ls by sLlmulaLlon of exlsLlng
blochemlcal/meLabollc paLhways as opposed Lo Llssue desLrucLlon whlch ls seen ln
ulLrasound and laser llpolysls Lechnlques. 8y only empLylng Lhe cell conLenLs raLher
Lhan desLroylng Lhe cell Lo release sLored conLenLs Lhe ablllLy for fuLure faL sLorage ln
LhaL area remalns. ln procedures where faL cells are surglcally removed or
desLroyed, any fuLure faL sLorage (from mlsmanaged dleL and exerclse llfesLyle) wlll

Page 6 of 8 F01-1332_1_A.doc
have Lo be dlsLrlbuLed for sLorage ln oLher anaLomlcal locaLlons, whlch could lnclude
around Lhe lnLernal organs and wlLhln Lhe vlsceral cavlLy, one of Lhe conLrlbuLory
facLors Lo developlng Lype ll non lnsulln dependanL dlabeLes. Low level laser Lherapy
leaves Lhe cells lnLacL and able Lo sLore fuLure faL ln Lhe orlglnal area, reduclng Lhls
rlsk.

llnally, Lhe lllpo devlce has pre-seL LreaLmenL parameLers whlch remove Lhe rlsk of
accldenLal lneffecLlve doslng or overdoslng of Lhe paLlenL, nor does LreaLmenL
requlre manual sklll by Lhe operaLor Lo ensure LreaLmenL success or mlnlmlse slde
effecLs, maklng lL one of Lhe slmplesL devlces Lo operaLe pracLlcally.



UL1kASCUND
LASLk
LICLSIS
LCW LLVLL LASLk
1nLkA
Invas|ve]Non-|nvas|ve
Non-|nvas|ve Invas|ve, surg|ca| procedure Non-|nvas|ve
Mechan|sm
Mechan|ca|]therma| destruct|on
of soft t|ssue
Surg|ca| |nc|s|on, therma|
destruct|on by ab|at|on &
coagu|at|on of soft t|ssue
St|mu|at|on of ex|st|ng
metabo||c pathways, no
t|ssue destruct|on
Lnergy 1ype]Dose
U|trasound waves
Increas|ng t|ssue temp |n excess
of 40
o
C
n|gh powered C|ass 4 |nfra
red |aser ||ght (Nd:AG or
d|ode)
Up to 30W
Low |eve| C|ass 3b v|s|b|e
red |aser d|odes
40mW
kestr|ct|ons of
1reatment Areas
Most dev|ces c|te abdomen,
f|anks and out th|gh]h|p areas,
spec|fy m|n|mum of 2cm fat
|ayer over bone to prevent
acc|denta| damage to bone
A|| dev|ces spec|fy
treatment |s on|y su|tab|e
for SMALL |oca||sed pockets
of fat
None
kequ|res
Anaesthes|a]Ana|ges|a
Cra| ana|ges|a and]or sk|n
coo||ng may be necessary
Loca| Anaesthes|a, sedat|on
and ana|ges|a requ|red

None
D|scomfort dur|ng
treatment
M||d and trans|ent pa|n, Sensat|ons of probe
movement w|th|n t|ssue
None
S|de effects
Lrythema for severa| hours,
bru|s|ng, oedema, sk|n burns,
deeper t|ssue burns
k|sks of acc|denta| exposure of
focused u|trasound energy on
unwanted organs]t|ssues]bone
a|n, tenderness, b|eed|ng,
bru|s|ng, oedema, |nfect|on,
nerve damage, scarr|ng,
pers|stent symptoms, burns
None
Downt|me after
treatment
M|n|ma|, ma|n|y v|sua|
appearance, some sensat|on
d|scomfort
1-2 days unt|| resumpt|on of
gent|e rout|ne, severa| days
before exerc|se
Compress|on garments for
up to 4 weeks
None
Cperator dependant
parameter
se|ect|on]treatment
de||very
es
1reatment head must be kept |n
mot|on to prevent burns
es
Manua| man|pu|at|on of
|aser through t|ssue |ayers
Lndpo|nt dec|ded by
operator [udgement of
temperature to touch of
surface sk|n above
treatment area
No, pre-programmed f|xed
treatment parameters
1able 1. Comparlson of ulLrasound, laser llpolysls and low level laser Lherapy

Page 7 of 8 F01-1332_1_A.doc
keferences:

(1) naLlonal clearlnghouse of lasLlc Surgery SLaLlsLlcs (2010) 8eporL of Lhe 2009
S1A1lS1lCS. Amerlcan SocleLy of lasLlc Surgeons, ArllngLon PelghLs.
(2) LehnhardL M. , Ma[or and leLhal compllcaLlons of llposucLlon: a revlew of
72 cases ln Cermany beLween 1998 and 2002, lasL 8econsLr Surg, 2008,
121: 396-403
(3) 1rlana L. , LlposucLlon: 23 years of experlence ln 26,239 paLlenLs uslng
dlfferenL devlces, AesLheL Surg !, 2009, 29: 309-312
(4) Moreno-Moraga !. , 8ody conLourlng by nonlnvaslve Lransdermal
focused ulLrasound, Lasers Surg Med, 2007, 39: 313-323
(3) Ascher 8., SafeLy and efflcacy of ulLrashape ConLour l LreaLmenLs Lo lmprove
Lhe appearance of body conLours: mulLlple LreaLmenLs ln shorLer lnLervals,
AesLheL Surg !, 2010, 30: 217-224
(6) laLeml A., Plgh-lnLenslLy focused ulLrasound effecLlvely reduces adlpose
Llssue, Semln CuLan Med Surg, 2009, 28: 237-262
(7) laLeml A., Plgh-lnLenslLy focused ulLrasound effecLlvely reduces walsL
clrcumference by ablaLlng adlpose Llssue from Lhe abdomen and flanks: a
reLrospecLlve case serles, AesLheLlc lasL Surg, 2010, 34: 377-382
(8) !ackson 8l. , Low-level laser Lherapy as a non-lnvaslve approach for
body conLourlng: a randomlsed, conLrolled sLudy, Lasers Surg Med, 2009,
41: 799-809
(9) Caruso-uavls Mk. , Lfflcacy of low-level laser Lherapy for body
conLourlng and spoL faL reducLlon, Cbes Surg, 2010 Aprll 13
Lh
[Lpub ahead of
prlnL]
(10) ManusklaLLl W. , Clrcumference reducLlon and cellullLe LreaLmenL wlLh a
1rlpollar radlofrequency devlce: a plloL sLudy, ! Lur Acad uermaLol venereol,
2009, 23: 820-827
(11) ALlyeh 8S. , CosmeLlc mesoLherapy: beLween sclenLlflc evldence, sclence
flcLlon, and lucraLlve buslness, AesLheLlc lasL Surg, 2008, 32: 842-849
(12) Avram MM., Parry 8S., Cryollpolysls for subcuLaneous faL layer reducLlon,
Lasers Surg Med, 2009, 41: 703-708
(13) 8rown SA, , CharacLerlsaLlon of nonLhermal focused ulLrasound for
nonlnvaslve selecLlve faL cell dlsrupLlon (lysls): Lechnlcal and precllnlcal
assessmenL, lasL 8econsLr Surg, 2009, 124: 92-101
(14) Avelar !., 8eglonal dlsrupLlon and behavlour of Lhe subcuLaneous Llssue
concernlng selecLlon and lndlcaLlon for llposucLlon, AesLheLlc lasL Surg,
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(13) Carcla-Murray L. , 1he use and mechanlsm of acLlon of hlgh-lnLenslLy
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