Lasers in Surgery and Medizine Cryolipolysis Versus Laser Lipolysis on Adolescent Abdominal Adiposity ‘Mohamed Serag Eldein Mahgoub Mostafa, pxp"* and Mohamed Ali Elshafey, Pan* "Department of Physical Therapy for Basic Sciences, Faculty of Physical Therapy, Cairo University, 77 Shathoub Sireet Ahmed Bssmat Ain Shams, Cairo 11911, Egypt *Depariment of Physical Therapy for Growth and Developmental Disorders in Children and itis Surgery, Faculty of Physical Therapy, Cairo University, Shahin Street Dakadous Meet Ghamar, Dakahlia, Egypt Background: Noninvasive body eontouring is one of the fastest growing segments of the eosmotic aesthetic indus- try. There is inereased public demand for procedures with ower side effects and shorter recovery times. Cryolipolysis and Laser lipolysis have been used as treatments for localized body contouring. Objective: To compare the effect of Cryolipolysis versus Laser lipolysis on adolescent's abdominal adiposity. Design: Randomized, controlled trial Subjects: Forty-five obese adolescents ofboth sexes ranged in age from 13 10 16 years participated in this study were to be categorized into three groups of equal number (each group 15 subjects) randomly selected from population. Methods: Participants were randomly assigned to three groups. Group A was received (Cryolipolysis and diet), Group B was received (Laser lipolysis and diet), Group C was received (only diet) all groups were observed for 8 weeks. Woight and height. seale for (change in weight), tape measurement for (waist-hip rato), skinfold ealiper, and MRI. Results: There was no significant difference between three groups post-treatment in BMI and body weight P- value were (0.2, 0.42, 0.67), respectively. ‘There was a significant improvement for Cryolipolysis group in waist- hip ratio, Suprailiac skin fold, and subcutaneous adipose tissue than other groups P-value (0.001) Conclusions: Cryolipolysis has a favorable effect than Laser lipolysis inthe reduction of waist-hip ratio, skinfolds at Suprailiac level and subcutaneous adipose tissue (SAT), there is no significant difference between them in the reduction of BMT and body weight. All groups did not have an effect on VAT. Lasers Surg, Med, © 2016 Wiley Periodicals, Inc. Key words: abdominal adiposity; cryolipolysis; laser lipolysis; subeutancous adipose tissue INTRODUCTION ‘The prevalence of obesity in both adults and children is increasing rapidly. Obesity in children is independently associated with arterial endothelial dysfunetion and wall thickening, key early events in atherogenesis that precede plaque formation (1 (© 2016 Wiley Periodicals, Ine ‘The carly onsot of obesity leads to an increased likelihood of obesity into adulthood and links to increased provalenee of ohesity-rolated disorders such as coronary diseases, insulin resistaneo, diabetes mellitus, hyperten- sion, sleep apnea, arthritis, cancer, stroke, and heart failure in later life [2]. Primary prevention should be emphasized as early as childhood to prevent the link bbotwoen obesity in early life with obesity in later life [3 Childhood obesity is associated with major morbidity. ‘Moreover, it is linked to obesity in adulthood and is a predictor of significant health consequences in early adulthood. Multiple studies have shown that the risk of adult ohesity is at least twice as high for ohese children as Jor non-obese children [4]. One study showed that as many as 80% of 10-15-yearold overweight children become obese adults [5 Body-sculpting and fat removal procedures are becom= ing increasingly more popular Cryolipolysis (CoolSculpt- ing) are a novel method of selective removal of fat. with cooling. This techniqueis based on the concept that fat cells are more sensitive to cold than the surrounding tissue. Prior studies and observations have demonstrated that cold exposure can induce selective damage to the subcula- neous fat via induction of panniculitis, resulting in the reduction in the superficial fat layer of the skin [6,7] Cryolipolysis is considered safe and effective, with a high patient satisfaction rateof up to73% alter onetreatment 8), This rate is comparable with that of high-intensity focused ultrasound and acoustic wave therapy (62.3% and 64% Conflict of Interest Disclosures: All authors have completed and submitted the ICMIE Form for Iiselosure of Potential Gonfiets of Interest and have disclosed. the following [We disclose that we did not receive any financial support fram a Institution of company iis aur prac and ensured al expenses, This is original manuscript dint publish or sent to ‘any other journal) Correspondence to: Mohamed Serag Eldein Mahgoub Mosta fa, PhO, Lepartment, of Physieal Therapy for Basie Sciences, Faculty ‘of Bhysical "Therapy, Caizo University, 77 Shalloub Street Ahmed ssmat Ain Shams, Cato 1L311, Beypt E-mail: drvergany. Taehotmcl co ‘Recepted danuary 2010 Poblished online in Wiley Online Library {wileyoniinelibrary com) BOT 10-1002!sm 32475,2 MOSTAFA AND ELSHAPEY respectively). However, these modalities are associated with either a higher rateofadverseevents and painor ahigh ‘numbor of up to eight treatments novossary to achiev the desired effect [9]. CCxyolipolysis is safe forall skin types, with no reported pigmentary changes, ands safefor repeated application. The best candidates arethose within their ideal weight range and those wino engage in regular exercise, eat a healthy diet, have noticeable fat bulges on the trunk, are realistic in'their expectations, and are willing to maintain the results of cxyolipolysis with a healthy, active lifestyle [10 United States Food and Drug Administration (FDA) approval in October of 2008 that Laser lipolysis is now a commonly used and accepted as a modality for removal of ‘unwanted fatty tissue [11]. Studios have continued to corroborate early clinical observations af decreased adi- posity, shorter recovery times, and improved skin tighten- ing, Throughout the last 5 years, we have discovered that laser lipolysis iquefies fatty tissue, coagulates small blood vessels, induces collagenases with remodeling, and pro- ‘motes tissue tightening [12,13] Low-level laser therapy (LLL) has been shown to be an cflcacious adjunct therapy for numerous eoametie proce- dures, including breast augmentation and lipoplasty [14,15] With regard to body contouring, a randomized, double- blind, sham-controlled study using a 635nm LLLT device showed a circumferential reduction ofthe waist, hips, and thighs following six treatments administered over a 2- wook period [14,16]. This device has boen shown to provide other significant clinical benefits including reduction in cholesterol and leptin levels while remaining noninvasive and relatively risk-free [17] ‘There is a lack in the literature concerning the effect of (Cryolipolysis versus Laser lipolysis on adolescent abdomi- ‘nal adiposity. We hypothesize that there was no significant difference between Cryolipolysis versus Laser lipolysis on adolescent abdominal adiposity. SUBJECTS, MATERIALS, AND METHODS Study Design This study pre-test post-test ontrol group design, the procedures were followed according tothe agreement ofthe institutional ethical committee and alter approval of childvon's families with written consent. ‘Tie study wa conducted in a specialized center for bosity, to investigate the effect of Crycipalysia versus Lasor lipolysis on adoloseont abdominal adiposity. Forty- five adoloscont ofboth genders (nineteen boys and twent- six girls) were assigned randomly nto three groups ofequal ‘number (each group fifteen subject. They randomly selected from the population according to the following criteria: Their ages were ranged from 13 to 16 years, They hhad nocurrent or previous neurological, musculoskeletal, or cognitive disorders, with normal liver funetions. ir body mass index BMI ofless than 30. They can understand and follow verbal commands and instructions included in the test. Adolewents’ randomly assigned into three groups Group A) consisted of 15 abdominal obese subject (six boys and nine girls) were received Cryolipolysis and diet. Group (Byconsisted of 15 abdominal obese subjects eight boys.and seven girls) wore received Lucor lipalysisand diot. Group(C) consisted of fifteen abdominal obese subjects (five boys and ten girls) were received diet only Instrumentation 1. Weight and height scale: Hanson professional scale was used to measure weight and height in order to calculate BMI (18) 2, Tape measurement: To measure the waist and the hip circumference. 8. Skin fold calipers: To measure the skin fold at the waist (Suprailiae) level, fat was pulled away from the ‘musele with the ealiper tongs situated at their ends. For boys, the direction of fold pulling was vertieal and was taken 2em to the sideof the umbilicus; and for girls, the skinfold was pulled diagonally and was taken above the iliae erest along the anterior axillary line. The supra- iliac skinfold thicknesses were measured pre-and post treatment to determine progress. 4. Magnetic resonance imaging (MRD: To measure abdominal fat images were obtained with a Magnetom Vision 1.5 Tesla whole-body seanner (Siemens, Mis. sissauge, Canada) [19] Procedure Assessment procedures. 1. Weight assessment: All groups were their weight measured by the Hanson professional seale before and after 2 months of intervention, 2 Waist-o-hip ratio measurement: Each subject assessed by the tape measurement and tacked the waist and the hip circumforence then divide the waist ‘measurement by the hip measurement. 3, Body mass index (BMD): Weight Iheight of power 2 (in meters) [1] 4. Skin fold calipers: A caliper was used to measure suprailiae skin fold thickness where subcutaneous fat ‘was pulled away from the muscle with the caliper tongs: situated at their ends. For hoys, the dizeetion of fold pulling was vertical and was taken 2cm to the side of the umbilicus; and for girls, the skinfold was pulled diagonally and wastaken abave the iliac erest along the anterior axillary line. The suprailiae skinfold thick- nesses were measured pre- and post-treatment. to determine progress. 5, Magnetic resonance imaging: To measure abdomi- nal fat using a Ti-weighted fastspin echo pulse sequence (TR 322ms, TE 12ms). The subjects were instructed to lie in the magnet in a supine position with arms extended above the head. A breath-hold sequence (~22seconds per acquisition) was used to minimize the ‘offocts of respiratory motion on the images. All images were acquired on @ 256 256mm matrix and a 480mm field of view. A single image was taken at the level of the umbilical cord, the image was retrieved from the scanner according to Digital Imaging and kilograms)