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F01-1330_1_A.

doc


1he Concept of Iract|ona| Iat keduct|on w|th the |||po
Low Leve| Laser Dev|ce

u lreeman M.Sc. h.u.
3
rd
March 2011




Introduct|on

Low level laser Lherapy (LLL1) for faL reducLlon LreaLmenLs uses a mechanlsm where
laser energy LargeLs Lhe mlLochondrla of Lhe adlpose cell, Lemporarlly sLlmulaLlng Lhe
elecLron LransporL mechanlsm wlLhln Lhls organelle. 1he prlmary ouLcome of Lhls
acLlon ls Lhe Lemporary lncrease ln Lhe producLlon of A1 (energy) wlLhln Lhe cell.
Secondary effecLs of Lhls cascade acceleraLlon ls Lhe lncrease of P
+
lons mlgraLlng
across Lhe mlLochondrlal membrane lnLo Lhe cell lnLerlor, decreaslng Lhe pP. Slnce
Lhe body sLrlves for homosLaLls, Lhe cell responds Lo Lhls lncreased concenLraLlon of
P
+
lons by openlng LransporL channels or pores ln Lhe cell membrane allowlng Lhe re-
dlsLrlbuLlon of lons across Lhe cell wall Lo redress Lhe pP lmbalance. ln addlLlon Lo P
+

concenLraLlon lncrease, Lhere ls also an lncrease ln Ca
2+
lons passlng lnLo Lhe maln
cell lnLerlor from Lhe mlLochondrla whlch Lrlggers Lhe release of a llpase enzyme
(1)(2)
.
1hls enzyme breaks cerLaln chemlcal bonds on Lhe sLored Lrlglycerlde molecules Lo
creaLe 3 free faLLy aclds and 1 glycerol molecule from each Lrlglycerlde unlL. 1he
smaller meLabollLes are Lhen able Lo pass Lhrough Lhe pores ln Lhe cell wall
(3)(4)
, ouL
lnLo Lhe exLracellular maLrlx, where Lhey wlll be LransporLed away from Lhe area by
Lhe lymphaLlc sysLem for re-dlsLrlbuLlon Lo Lhe body's Llssues, and meLabollsm
durlng posL LreaLmenL exerclse.

1he lllpo has been ln use for almosL 3 full years ln aesLheLlc pracLlces around Lhe
world wlLh greaL success, supporLlng paLlenLs Lo speclflcally reduce chosen or
Lroublesome faL sLorage zones. ln con[uncLlon wlLh a healLhy dleL and exerclse
llfesLyle Lhe LreaLmenL provldes long Lerm non-lnvaslve and paln free body
reshaplng.

1he alm of Lhls documenL ls Lo answer Lwo of Lhe mosL frequenL quesLlons LhaL are
posed wlLh regards Lo Lhe LreaLmenL and explaln Lhe beneflLs of fracLlonal faL
reducLlon.


F01-1330_1_A.doc

1. Is the fat re|eased by |||po dangerous?

uurlng lllpo LreaLmenL Lhe sLored Lrlglycerldes are broken down lnLo free faLLy aclds
and glycerol before belng released from Lhe cell. Cnce ouLslde of Lhe cell Lhey are
LransporLed by Lhe lymphaLlc sysLem, whlch dralns lnLo Lhe body's clrculaLory
sysLem, Lhus lnLroduclng Lhe conLenLs of Lhe cell lnLo Lhe blood supply. 1hese faLLy
aclds and glycerol would Lhen be Laken up and re-esLerlfled (made back lnLo
Lrlglycerlde molecules) unless burned by Lhe body Lo provlde energy. 1hls ls why Lhe
posL LreaLmenL exerclse ls so lmporLanL, wlLhouL sulLable amounLs of Lhls, some or
all of Lhe freed faLLy aclds could be resLored back lnLo faL cells. A randomlsed
conLrolled sLudy publlshed by Caruso-uavls eL al
(3)
, ln 2010, deLalled Lhe effecL of a
LLL1 devlce on clrcumference reducLlon of Lhe abdomlnal reglon. uaLa show
sLaLlsLlcally relevanL effecL, wlLh an average of 0.4-0.3cm reducLlon ln each
LreaLmenL sesslon buL observed LhaL whlle Lhls LreaLmenL offered sLaLlsLlcally vlable
reducLlon of walsL clrcumference, Lhe moblllsed faL would elLher be burned for food
or be dlsLrlbuLed lnLo Lhe faL depoLs Lyplcal of LhaL person's faL dlsLrlbuLlon and
wlLhouL perlodlc LreaLmenLs, Lhe body would redlsLrlbuLe faL Lo lLs orlglnal paLLerns.

lL ls undersLandable Lo see why some paLlenLs mlghL be concerned abouL Lhe ldea of
faL cell conLenLs geLLlng lnLo Lhelr clrculaLory neLwork, wlLh so much emphasls from
Lhe medlcal communlLy as Lo Lhe cardlac and clrculaLory rlsks of hlgh
cholesLerol/Lrlglycerlde levels and faL 'furrlng' of Lhe arLerles. ldeally Lhey need Lo
be educaLed on Lhe facLs LhaL flrsLly, lllpo LreaLmenL does noL release Lrlglycerldes
lnLo Lhe body's clrculaLory sysLems, lL releases faLLy aclds, whlch are a normal
meLabollLe LransporLed around Lhe body on a dally basls and secondly, Lhe
movemenL of hlgher concenLraLlons of faLLy aclds and glycerol around Lhe clrculaLory
sysLem occurs afLer every meal LhaL Lhey eaL as well as afLer lllpo LreaLmenL, Lhus
lllpo poses no lncreased rlsk on Lhe body Lhan eaLlng a normal dally meal. laL eaLen
as food ls processed lnLo chylomlcrons ln Lhe guL and absorbed Lhrough Lhe
gasLrolnLesLlnal LracL lnLo Lhe lymphaLlc sysLem, whlch subsequenLly dralns Lhem
lnLo Lhe venous (clrculaLory) sysLem, l.e. faL released by lllpo and faL eaLen ln Lhe
dleL, boLh enLer Lhe clrculaLory sysLem ln a slmllar manner, [usL from Lwo dlfferenL
slLes and are processed from LhaL polnL ln a slmllar manner.





2. What ||m|ts are there to |||po treatment and reduc|ng fat?

Whlle lL would be nlce Lo Lhlnk LhaL we could have a whole body LreaLmenL and
remove any excess faL ln one slLLlng, lL slmply lsn'L achlevable because of Lhe llmlLs
placed on us by Lhe human body noL by Lhe devlce lLself.

llrsL of all, Lhe human body ls noL deslgned Lo ellmlnaLe sLored faL or calorles unless
needed Lo meeL a demand for energy elLher by lncreased exerclse or reduced dally

F01-1330_1_A.doc
calorle lnLake. 1herefore, afLer an lllpo faL reducLlon LreaLmenL, Lhere needs Lo be a
perlod of exerclse Lo cause Lhe 'freed' energy Lo be meLabollsed or burnL off and
Lhus be permanenLly removed from Lhe body's reserves. lf Lhls ls noL compleLed
effecLlvely, Lhe unused energy wlll slmply be resLored lnLo Lhe body's faL cells for
fuLure use.

Would Lhls resLorlng occur ln Lhe cells LhaL have [usL been empLled? 1hls,
unforLunaLely, ls an unknown facLor LhaL would be hard Lo ldenLlfy concluslvely. lL
would be easy Lo assume LhaL Lhe newly empLy cells would be Lhe mosL aLLracLlve re-
sLorage polnL aL LhaL Llme buL aL Lhe end of Lhe day, Lhe body could choose Lo sLore
Lhem any where wlLhln Lhe subcuLaneous Llssue LhaL lL normally prefers Lo sLore faL
ln. Lach paLlenL can probably ldenLlfy a zone of Lhe body where Lhey mosL qulckly
noLlce faL galn - Lhelr bodles preferred area of sLorage, and Lhls would sLlll conLlnue
Lo be a zone of concern afLer lllpo LreaLmenL lf Lhe paLlenL conLlnues Lo mlsmanage
Lhelr dleL vs. exerclse balance.

We are also llmlLed Lo how much faL reducLlon can be done ln a slngle slLLlng. lf Loo
large an volume of faL ls moblllsed from Lhe faL cells, Lhere mlghL well be an amazlng
lnsLanL lnch loss Lo congraLulaLe Lhe paLlenL over, buL would be so much avallable
energy requlrlng meLabollsm LhaL Lhe paLlenL would be exerclslng for Lhe nexL 8+
hours Lo use lL all up! lor Lhe ma[orlLy of paLlenLs Lhls ls unllkely Lo happen, leavlng
Lhe ma[orlLy of Lhe freed faLLy aclds Lo be resLored and resulL ln some of Lhose
amazlng 'lnches-losL' Lo creep back on agaln before Lhe nexL LreaLmenL.

1here ls also a llmlLaLlon on how many free faLLy aclds can be LransporLed by Lhe
blood aL any one Llme, slnce Lhe faLLy acld molecules need a LransporLlng carrler
molecule Lo enable Lhe lnsoluble faL Lo solublllse ln Lhe waLer based blood serum
(Lhlnk of lL llke when you pour faL lnLo waLer, Lhe Lwo do noL mlx unLll you add some
dlshwashlng soap, whlch asslsLs Lhe faL Lo dlsperse or solublllse ln Lhe waLer). Cnce
all of Lhese carrler molecules spaces are fllled, no new faLLy aclds wlll be plcked up
and LransporLed by Lhe blood unLll some of Lhe prevlous molecules have been
removed from Lhe clrculaLlon. 1hls wlll llmlL Lhe amounL of faLLy aclds LhaL can be
moblllsed around Lhe body afLer each LreaLmenL sesslon prlor Lo Lhe posL LreaLmenL
exerclse Laklng place.




3. What |s the Iract|ona| Iat keduct|on (IIk) effect w|th the |||po
and why |s |t |mportant?

1he deslgn of Lhe lllpo ls such LhaL small pockeLs of adlpose cells are lrradlaLed and
sLlmulaLed Lo release Lhelr sLored faL conLenLs raLher Lhan sLlmulaLlng faL cells Lo
empLy ln a conLlnuous layer across Lhe whole surface area belng LreaLed. 1hls
lracLlonal laL 8educLlon (ll8) resulLs ln Lhe creaLlon of a porous 'sponge-llke'
sLrucLure ln Lhe LargeLed faLLy Llssue.


F01-1330_1_A.doc
1he skln ls made up of varlous dlscreLe layers wlLh Lhe Lhln epldermls ouLermosL, Lhe
dermls beneaLh lL and Lhen Lhe subcuLaneous adlpose/faL layer sandwlched beLween
Lhe dermls and Lhe muscle facla underneaLh Lhe skln (see llg 1. below).



llq 1. 5ttoctote of tbe sklo


Many LLL1 devlces ofLen descrlbe Lhelr laser llghL dlsLrlbuLlon Lo be even across Lhe
enLlre skln surface Lo provlde a unlform LreaLmenL. 1hls ls even used as a markeLlng
polnL (see llg 2. below).



llq 2. Appllcotloo of otbet lll1 wltb 100X loset covetoqe of sklo sotfoce ooJet tbe
tteotmeot poJ


F01-1330_1_A.doc
lf Lhe laser LreaLmenL was Lo LargeL and empLy a whole layer of faL cells under Lhe
sklns surface of Lhe LargeLed LreaLmenL area lL could creaLe a large area vold dlrecLly
under Lhe epldermls/dermls (see llg 3. below).



llq J. 5btlokoqe of totqeteJ fot cells, cteotloq volJ lo tbe sobcotooeoos loyet ooJet tbe
eplJetmls/Jetmls sotfoce tbot woolJ tbeotetlcolly covet tbe eotlte oteo ooJet tbe tteotmeot
poJ

1hls mlghL resulL ln Lhe formaLlon of unslghLly wrlnkles or mlnl folds of excess skln
Llssue as Lhe surface collapses lnLo Lhls vold slnce Lhe naLural skln elasLlclLy would
requlres some Llme Lo 'conLracL' and LlghLen across Lhe area (see llg 4. below). 1hls
unwanLed effecL could be longer lasLlng ln older paLlenLs or paLlenLs wlLh
slgnlflcanLly reduced elasLlclLy ln Lhelr skln Llssue.



llq 4. 1be posslble sklo folJ/cteose fotmotloo wbeo tbe eplJetmls/Jetmls collopses loto tbe
volJ ooJetoeotb lt

F01-1330_1_A.doc

8y creaLlng a fracLlonal faL reducLlon effecL wlLh low dlvergenL laser dlodes we see
Lhe producLlon of channels of sLlmulaLed faL cells wlLhln Lhe faL layer.



llq 5. lllpo lll1 tteotmeot poJ oo tbe sklo totqetloq ftoctloool colomos of loset oteo

Cnly Lhe faL cells wlLhln Lhe laser beams would be sLlmulaLed Lo release Lhelr
conLenLs creaLlng channels whlch wlll essenLlally be volds of empLy faL cells. CLher
unLreaLed 'full' faL cells can Lhen relocaLe and space-flll lnLo Lhese empLy channels
(see llg 6. below).



llq 6. lmoqe of ftoctloool cboooels of volJ fotmotloo ftom lllpo, cteotloq spooqe effect wltb
ooJetplooloq soppott to eplJetmls/Jetmls ooJ qtoJool mlqtotloo of ootteoteJ fot cells to flll
volJs



F01-1330_1_A.doc

Cver-all faL volume ls reduced, causlng lmmedlaLe and measureable clrcumference
reducLlon, buL Lhls sponge sLrucLure would malnLaln Lhe supporL for Lhe skln surface,
provldlng 'scaffoldlng' supporL of unLreaLed faL cells Lo underpln Lhe
epldermls/dermls lmmedlaLely afLer Lhe LreaLmenL and gradually allow Lhe naLural
skln elasLlclLy Lo conLracL aL lLs own pace as Lhe remalnlng faL cells relocaLed lnLo Lhe
volds. 1hls would prevenL Lhe posslble formaLlon of excess puckered skln and also
allows a more even LreaLmenL. Many paLlenLs can acLually feel Lhls effecL, where Lhe
LexLure of Lhelr LreaLmenL area ls descrlbed as 'doughy' or more 'spongy' afLer
LreaLmenL (See llg 7. below).


llq 7. CtoJool sklo tlqbteoloq olloweJ os fot loyet sbtloks wltb telocotloo of
ootteoteJ cells loto ftoctloool cboooels


1he oLher lmporLanL facLor of fracLlonal faL reducLlon ls Lhe amounL of calorles Lhls
meLhod moblllses wlLh each LreaLmenL, ensurlng faL reducLlon aL a much more
susLalnable raLe for each LreaLmenL, and for each paLlenL, Lhan LreaLmenL of Lhe
enLlre cosmeLlc area as descrlbed by oLher devlces.

lor example, anoLher LLL1 devlce LhaL markeLs Lhe homogenous LreaLmenL of Lhe
enLlre area covered by Lhe laser pads durlng LreaLmenL would LreaL an area of
78.0cm
2
per pad per LreaLmenL. 1helr suggesLed proLocol ls Lhe placemenL of 4 pads
ln 2-3 locaLlons on a LreaLmenL zone, l.e. 8-12 pads worLh of surface area covered.
1hls equaLes Lo 624-936cm
2
of skln surface and Lhus, subcuLaneous faL exposed Lo
Lhe lasers durlng a Lyplcal LreaLmenL. lrom Lhelr cllnlcal resulLs publlshed, Lhe
manufacLurers lndlcaLe an average reducLlon of 0.33cm per LreaLmenL from any
slngle clrcumference measuremenL of Lhe LreaLmenL zone.

1o calculaLe amounLs of calorles lnvolved we do have Lo make some assumpLlons Lo
make Lhe maLhemaLlcs a llLLle easler Lo manage, so Lhe followlng resulLs are

F01-1330_1_A.doc
approxlmaLlons of Lhe real llfe slLuaLlons. 1he baslc assumpLlons made are LhaL Lhe
paLlenL Lorso ls cyllndrlcal wlLh a sLarLlng clrcumference of 80cm.

uaLa presenLed aL Lhe 30
Lh
ASLMS annual conference ln Aprll 2010
(6)
demonsLraLed
from a reLrospecLlve sLudy of 311 paLlenLs, an average measured loss from a slngle
LreaLmenL sesslon of 0.33cm.

1o calculaLe Lhe volume of faL reduced from Lhe LreaLmenL we need Lo calculaLe Lhe
radlus of Lhe cyllndrlcal Lorso before LreaLmenL and Lhen agaln afLer LreaLmenL uslng
Lhe clrcumference daLa measuremenLs.

Clrcumference c = 2nr
and Lhe reducLlon ln faL layer Lhlckness
r
loss
= r
before
- r
afLer

8efore we begln Lhe calculaLlons we have Lo Lake lnLo accounL Lhe facL LhaL Lhe
calculaLed reducLlon ln radlus of Lhe cyllndrlcal Lorso, wlll only acLually be from one
half of Lhe Lorso belng LreaLed slnce a Lyplcal LreaLmenL of pads placed around Lhe
Lorso, 8 ln number, lald slde by slde on a paLlenL of clrcumference 80cm wlll only
acLually cover half of Lhe clrcumference of Lhe Lorso. 1hls means we have Lo
conslder Lhe Lorso as Lwo separaLe semlclrcles, wlLh Lhe fronL half or semlclrcle belng
LreaLmenL and Lhe back semlclrcle unLreaLed.

1herefore Lhe measured average reducLlon of 0.33cm ls only caused by volume
reducLlon effecL on Lhe fronL semlclrcle, Lhe half of Lhe clrcumference aL Lhe back
would be consLanL ln before and afLer measuremenLs.

1hus c before LreaLmenL = 80cm = 2nr
And radlus before LreaLmenL r
before
= 12.74cm

Measured c afLer LreaLmenL = 79.43cm (measured reducLlon of 0.33cm)

8uL Lhls reducLlon ls all accounLable Lo Lhe fronL half of Lhe Lorso, meanlng Lhe radlus
of Lhe fronL of Lhe Lorso afLer LreaLmenL has Lo be calculaLed as Lhe radlus of a clrcle
wlLh clrcumference reducLlon of Lwlce Lhe measured value

C requlred Lo calculaLe r
afLer
=78.9cm

And radlus afLer LreaLmenL r
afLer
= 12.33cm

r
loss
= 0.19cm
= Lhe calculaLed reducLlon ln faL layer Lhlckness
under Lhe LreaLmenL pads

So, from Lhe surface area calculaLlons prevlously, we would expecL Lo see a volume
of faL reduced afLer LreaLmenL Lo equal 118.6cm
3
, where volume = area x Lhlckness.


F01-1330_1_A.doc
Slnce 1cm
3
of faL equals 1.09g and 1g of faL ls equlvalenL Lo 9.072kcals, Lhen each
LreaLmenL ls averaglng 1172 kcals of faL moblllsed ln a slngle LreaLmenL.

1hls ls equlvalenL Lo over half a day worLh of calorles for Lhe average woman (who
would be Lrylng Lo malnLaln currenL welghL) and would requlre slgnlflcanL hours of
cardlovascular exerclse Lo ensure compleLe meLabollsm.

1hls devlce also has one of Lhe smallesL acLual LreaLmenL pad areas compared Lo
oLhers on Lhe markeL suggesLlng LhaL oLher devlces, lf Lhey are LreaLlng Lhe enLlre
surface area evenly, may be moblllslng even more calorles.

1he concluslon we can derlve from Lhls ls LhaL elLher:

1. Lhe oLher devlces are movlng so much faL LhaL much of lL, perhaps as
much as 30-60 ls llkely Lo be resLored agaln ln Lhe hours/days afLer
LreaLmenL even wlLh a slgnlflcanL posL LreaLmenL exerclse perlod or
2. Lhese devlces professlng homogenous surface LreaLmenL are noL acLually
achlevlng Lhls.

1he lllpo has been speclflcally deslgned Lo perform fracLlonal faL reducLlon Lo reduce
Lhe rlsk of skln folds or laxlLy afLer LreaLmenL and also Lo malnLaln Lhe acLual raLe of
faL reducLlon aL a susLalnable level for paLlenLs Lo be able Lo manage compleLe
ellmlnaLlon from Lhe body Lhrough a reasonable exerclse reglmen.

uslng speclallsL speclflcaLlon laser dlodes wlLh mlnlmal dlvergence as opposed Lo
more compeLlLlvely prlced dlodes found ln some devlces LhaL are much more
dlvergenL, Lhe lllpo ls able Lo malnLaln a colllmaLed focus lnLo Lhe subcuLaneous faLLy
Llssue Lo empLy Lhe faL cells ln fracLlonaLed columns wlLhln Lhe LreaLmenL area as
descrlbed prevlously.

1radlLlonal laser Lheory suggesLs LhaL Lhe vlslble red wavelengLhs used ln Lhe lllpo
have a depLh of peneLraLlon of several mm lnLo Lhe Llssue, alLhough Lhose
calculaLlons and measuremenLs have been based on depLh of peneLraLlon Lo provlde
sulLable power denslLles capable of creaLlng a phoLo Lhermal reacLlon ln Lhe LargeL
chromophore. Slnce Lhe lllpo relles on a mechanlsm of phoLochemlcal sLlmulaLlon
Lhe amounL of phoLons of llghL requlred Lo do Lhls are conslderable lower.

1he human reLlnal cell can respond Lo phoLon denslLles of as few as 30 phoLons per
second Lo creaLe a chemlcal slgnal vla Lhe nerve cells.

lf we Lake a laser probe of 40mW and dlrecL Lhls over a 3mm dlameLer surface area
(Lyplcal dlode slze), Lhe power denslLy ls 440mW/cm
2
. AL 2cm lnLo Lhe Llssue
(assumlng Lransmlsslon value of 0.01 whlch ls Lhe mosL conservaLlve esLlmaLe ln
human Llssue) Lhe laser power ls as low as 4.4x10-3/cm
2
, Lhe resL of Lhe llghL has
been absorbed, been LransmlLLed or afLer scaLLerlng, has been reflecLed away. AL
Lhls power Lhe amounL of phoLons passlng Lhrough Lhe 2cm depLh barrler ls equal Lo

F01-1330_1_A.doc
130,000,000,000,000 phoLons per second (6.6x10
-3
/3x10
-19
! = 1.3x10
14
phoLons per
second)

AL 4cm deep Lhe power would be 0.004mlcrowaLLs, correspondlng Lo
13,000,000,000 phoLons per second - sLlll abouL 300 mllllon Llmes more Lhan Lhe 30
phoLons per second lL Lakes Lo sLlmulaLe Lhe reLlnal nerve slgnal.

AL 6cm deep we geL 13,000,000 phoLons per second, 30000 Llmes more Lhan Lhe
requlred amounL Lo sLlmulaLe a nerve slgnal ln Lhe human eye.

Cllnlcal sLudles uslng laser llghL Lo acLlvaLe u1 Lheraples for cancer LreaLmenLs also
reporL effecLlve resulLs aL depLhs of 1.3cm or more
(7)(8)
.

Lach dlode has a small angle of dlvergence, meanlng LhaL Lhe area of Lhe beam does
lncrease as we pass deeper lnLo Lhe Llssue. 1he volume of faL cells exposed Lo Lhe
laser effecL ls ln effecL a cone wlLh Lhe dlode source aL Lhe Llp.


CalculaLed volume of faL cells exposed wlLh each slngle dlode durlng LreaLmenL

v = 1/3nr
2
h
Where r ls Lhe radlus of Lhe cone and h ls Lhe peneLraLlon
depLh lnLo Lhe Llssue

1hus assumlng 1cm peneLraLlon lnLo Lhe Llssue

v = 1/3n(0.3728)
2
x 1.3
Were r ls calculaLed from Lhe angle of dlvergence and Lhe ad[acenL measuremenL
(1.3cm) and PelghL h = 1.3cm allowlng for Lhe 1cm peneLraLlon depLh and Lhe
addlLlonal facLor for Lhe lengLh of dlsLance from Lhe dlode surface wlLhln Lhe
LreaLmenL pad Lo Lhe skln surface.

1hus v = 0.19cm
3
per dlode
v = 1.71cm
3
per pad
v = 13.6cm
3
per LreaLmenL of 8 pads

13.6cm
3
of faL equaLes Lo approxlmaLely 13g of faL or 133kcals of faL.

lf we Lhen assume a 1.3cm peneLraLlon depLh lnLo Lhe Llssue

F01-1330_1_A.doc

v = 0.3cm
3
per dlode
v = 36cm
3
per LreaLmenL

= 39g of faL or 336kcals


8ased on prevlous experlences wlLh u1 acLlvaLlon lL ls noL unreasonable Lo assume
effecLlve faL cell sLlmulaLlon Lo depLhs of 1.3cm, whlch wlLh Lhls fracLlonal meLhod of
reducLlon would moblllse approxlmaLely 336kcal of energy, a reasonable amounL Lo
meLabollse off wlLh a sulLable exerclse sesslon posL LreaLmenL.

aLlenLs wlLh very Lhlck layers of faL wlLhln Lhe LargeL zone could concelvably have
sLlmulaLlon aL depLhs deeper Lhan 1.3cm, alLhough Lhe amounL of calorles moblllsed
ln Lhls may be Loo much for Lhem Lo successfully manage ellmlnaLlon of. ln reallLy
for susLalned long Lerm resulLs, we suggesL faL reducLlon aL a conLrolled pace of
around 300-400 kcals per sesslon.

Conc|us|on

1he mechanlsm of acLlon of Lhe lllpo uses exlsLlng naLural reacLlons and processes
used by Lhe body on a day Lo day basls. 1he lllpo slmply glves Lhe paLlenL Lhe conLrol
of whlch faL Lo LargeL for meLabollsm raLher Lhan leL Lhe body make Lhe declslon.
8ecause of Lhls, Lhe lllpo poses no lncreased rlsk Lo a paLlenL's medlcal well belng aL
Lhe Llme of LreaLmenL or ln Lhe fuLure.

1he llmlLs of speed aL whlch a paLlenL can reduce faL ls llmlLed by Lhe body, only so
much faL can be LransporLed aL a Llme and only so much exerclse can reallsLlcally be
achleved effecLlvely ln one sesslon. Long Lerm malnLenance of Lhe resulLs are
llmlLed by how commlLLed Lhe paLlenL ls Lo achlevlng and malnLalnlng Lhelr goal. lf
Lhey over lndulge ln calorles surplus Lo Lhe body's requlremenLs, Lhese calorles wlll
be sLored as faL.

lracLlonal faL reducLlon Lechnlques Lo LreaL an anaLomlcal LargeL area wlll:

1. provlde addlLlonal supporL Lo Lhe epldermls/dermls afLer
LreaLmenL by LargeLlng columns of faL cells for evacuaLlon whlle
leavlng oLher columns of unLreaLed cells Lo acL as underplnnlng
supporL Lo Lhe epldermls/dermls and Lo allow Llme for Lhe naLural
skln elasLlclLy Lo LlghLen and reduce Lhe rlsk of excess skln
puckerlng and
2. manage Lhe raLe of faL release per LreaLmenL Lo susLalnable levels
for Lhe paLlenL Lo supporL LreaLmenL success, calculaLlons
suggesLlng approxlmaLely 360kcals per LreaLmenL sesslon as
opposed Lo nearly 4 Llmes LhaL lf more dlffuse dlodes are used Lo
cover Lhe enLlre surface area.


F01-1330_1_A.doc

keferences:

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(2) karu 1. eL al, Molecular mechanlsm of Lhe LherapeuLlc effecL of low lnLenslLy
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(3) nelra 8. eL al, Low level laser-asslsLed llpoplasLy appearance of faL
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