Obesity and being overweight is a global health crisis, with almost one in two people currently trying to lose weight.1,2 And their success in doing so isn’t just important in terms of helping improve their health status, reduce their risk of comorbidities like hypertension and liver disease,3 and help manage conditions like type two diabetes4 – it also helps with the significant burden of psychosocial issues associated with obesity, including issues related to their mood, self-esteem, body image, social interactions and overall quality of life.5
With the weight loss and management industry being valued at over US$175 billion in 2022, it’s clear that health consumers are searching for effective, safe and reliable approaches to weight loss as traditional diet-and-exercise methods continue to pose significant adherence barriers – with many companies leveraging the use of medical procedures or technology such as liposuction and fat freezing treatments. With the Emerald laser gaining significant popularity over recent years in the field of body contouring due to its significant benefits over alternative fat reduction therapies paired with its FDA clearance and impeccable safety profile, here is an overview of the Emerald laser’s mechanism of action, clinical evidence behind it, and comparison to other medical fat loss therapies, namely fat freezing and liposuction.
Overview: What Is The Emerald Laser And How Does It Work?
The Emerald laser device consists of a control unit and a
semi-circular laser unit, connected via an arm. The laser
unit has four distinct areas of laser emission, as pictured
here. The laser unit is placed over the torso or targeted
area of the body as a person lays down. The laser unit
never comes into direct contact with the body. Instead, it
emits light energy in a single wavelength from a short
distance of 9-12cm. This visible-green wavelength is
non-thermal, meaning they produce no heat (nor any
extreme cold), instead, they work to engage with the
cells and their mitochondria (on a cellular level), as
opposed to trying to freeze, destroy or physically (and
invasively) remove the fatty tissue.
1 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5215364/
2 https://www.greatgreenwall.org/supplements/weight-loss-statistics
3 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5497590/
4 https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-017-4081-6 5 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6052856/
Getting into the specifics, the Emerald laser produces a 532 nm green-coloured laser that is able to target the subcutaneous fat layer within the skin (the adipose tissue). The energy that is produced by the laser triggers a chemical reaction in the mitochondria of the cell that starts a biochemical cascade (a series of chemical signals) that leads to fat being emulsified and then transported away through the lymphatic system. With the mitochondria housing a specific protein called cytochrome-c-oxidase (CcO), the specific wavelength and energy produced by the laser excites this protein, which influences the production of Adenosine Triphosphate (ATP), which in turn influences the production of respiration byproducts including Nitric Oxide (NO) and Reactive Oxygen Species (ROS). The cell responds to the biochemical cascade by emulsifying the lipid (fat content) into fatty acids, while the ROS interactions with the cell wall opens up transitory pores. Fat is then gradually released from the cells through these pores and into the interstitial space, from where the lymphatic vessels transport the free fatty acids to the lymph nodes, where they are broken down by cells called macrophages, and finally used up as carbon dioxide in breathing or feeding our muscles and organs. This process causes the fat cells to shrink, while also stimulating the remaining cells to function like healthy lean fat cells, which can create a chain reaction through the messages sent to the brain and around the body to encourage other fat cells to release some of their own fatty content.
It is important to note that this process relies solely on optimising the existing, natural processes of the cells and the body, which is why the Emerald laser has been described as the “healthiest” fat loss treatment available on the market, especially when compared against invasive surgeries, maintaining a strict or unsustainable diet, pushing the body beyond its physical limits (that can pose an injury risk), or generally undergoing any treatments or therapies that lead to pain, psychological distress, or even the risk of any adverse outcomes.
Emerald Laser: What Is The Research And Evidence Saying?
The first boost of confidence for any health professional assessing whether the Emerald laser is a safe, suitable and effective addition to their clinic is that it’s the only laser in the world that has been given FDA clearance for overall body circumference reduction in patients with small pockets of fat and patients with a BMI of up to 40. The second boost of confidence is its efficacy and safety profile, meaning that patients undergoing treatment with the Emerald laser require no downtime, experience no pain, and have no negative side effects from the treatment.
Efficacy: Body circumference reduction
In 2012, a randomised, double-blind, sham-controlled study investigated Emerald’s 532 nm wavelength lasers for body contouring and weight-loss.6 This study was one of the first to showcase the efficacy of this wavelength in a controlled environment. Using only three treatments per week for just a two week duration on participants aged between 18-65 years, the laser-treated subjects demonstrated a mean (SD) decrease in total combined circumference measurements of 9.9 cm by week two, compared to just 2.8 cm for the sham-treated group. Participants were treated in several areas, including the waist, hip, and both
6 https://journals.sagepub.com/doi/10.5992/AJCS-D-12-00048.1
thighs, and compared to baseline measurements, the LLLT-treated subjects demonstrated significant decreases in circumference measures for each individual treatment area at week 1, week 2, and the 2- week post-treatment evaluation. By the end of the study, over two-thirds of participants had a greater than or equal to 7.6 cm mean decrease in total combined circumference measurements, compared with less than one in five of the sham participants.
Efficacy: Body circumference reduction in higher BMIs
With the Emerald laser being the only device with FDA approval to be used in those with a higher BMI and higher BMIs often being contraindicated in other fat reduction treatments (such as fat freezing in all areas aside from a double chin), it was also necessary for the laser to demonstrate its efficacy for this population specifically – which it did with flying colours. In a 2013 study looking at the efficacy of the laser in those with a BMI of between 30-40 and that did not respond to traditional diet and exercise, they carried out three treatments per week for a four-week period and compared the results to a sham treatment group. The average age of those who participated was 47 years old. 71.43% of subjects who received laser treatment attained a decrease in combined circumference measurements of 7.6 cm or greater, compared with only 12% of subjects who received the ‘fake’ (placebo) laser procedures. The mean change in combined circumference measurements with the laser was 10.5 cm, compared to just 1.8 cm with the placebo, once again concluding and proving the efficacy of the treatment in a relatively short time frame.7
Efficacy: Cellulite
Following the success of the 2012 study, another study was completed in 2013 that looked primarily at the ability of the 532 nm green laser to reduce the appearance of cellulite, as well as secondarily looking at body circumference reduction.8 It followed a similar protocol as above – just two weeks of treatment at 2-3 days apart, for only 15 minutes per treatment area (front and back of the hips, thighs and waist). This was compared to sham treatment, and the results were compared against the Nurnberger-Muller cellulite classification scale. In just two weeks, over half of the treated subjects had a decrease of either one or two stages of the classification scale, compared to only 8.8% of sham subjects. In line with the above body circumference reduction findings, this study also found that those treated with laser achieved a significant decrease in combined baseline thigh circumference at both the 2-week study endpoint as well as the 6-week follow-up evaluation versus a 0% significant reduction in sham-treated subjects.
Safety
The Emerald laser has shown a superior safety profile throughout all of its trials and studies, reporting no adverse events throughout any of its trials and studies.9,10,11
7 https://pubmed.ncbi.nlm.nih.gov/27935737/
8 https://pubmed.ncbi.nlm.nih.gov/23508376/
9 https://journals.sagepub.com/doi/10.5992/AJCS-D-12-00048.1
10 https://pubmed.ncbi.nlm.nih.gov/27935737/
11 https://link.springer.com/article/10.1007/s10103-019-02867-5
Satisfaction
Laser treatment has maintained high satisfaction rates throughout its studies, with the 2013 study on cellulite reduction (alongside body circumference reduction), with almost two-thirds of participants satisfied with their outcomes.12 The Mayo Clinic study yielded similar results, with a 65% satisfaction rate in those treated in the optimal time frame.13 In the efficacy study in those with BMIs of between 30-40, the satisfaction with laser was at 79% compared to 16% in the placebo group.14
Ideal treatment frequency
In 2019, the world-renowned Mayo Clinic set out to determine the ideal frequency of laser treatments using the Emerald laser to achieve the best treatment outcomes, categorising participants in one of three groups: three weekly treatment sessions for four weeks, twice weekly for six weeks, or once weekly for twelve weeks. They found that the best results were achieved by receiving laser treatment twice per week for six weeks, where the researchers found that weight, BMI and waist circumference were all significantly reduced from baseline at weeks 4 and 6, with significant reductions in waist circumference also observed at 12 and 26 weeks in the post-treatment follow-ups. Throughout this study, laser was associated with a reduction in body circumference of between 2.3 and 4.0 cm and a reduction in weight of between 1 and 3.5 kg.
How Does The Emerald Laser’s Action Compare To Liposuction And Fat Freezing?
Liposuction is a type of plastic surgery performed under anaesthesia where the tissue is cut into in several small incisions, the quantity determined by how many areas are being targeted. A thin, hollow tube (cannula) is then inserted through the incisions to loosen excess fat using a back-and-forth motion. The dislodged fat is then suctioned out of the body using a surgical vacuum or syringe attached to the cannula.15 By removing the number of fat cells in the area, the area reduces in size. The remaining fat cells in the same location and throughout the body are unaffected in terms of their size and may increase in size if the weight does not remain controlled. Liposuction does not help with dimpled skin from cellulite or other differences in the surface of the skin. Liposuction also does not remove stretch marks.
As with any invasive surgery, there are many risks and potential for adverse events, ranging from contouring irregularities to numbness, infection, internal punctures, build-ups of fluid and much more. Liposuction also carries a notable recovery time with pain that may be managed through taking painkillers. It often takes a few weeks before usual activities such as exercise can be resumed once your surgeon gives you the all-clear.
On the other hand, fat freezing uses controlled cooling to freeze and destroy fat cells in targeted areas of the body. It uses a specially designed machine to vacuum the skin above the area of fatty tissue into an
12 https://pubmed.ncbi.nlm.nih.gov/23508376/
13 https://link.springer.com/article/10.1007/s10103-019-02867-5
14 https://pubmed.ncbi.nlm.nih.gov/27935737/
15 https://www.plasticsurgery.org/cosmetic-procedures/liposuction/procedure
applicator that then rapidly cools fat cells to a temperature of between -11°C to -7°C. As fat cells are particularly vulnerable to these cooler temperatures, they can undergo a process called apoptosis, whereby the cells can break down and die. This can permanently remove the targeted fat cells, though it doesn’t prevent new fat deposits from accumulating around the body.
Again, fat freezing carries risks of adverse events, including pain (described as cold “shark bites”), swelling, bruising, numbness, tingling, nerve damage, skin hyperpigmentation, muscle weakness and more. Additionally, one side effect estimated to affect 1 in 4,000 procedures is the exact opposite of the intended effect of fat freezing, where instead of the fat cells shrinking and dying, they become bigger and firmer, being left with a “stick of butter” appearance.16
Safe And Effective For Patients And Practitioners
With the Emerald laser not only repeatedly proving its efficacy but also delivering high satisfaction rates with no adverse effects, it makes an ideal treatment solution not only for patients but for the treating practitioners who can rely on this product as a trusted, safe and effective service to have available.
The Emerald Laser is available exclusively from InnovaMed Aesthetics.
For more information on the device or for any questions, please get in touch with us at info@innovamedaesthetics.com.au
16 https://www.eurekalert.org/news-releases/807341
