Efficacy of Endolift laser for arm and under abdomen fat reduction

Noninvasive laser for body fat contouring is a quickly growing field in the cosmetic dermatology. Surgical options carry disadvantages, such as the usage of anesthetics, swelling, pain and long time for recovery, so there is a growing public request for the techniques with fewer side effects and shorter recovery periods. Several new noninvasive body contouring ways have been advanced such as, cryolipolysis radiofrequency energy, suction‐massage, high‐frequency focused ultrasound, and laser therapy. Noninvasive laser improves the body's appearance by the elimination of excess adipose tissue, specifically in areas in which fat perseveres in spite of diet and exercise.

its severe complications are very worrying for patients. Liposuction needs anesthesia and is usually accompanying by many surgical risks like pulmonary embolism, which leads to a fatal result. These unpleasant features have changed the demand for effective and noninvasive treatments with a lower cost, short recovery time and minimal risks. A number of diverse treatment routes are now available, that allow for customized treatment that fits to the patient's personal favorites, body type and body goals. In current years, noninvasive body contouring techniques have developed as an increasingly popular area of cosmetic in the aesthetic cosmetic industry. 2 Laser therapy is a novel noninvasive technique that can lyses excess fat without the adverse side effects related to surgical procedures like liposuction. [3][4][5][6][7] This technology can also be used to tighten the skin. 8 The use of lasers in the unwanted fat reduction was reported in the early 1990s. 9 In a split study, patients treated with standard liposuction on one side of the body and laser-assisted liposuction on the contralateral side and they reported that their results did not show a statistically significant difference between the two sides. 9 The usage of lasers for adipose tissue removal has been noticed in recent years with reports of low-level laser device. 10,11 In recent study we evaluated the efficacy of Endolift laser in the reduction of arm and under abdomen fat.

| Study subjects
The study enrolled 10 patients including women and men aged 25-55 years. Reasons for exclusion from participation in this research study comprised; prior cardiac surgery; chronic illness, like cardiovascular disease and diabetes mellitus, cancer, medical conditions that cause weight variations, swelling, or edema; pregnancy, breast feeding, prior surgical procedure for sculpting of the arms or weight loss like mesotherapy for local slimming, the use of fillers for local slimming, use of other devices like cool sculpting, trusculpt, slimming massages, local slimming RF; wounds, active infection, or external trauma in the treated areas; defect in the coagulant system or take anticoagulant drugs, sensitivity to the injectable lidocaine, have not received any slimming or low calorie diets as well as an intense physical activity program, mental or hormonal illness that needs some drugs which cause cellulite and fat tissue in the body.

| Intervention
The 1% lidocaine was used as a common local anesthetic. Patients underwent Endolift laser for one session. Endolift™ (LASEMAR1500TM machine, Eufoton s.r.l.) was used in this research study. The Endolift laser with the power 5-8 Watt, pulse 50-50, and fiber 400-600 μm was performed for each patient. The number of treatment sessions was between one and three sessions depending on the amount of adipose tissue, cellulite, age of the patients and the area of interference. This technique does not need general anesthesia and also recovery time. The patients were followed up for 2 and 3 months after treatment. Blinded dermatologists noted other changes in existing skin condition like, cellulite, and skin elasticity and quality following treatment.

| Ethics and study assessments
All study assessments were done at baseline, and 2 and 3 months after treatment. In addition, digital images of the treated areas were taken before and 3 months after treatment. The adverse effect for each subject were documented daily.

| Statistical analyses
The data were analyzed by SPSS program version 22.0. Data were summarized using mean ± SD (standard deviation). The obtained results were analyzed by t-test and analysis of variance (ANOVA). A value of p < 0.05 was considered statistically significant.

| Arm and under abdomen circumference
Among the patients undergoing Endolift treatment, 7 (70%) achieved a ≥1.5 cm decrease in arm circumference and 8 (80%) ≥2 cm in under abdomen circumference at the 2 months post-treatment assessment (p < 0.01) (Figures 1 and 2). The treated patients (80%) showed a 2 cm reduction in arm circumference and a 3 cm reduction in the under abdomen circumference 3 months after the Endolift laser procedure (for each, p < 0.01) (Figures 1 and 2). There was a significant decrease in arms circumference between baseline and 2 months (p < 0.01) and between 2 and 3 months after treatment (p < 0.01) ( Figure 1). Similarly, for the under abdomen, there was a significant reduction in circumference between baseline and 2 months and between 2 and 3 months after treatment (p < 0.01) (Figure 2).

| Subject satisfaction and physician assessments
The subjective measurements showed that a significantly greater number of patients were well satisfied with their results for arm (N = 7 after 2 months (Table 1 and Figure 3) and N = 8 after 3 months (Table 1 and Figure 3; p < 0.05)) and under abdomen (N = 7 after 2 months (Table 2 and Figure 4) and N = 8 after 3 months (p < 0.05; Table 2 and Figure 4)) and believed that the acceptable effects of the Endolift laser procedure met their expectations. The patients did not report any adverse side effects. Also physician satisfaction is shown in the Table 3. As shown in the table, after treatment a significant difference in satisfaction was observed (p < 0.05).

| DISCUSS ION
In this study Endolift laser was used for arm and under abdomen fat reduction. The results of this study showed acceptable efficacy F I G U R E 1 Arm circumference was significantly decrease 2 and 3 months after treatment. *p < 0.01.

F I G U R E 2
Under abdomen circumference was significantly decrease 2 and 3 months after treatment. *p < 0.01.

Valid
Frequency Percent  6 In other study the efficacy of noninvasive 1060 nm diode laser was evaluated for abdomen fat and they informed 1060 nm based laser treatment is effective and safe procedure for reduction of the fat contour in the abdomen. 16 Recently Endolift laser was used to treat several skin disorders. [26][27][28][29] Also Endolift laser was used for jowl fat reduction. 30 Histologically, coagulation of small vessel and adipocyte rupture were obvious after laser treatment. Also, degeneration of collagen and reformation of the reticular dermis were seen. 31

| CON CLUS ION
Endolift laser was significantly effective for reduction of arm and under abdomen fat reduction.
Patient assessments were significantly positive. This technique does not need general anesthesia and recovery time. No adverse effects were reported by any patient during the study.

| S TU DY LI M ITATI O N
The small cohort can be considered as limitation of this study. Our future consideration is the further research with larger sample size.

AUTH O R CO NTR I B UTI O N S
MAN and TF, EB, MS, NNN and SR performed the research. MAN designed the research study. MH-K and NNN collected the data.

ACK N OWLED G M ENTS
We appreciatively acknowledge the colleagues and staffs in Skin and

DATA AVA I L A B I L I T Y S TAT E M E N T
The data that support the findings of this study are available from the corresponding author upon reasonable request.

E TH I C S S TATEM ENT
All patients were provided with a complete explanation of the study purpose, design, and possible results and informed consent was gained from all the patients.

F I G U R E 4
Significantly more subjects were satisfied with their results in under abdomen fat reduction after Endolift laser therapy. None of the treated subjects indicated any level of dissatisfaction. *p < 0.05.

TA B L E 3
Physician assessment after treatment. The data were shown as Mean ± SD.