Q: I read an article by you on non-surgical fat reduction and understand from your writings that you have one of Erchonia’s Zerona cold laser devices. I was wondering if you have had any experience or success with reducing large lipomas?
A: Your question represents a common and understandable misconception about lasers in general and the Zerona device in particular. Almost everyone envisions a laser as a device which shoots a beam which melts, explodes or destroys the target. This would be a high energy focused ‘hot’ laser and is the most typical laser concept that is employed around the world. The Zerona device, however, is a ‘cold’ laser meaning it does not shoot high energy beams toward its target. Rather it is a very low energy photochemical light which causes a reaction that has a much different effect on the targeted fat cells. It passes through the skin, without injury or discomfort, and causes the fat cells to become temporarily ‘leaky’. This releases some fat and, if done enough times, the fat volume in the targeted area will decrease in size.
Because of the way the cold laser works, its effect will not have any impact on the concentrated tumor fat of a lipoma. It simply is the wrong type of laser energy.
There is a laser method for lipoma treatment that does use a hot focused laser. Under local anesthesia, the fiberoptic probe of the Smartlipo (laser liposuction) machine can be introduced into the lipoma and activated for a few seconds. This melts the center of the lipoma and can definitely shrink its size and/or destroy it completely. This does require a tiny little incision into the skin to pass the probe through so it is a minimally invasive approach but would not properly be called a non-invasive procedure.
Dr. Barry Eppley
The desire for fat reduction is a near universal one that crosses all age, gender and ethnic lines. From the countless number of diet and exercise approaches to the opposite choice of liposuction surgery, loss of body fat can be successfully done with varying degrees of individual effort. But between these two ends of the fat loss spectrum lies the developing field of non-invasive body contouring. The concept of losing fat without surgery through an external device is both appealing and promising.
External ‘machine-driven’ methods for fat reduction are not new. Whether it was the belt-driven shaking machines from the first half of the last century to sitting in a sauna box and sweating it off, letting something else do the work and hopefully losing weight will always catch the public’s attention. Taking a pill, of course, is the simplest and requires the least amount of effort. But you probably didn’t get overweight or develop those few fat areas by taking pills, so it seems unrealistic that you can lose this fat by pills alone. While science and technology has come a long way, does today’s non-invasive body contouring devices really work…or are they just a modern-day version of the old ‘shaking machine’?
The newest technology for non-surgical body contouring is Zerona. This is an external cold laser that helps make fat cells leaky and loss some of their lipid contents. While people think of a laser as being a focused beam of light that hits a target and causes it to vaporize or melt, cold laser technology is different. It can pass through the skin without injuring it and penetrate up to 5 cms (2 inches) in depth. This can reach localized fat and exert its photochemical effect. The concept of photochemical-induced leakiness of fat cells is a bit hard to grasp but its physics are a little similar to the way cell phones actually work. I have a hard time wrapping my mind around cell phone technology to understand how all these messages and images are flying around and get to their intended recipients….even when I am on an elevator or a plane. But despite my ignorance I have plenty of evidence every day that it does work. So I won’t hold it against photochemical-induced fat loss simply because I don’t completely understand the science behind it.
The effects of Zerona on fat is very short-lived so multiple treatments are needed, spaced but a few days apart. Over a course of several weeks and multiple treatments, many patients have been shown to lose several inches around the waist, hips and thighs. But along with the treatments it is advised to drink water and take a niacin supplement to support the lymphatic clearance of the released fat. Herein lies the important difference from today’s technology and yesterday’s devices of hope…the use of some modest lifestyle changes and good patient selection.
Non-invasive body contouring is not a substitute for what liposuction can achieve or for the large amounts of weight loss that occur from bariatric surgery. Rather it is intended to benefit those who have some stubborn areas of fat that are just not responsive to what you can do at home with your best efforts. And for those who do not feel they have enough of a fat problem to justify surgery or want to do anything to try and avoid that solution. By using these criteria, most patients that use Zerona have more modest fat collections. This size of the problem and the modest lifestyle changes that are part of the program account for the generalized success and satisfaction that occurs from this non-invasive body contouring device.
Dr. Barry Eppley
Q: I had breast reduction surgery last year and , while those results were great, my stomach area is now the problem. What is the best way to get rid of some (or a lot of!) stomach fat? I have read about Zerona. Is it better than liposuction or does it just depend on the person?
A: It is not uncommon after breast reduction that one notices that they now have ( or have had) a larger stomach than they knew. Since the breasts hung down on the stomach, the size of the stomach is usually obscured. After breast reduction, where the breasts are lifted and reduced, these ‘new’ stomach problem appears.
While fat reduction can be done both surgically (liposuction) and non-surgically (Zerona), the results and the process are not the same. Do not equate Zerona and liposuction as providing the same results. Liposuction is a much more effective and rapid way of eliminating unwanted fat, albeit with surgery. Zerona is best considered as a non-surgical step before one considers liposuction. In the right patient (5 to 20 lbs overweight), Zerona may provide enough of a result that liposuction may never be needed. In larger fat collections, liposuction may ultimately be needed.
Therefore, patient selection is critical when deciding what approach to take for abdominal fat reduction. For small to modest abdominal fat fullness, Zerona is probably worthwhile as enough of a result can usually be obtained without surgery. But if you have a large abdominal girth or any excess overhanging abdominal skin, some form of surgery will be more effective whether it is liposuction, a tummy tuck or some combination thereof.
Dr. Barry Eppley
Q: Can you tell me how the Zerona laser is supposed to remove fat. When I think of a laser it seems to be that it is hot and would burn the skin before it ever got to the fat underneath. I am interested in it to help me reduce my lower tummy, back and thighs. I just can’t bring myself to have liposuction as that seems too invasive and painful. I like the idea of not having surgery and not having to recover and less money is good too! but I want to know it is safe and won’t hurt me in anyway.
A: The type of laser that is used in Zerona treatments is not a ‘hot’ laser. It is a low frequency laser which makes it ‘cold’. It passes through the skin without injuring it. It can not cause a burn injury. It has a photochemical effect on the fat cells which makes them temporarily leaky. By being leaky, they ooze out some of their fatty acid content. This leakiness is only very temporary which is why treatments are needed every few days to keep them open for a period of time. Once the free fatty acids are out of the fat cells, they enter what is known as the interstitial space. In this space they are transported to the liver where they are broken down and eliminated. This is the process of fat reduction and elimination.
It is important to remember that Zerona is not a substitute for liposuction and it is a program, not just a machine. Other components of the program include water intake, niacin supplements and exercise. These help the effects of the laser treatments to be more pronounced.
Dr. Barry Eppley
Q: I have always been bothered by these fat collections on the lower part of my stomach and around into my back. Despite working out regularly and really focusing on these araes, I have been unable to lose them. Several years ago I tried fat-dissolving injections (I can’t remember their name) but they were very painful so I never did it more than one time. I have been hearing about the Zerona laser and it seems that these fat treatments do not cause any pain or swelling afterwards. This sounds almost too good to be true. Do you think as a plastic surgeon that it really works?
A: Zerona is the newest and most popular method of non-invasive fat removal. Using cold laser technology, it has the ability to pass through the skin and disrupt the membranes of the fats cells. This causes release of fat when the cell membranes breaks open. This released fat is absorbed and eliminated through the lympatic system. This is proven science and is significant enough that its clinical data passed through and was approved by the FDA. Through the concomitant use of exercise, increased water intake, and oral supplements, the effects of the laser are enhanced.
Is Zer0na a replacement for liposuction….no. It is effective but not that dramatically effective and effiicient as actual surgery. I think it is a proven method that for the right patient can be very effective at making visible fat reduction. Its success is patient-specific and better results are undoubtably obtained when the patient follows all of the adjunctive recommendations.
Dr. Barry Eppley