The Shambulance: Laser Lipo Only Kind of Sucks

The Shambulance is an occasional series in which I try to find the truth behind overhyped or bogus health products. With me at the reins are Steven Swoap and Daniel Lynch, both of Williams College.

People selling no-suction liposuction are not totally sure what they're offering you. "Low levels of visible red laser light...create a safe and painless bio-stimulation effect," says one center. "Transitory pores" open in the fat cells, sending their contents out for "detoxification," says another, adding that the process is "almost exactly the same as exercise." Except for the lasers.

Despite the confusion, laser lipo does—seemingly, in some ways—work. Wait! Don't panic. Put away your wallet and let's talk about it.

"This is not a weight loss therapy," says Williams College physiologist Steven Swoap. At best, it's "a redistribution of fat therapy."

Many spas offer treatment with a specific laser system called i-lipo. The FDA approved this device in 2012 "for non-invasive aesthetic treatment for the temporary reduction in circumference of the waist."

It's "non-invasive" as opposed to something called laser-assisted liposuction, where doctors blast your fat with a laser before actually cutting into you and sucking it out. What about the rest? "Aesthetic" is because this is meant to change your looks—not to address any health problems. "Temporary," because the FDA based their approval on a study lasting just a few weeks. If you want your new waist shape to last longer, they're not making any promises. And, of course, "reduction in circumference"—but not loss of weight. Something inside you may move around, but that doesn't mean it's going away.

FDA approval was based on a placebo-controlled study in which some participants had a fake laser treatment. After eight sessions over three to four weeks—each session followed by a required workout—the group getting real laser treatment had lost almost an inch and a half more from their waists than the placebo group. (If anybody finds this study itself, and not just a PR summary, I'd love to see it.)

As for how it works, the FDA approval statement says that laser energy "promotes disruption" of fat cells, making them release their contents. But a 2013 review paper says that "the mechanism of action of LLLT [low-level laser therapy] on fat remains somewhat controversial." Various scientists have suggested that the laser makes tiny pores open in the fat cells to release fats; that the cells themselves are destroyed; or that the laser stimulates your cells' machinery to start breaking down fats and discarding their components. There are challenges to the evidence in every camp.

"The use of lasers to essentially heat the fat seems a bit dubious," says Williams College biochemist Daniel Lynch. He's curious whether the results could really be coming from changes in water and salt balance in heated areas of the body. "I wonder if similar effects could be obtained simply [with] heating pads," he adds. Actually, the so-called infrared body wraps offered by some spas aren't far off—these places wrap clients in heated pads and report inches lost after all the squishing and sweating is over.

Assuming that the procedure does kick fat out of your cells, many spas recommend that you exercise immediately afterward. You need to burn up that wandering fat right away, they warn, or else it will just find its way home to your belly.

Lynch agrees that mild exercise afterward would help you use up any fats that the laser has shaken loose. Swoap points out that when we do tougher exercise, our bodies switch to using carbs as fuel instead of fats—so an intense workout right after laser treatment would be less helpful than a tame one. Either way, if fatty acids travel to your liver, it will likely send them right back into storage in your body's squishy areas.

Even if you manage to lose fat from your midsection, you may not be doing yourself any favors in the long term. "Certain types and locations of fat are beneficial, whereas others are harmful," Swoap says. The fat that's reachable by liposuction—laser or traditional—is "subcutaneous" fat, just under your skin. "Subcutaneous fat is a good fat—[it provides] insulation, cushioning, even endocrine function," Swoap says.

"Liposuction is, unfortunately, removing mainly subcutaneous 'good fat' in the name of body sculpting and body image," Lynch agrees.

The fat that's harmful to your health is "visceral" fat, the stuff wrapped around your organs. And if you suck out subcutaneous fat, your body may respond by hiding more fat where you can't reach it.

A 2011 study found that one year after surgical liposuction in their thighs and bellies, women had regained their lost fat—and stored more of it into their abdomens than originally. In 2012, a different research group found that six months after abdominal lipo, women's visceral fat had increased by 10%. This was prevented if they followed an exercise program.

So laser lipo may shrink your waist a little, if you exercise every time you do it. And fat removed surgically might not reappear to strangle your organs, as long as you keep exercising after liposuction. There's no word yet on whether laser lipo can also lead to more visceral fat, but to be safe you might just want to keep working out after it's done.

Maybe the people who called this treatment "almost exactly like exercise" were closer than they knew.


Image: NU:U Laser Lipo Centers