دکتر شهریار پیرانی

پوست و مو


هایفوتراپی

آموزش

لاغری موضعی باکرایو لیپو

تغذ یه ورژیم درمانی

SKIN CARE

فرم دهی باسن

( PRP ) سلول درمانی یا مزوت

لاغری موضعی

لاغری و تناسب اندام

کاهش سایز و تناسب اندام :
ایده آل ترین روش تناسب اندام ورزش مداوم و رعایت الگوی تغذیه صحیح است . هنگامی که این توازن به هم بخورد افزایش وزن ایجاد می شود . با ورزش و تغذیه می توان تا حدودی این معضل را برطرف کرد ، ولی چاقی موضعی را فقط با روش های جراحی یا غیر جراحی می توان از بین برد . در روش های غیر جراحی ، مزوتراپی کلاسیک و لیزر کم توان با طول موج مشخص طرفداران خاص خود را دارد . در مزوتراپی استفاده از داروهای معتبر و میزان ترکیب آنها مهم است . در خانم هایی که در دوران شیردهی به سر می برند و از چاقی موضعی در رنج هستند LLLT یا همان لیزر کم توان تنها روش موثر و بدون عارضه است . از مزایای LLLT می توان به صرف هزینه پایین ، بی نیازی به اتاق عمل و جراحی و بدون عا رضه بودن آن اشاره کرد به علت طولانی بودن دوره درمان ، صبر و حوصله از ارکان اصلی این روش درمانی است .

پک لاغری که در این مرکز ارائه می شود ، می تواند تلفیقی از مزوتراپی ، لیزر ، ماساژ جلبک و نمکهای دریایی ، Grascontrol و یا هر کدام از این روشها به تنهایی می باشد.
“ لاغری را با لیزر لیپولیز LAPEX 2000 تجربه کنید “

این سیستم تنها دستگاهی است که از صفحات پارویی شکل برای نفوذ پرتوهای لیزر به چربی زیر پوست استفاده می کند . وقتی صفحات دستگاه روی پوست قرار می گیرد نور لیزر به صورت تخم مرغی به زیر پوست نفوذ کرده و این اثر بخشی را بیشتر می کند . آنچه این سیستم را منحصر به فرد کرده وجود قسمت محرک سیستم لنفاوی است که در نتیجه و اثربخشی درمان فوق العاده مهم است ، مزیت مهم این دستگاه لیفت همزمان پوست با لیزر کردن چربی است . این دستگاه جزو لیزرهای کم توان می باشد که دارای FDA ,CE , Health Canada , sante Canada می باشد .
صفحات دستگاه را می توان به طور دلخواه تنظیم کرد و در اندامهایی مانند باسن ، غیغب و بازو تغییر شکل و فرم دهی ایده آل را ایجاد نمود .

دستگاه را می توان برای غبغب ، پشت ، بازو ، شکم ، ران ، باسن ، قفسه سینه و غیره استفاده کرد . از آنجایی که می توان سیستم را برای نواحی که چربی دارند مستقیما استفاده کرد نتیجه به صورت محسوس توسط بیمار مشاهده می گردد .
وضعیت تابش پرتو لیزر به چربیهای زیر پوست در این دستگاه در مقایسه با انواع مشابه به صورتی است که عمق نفوذ لیزر به دلیل شکل تابش آن عمقی تر و موثرتر است .
- چرا این تکنیک لیزر کم توان نامیده شده است ؟ چون انرژی این لیزر کمتر از لیزرهای است که برای سایر موارد مانند رفع موهای زائد ، جراجی های چشم ، درمان عروق و .... به کار میرود .

- وقتی لیزر به سلولهای چربی برخورد می کند چه موادی تولید می شود ؟ آب ، گلیسرول و اسیدهای چرب .
- آیا در طول درمان حرارت ایجاد می شود ؟ خیر ، این لیزر در سطح سلولی عمل می کند و هیچگونه لرزش ، حرارت و یا صدا ایجاد نمی کند .
- اسیدهای چرب آزاد و گلیسرول چه چیزهایی هستند ؟ اجزای تشکیل دهنده چربیها هستند .
- چه اصولی پس از انجام هر جلسه درمان با این لیزر باید مورد توجه قرار گیرد ؟ استفاده ازدستگاه ویبره جهت کل بدن .
- آیا عوارض جانبی با این روش درمان دیده شده است ؟ خیر ، این دستگاه هیچگونه عوارض جانبی ندارد . باید از تابش نور آن به چشم جلوگیری کرد .
- با اینکه بعد از 6 دقیقه چربیها شکسته می شوند چرا باید تابش لیزر تا 10 دقیقه ادامه یابد ؟ چون ممکن است بعد از 6 دقیقه بعضی از اسیدهای چرب به هم متصل شده و تری گلسیرید ایجاد کنند ولی ادامه تابش تا 10 دقیقه مانع از این حالت می شود .

- آیا این روش اساس علمی دارد ؟ بله ، سالهاست که تاثیرات لیزر کم توان به صورت علمی طی آزمایشات متعدد اثبات و ثبت شده است .
- چه مقدار چربی طی یک درمان استاندارد با این دستگاه آزاد می شود ؟ در هر جلسه درمان استاندارد حدود 60 40 گرم
- در چه مواردی نباید از این روش استفاده کرد ؟ در مواردی چون حاملگی ، صرع ،اختلالات غده تیروئید ، ، سرطان ، بیماریهای قلبی و آریتمی و یا وجود pacemaker ، توصیه نمی گردد .
- اسیدهای چرب آزاد کجا می روند ؟ زمانیکه اسیدهای چرب از سلول خارج می شوند به فضای بین بافتی وارد شده و جذب سیستم لنفاوی می گردند ، آنها وارد عروق لنفاوی شده اسید بین متصل شده به داخل گره های لنفاوی جذب می شوند و از طریق سیستم گردش خون به کبد می رسد تا در آنجا به قند تبدیل و به عنوان منبع انرژی بدن مورد استفاده قرار گیرد .

در کبد مقداری از اسیدهای چرب به تری گلیسرید تبدیل شده به خون می روند . سرعت انتقال اسیدهای چرب و پاک نشدن آنها ازدرمان خون سریع و حدود 2.5 1.5 دقیقه است . ترکیب اسیدهای چرب با اکسیژن و سوختن آنها انرژی تولید می کند پس از آزاد شدن اسیدهای چرب از سلولهای چربی می تواند به عنوان سوخت و انرژی بدن مورد توجه قرارگیرد . آخرین مقصد اسیدهای چرب میتو کندریهای سلولهایی است که به انرژی نیاز نیاز دارند .
- گلیسرول کجا میرود ؟ گلیسرول آزاد سریع به جریان خون وارد شده و رقیق می شود . گلیسرول به طور گسترده از جریان خون به داخل مایعات بدن انتشار پیدا کرده و ادرار ظاهر می شود سرعت انتقال آن از این شرایط 30 دقیقه است . همچنین مانند بخشی از اسیدهای چرب آزاد ، مقداری از گلیسرول هم در کبد به صورت منبع مفیدی از انزژی وارد و مصرف می شود .

راهنمایی هایی جهت قبل و بعد از هر جلسه درمانی :
قبل از درمان : رژیم غذایی و ورزش بخشهای مهمی ازموفقیت در درمان هستند ، حتی الامکان چربیهای شکسته شده باید مورد استفاده بدن برای سوخت انرژی قرار گیرد نه چربی مواد غذایی .
طی درمان : درهر جلسه 60 40 گرم چربی معادل 500 400 کالری آزاد می شود . بیماران باید رژیم کم کالری و کم چربی داشته باشند البته این دستگاه یک سیستم کاهش وزن نیست . وزن مطلوب خود را ( به پوند ) در عدد 10 ضرب کرده مقدار کالری مورد لزوم درهر روز به دست می آید . مثال یک فرد 75 کیلوگرمی : cal 75kg ====== 165 (pond) * 10 = 1650 مقدار مصرف کالری این فرد از 1650 کالری در روز نباید بیشتر شود .
استفاده از دستگاه ویبراتور به مدت 10 دقیقه بعد از درمان نیز توصیه می گردد .
تغییر رویه زندگی از قبیل رژیم غذایی و ورزش و مصرف آب و خواب کافی توصیه می گردد .
حداقل خواب لازم از 24 ساعت مدت 7 ساعت است .

توصیه های لازم : حداقل 3 جلسه در هفته به مدت 3 هفته در جلسه 40 دقیقه و یا 10 دقیقه به ازای هر صفحه مصرف آب کافی پس از هر جلسه درمانی و مصرف مقدار حداقل کالری لازم .
تحریک سیستم لنفاوی جهت جذب چربی و دفع آن توسط دستگاه ویبراتور ، سونا مادون قرمز و ورزش به مدت 10 دقیقه پس از هر جلسه به مدت 2 ساعت قبل و پس از درمان غذایی مصرف نشود .
این دستگاه مورد تائید انجمن جراحی چاقی ( OBESITY SURGERY ) است ، که به پیوست ذیل می باشد .

Obesity Surgery

The Journal of Metabolic Surgery and Allied Care
Cite this as: Obesity Surgery, 2009 Pending Publication
Efficacy of Low Level Laser Therapy for Body Contouring and Spot Fat Reduction
Mary K. Caruso-Davis* ,Thomas S. Guillot** ,Vinod K. Podichetty† , Nazar Mashtalir***, Nikhil V. Dhurandhar***,
Olga Dubuisson***, Ying Yu***, Frank L. Greenway***
*School of Human Ecology, Louisiana State University, Baton Rouge, LA, **Plastic and Reconstructive Surgery, Baton Rouge, LA, †Research Practice Partners, Miramar, FL, ***Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA
ABSTRACT
Background Low level laser therapy (LLLT) is commonly used in medical applications, but scientific studies of its efficacy and the mechanism by which it causes loss of fat from fat cells for body contouring are lacking. This study examined the effectiveness and mechanism by which 635-680nm LLLT acts as a non-invasive body contouring intervention method.
Methods Forty healthy men and women ages 18-65 years with a BMI <30 kg/m2 were randomized 1:1 to laser or control treatment. Subject’s waistlines were treated 30 minutes twice a week for 4 weeks. Standardized waist circumference measurements and photographs were taken before and after treatments 1, 3, and 8. Subjects were asked not to change theirdiet or exercise habits. In-vitro assays were conducted to determine cell lysis glycerol and triglyceride release.
Results Data were analyzed for those with body weight fluctuations within 1.5 kg during 4 weeks of the study. Each treatment gave a 0.4-0.5 cm loss in waist girth. Cumulative girth loss after 4 weeks was -2.15 cm (-0.78+2.82 vs. 1.35+2.64 cm for the control group, p<0.05). A blinded evaluation of standardized pictures showed statistically significant cosmetic improvement after 4 weeks of laser treatment. In vitro studies suggested that laser treatment increases fat loss from adipocytes by release of triglycerides, without inducing lipolysis or cell lysis.
Conclusions LLLT achieved safe and significant girth loss sustained over repeated treatments and cumulative over 4 weeks of 8 treatments. The girth loss from the waist gave clinically and statistically significant cosmetic improvement.
Laser based devices are used in a broad array of medical and surgical applications and their biological effects have been documented for over 20 years. More recently low level laser (LLL) devices have been used to facilitate tissue repair and healing processes. Although physiological methods responsible for augmented cell proliferation and pain relief are unknown, well-controlled clinical trials have demonstrated that low level lasers provide therapeutic relief of pain. Low level laser therapy is defined as management with a dose rate that causes no immediate demonstrable temperature rise of the treated tissue and no macroscopically visible change in tissue structure [1]. The dosage is a magnitude used to define the laser beam energy applied to a particular area of the body tissue measured in joules per square centimeter. The Meridian LAPEX 2000 LipoLaser System is a semi-conductor-based, low level laser therapy device (LLLD). The LAPEX 2000 LipoLaser was originally developed and approved for the treatment of pain due to carpel tunnel syndrome. The LAPEX 2000 LipoLaser has been modified and is now being rigorously evaluated for its effectiveness in reducing areas of local fat accumulation for cosmetic purposes. The LAPEX 2000 LipoLaser emits light at 635-680 nm. It is non-thermal and does not heat the tissues. As such, it is considered to be a non-invasive treatment.
Neira et al [2] evaluated the effect of a 635-680 nm, 10-mW diode laser radiation with exclusive energy optics on treated fat cells in biopsy specimens. Fat cells were treated in vivo with 1.2-3.6 J/cm2 of energy from the laser for 2 to 6 minutes. The cells were then removed by
lipectomy, examined by electron microscopy and compared to cells removed by lipectomy that were not treated with the laser. Fat cells that were not exposed to the laser treatment looked like round grapes. Eighty percent of the fat was released from the fat cells after 4 minutes of laser light exposure and 99% was released after 6 minutes of exposure. After exposure to the laser light, pores in fat cells were visible by scanning electron microscope. It was presumed, but not demonstrated, that the fat was released from these pores, taken up in the lymphatics and reesterified in other tissues or metabolized for energy [2].
Several studies have recognized that LLL accelerates repair processes, stimulates cell proliferation and promotes vascularization in injured tissues [3-8]. However, clinical application to body fat reduction as a minimally invasive option is an evolving field which is not well studied. We conducted a blinded clinical trial to describe the application of low level laser therapy to local fat reduction for cosmetic purposes. As a secondary objective we also investigated the mechanism by which the laser causes fat loss from fat cells

Methods
Clinical Trial
Forty healthy men and women between the ages of 18-65 years, inclusive and body mass index (BMI) no greater than 29.9 kg/m2were randomized in a 1:1 ratio to an experimental laser treatment or to a control laser treatment. Randomization was created from random number tables and the treatment codes were stored in sealed envelopes during the study. Subjects could not be using light sensitizing agents or diuretics, or undergoing photodynamic therapy. Subjects were required to have a stable weight, gaining or losing no more than 2.5 kg in the 6 months prior to the trial. Subjects could not be on a weight reduction regimen, and they were asked not to change their diet or exercise habits during the trial. This study was performed in accordance with the Declaration of Helsinki, and approved by the Argus Institutional Review Board. Written informed consent was obtained from all participants prior to study participation.
The laser therapy device consisted of a console housing most electronics, the controls for the device and two multi-probes that housed four lasers emitting visible laser light at a wavelength of 635-680 nm. Each subject had 2 treatments per week for a total of 8 treatments over 4 weeks. Each treatment session lasted approximately 30 minutes. The two multiprobes were placed over the waist bilaterally in three positions as well as two enhancement probes that were placed to both sides of the inguinal region and the laser was activated for 10 minutes in each of these positions to encompass the waist from the back to the front. The control arm of the trial utilized the device, but the multi probes of the device were inactivated during the treatment session.
Two individuals conducted the study. One administered the treatment, and the other, who was blinded to treatment allocation, obtained measurements and photographs. The individual administering the treatment remained blinded to photographic and girth measurements. Each subject was advised about the rules of blinding, and the individual taking photographs and measurements could not relay this information to the subject. The individual administering the treatment did not enter the room where the photographs and measurements were obtained. A case report form was used for each measurement session and these forms were placed in a sealed envelope until data was analyzed at the end of the study. Two separate people who were not involved in other aspects of the study did the blinded evaluations of the photographs.
All subjects had photographs taken at a standardized distance with a standard background and lighting. Girth measurements of the waist were obtained in the manner recommended by the United States National Institutes of Health (NIH) guidance at the iliac crest using a tape measure with standardized tension and oriented parallel to the floor [9]. A reference point on the body for the pictures and measurements was relocated at each evaluation by measuring a distance from the floor that was determined in the first measurement at baseline. The specified measured distance was used to ensure all measurements and photographs were obtained in the same location. The camera was placed on a tripod at a fixed distance from the floor, but was adjusted to the specific height of each individual participant. Standardized waist measurements were taken at baseline, treatment 3, and treatment 8. Standardized photographs were taken before and after the initial treatment, treatment 3, and treatment 8. Weight was measured and BMI calculated at baseline and at treatment 8 (week 4). Blood pressure was measured at baseline, treatment 3, and treatment 8. All adverse events were recorded in the case report forms
Statistics
The waist circumference measurements were compared between the control and laser treated group using a t-test. The data were analyzed using completers and the more conservative intent to treat analysis. The blinded observers judged improvement on a 0-3 scale. Zero on this qualitative scale represented no improvement, 1 represented mild improvement, 2 represented moderate improvement and 3 represented marked improvement. The results ofthe two observers were averaged and compared by t-test.
In vitro studies using human fat cells
Experiment 1
Human adipose derived stem cells obtained from subcutaneous fat during abdominal surgery were plated and differentiated to form adipocytes as described by Bunnel et al [10]. Human adipocytes were differentiated in 12-well plates. Three of the wells in the plates were left as a control. Fresh plasma replaced one-third of the cell culture media in another three wells. The next three wells had one-third ofthe media replaced with plasma that was heat-inactivated to destroy complement. The final three wells in each plate had one-third of the media replaced by a combination of fresh human plasma and white blood cells. One experimental plate was irradiated with the LAPEX 2000 LipoLaser for 10 minutes and the other was left as a non-irradiated control. The cells were then evaluated for evidence of lysis under the microscope.
Experiment 2
To evaluate influence of LAPEX 2000 LipoLaser on adipose cell death andviability we used LIVE/DEAD® Cell Viability Assays (Invitrogen). Human adipocytes were differentiated in 96-well plates. The experimental plate was irradiated with the LAPEX 2000 LipoLaser for 10 minutes and the other was left as a non-irradiated control. The cells were then probed with cell viability assay reagent using the manufacturer’s protocol. Calcein and propidium iodide emissions were then analyzed using a fluorescent plate reader. Images were acquired on a Zeiss Axiovert 40 CFL using a 10X (Zeiss Achroplan objective) and a 20X (LD plan NeoFluor objective) and a Zeiss Axiocam HRc camera [11].
Experiment 3
This experiment used human adipocytes in eight 6-well plates. Two wells in each plate were used as a control with media containing 10% fetal bovine serum (FBS). Two other wells had 25% of the media with 10% FBS replaced with human serum with 10% FBS. The last two wells had 25% of the media with 10% FBS replaced with heat inactivated human serum with 10% FBS. Four of the plates were irradiated for 10 minutes with the laser and the other four plates served as a non-irradiated control. Media from the eight replicates of each of the three conditions in the laser irradiated plates and the nonirradiated control plates were used for glycerol and triglyceride determination
Results
Clinical Trial
Forty subjects participated in the clinical trial. Twenty were treated with the LAPEX 2000 LipoLaser and 20 were treated with an inactive version of the device. One subject in the treatment group did not complete the study due to scheduling conflicts. The groups were well balanced at baseline, and the group characteristics are illustrated in Table 1.
Mean weight and BMI did not change significantly over the 8 treatments and 4 weeks. Blood pressure did not change significantly from baseline to treatment 3, from treatment 3 to treatment 8, or from baseline to treatment 8. The mean placebo subtracted reductions in waist girth at treatments 1, 3, and 8 with the LAPEX 2000 LipoLaser were 0.49, 0.41 and 0.40 cm, respectively. This single treatment difference, 0.41 cm (Laser -0.59 + 0.71 cm vs. Placebo -0.19 + 0.47 cm) (mean + SD), was significant (p<0.05) on the third treatment done during week two in the completers analysis, but was not statistically significant by the intent to treat analysis.
The cumulative girth loss at treatment 3 on week 2 was a significant 1.74 cm (Laser -1.89 + 2.97 cm vs. Placebo -0.16 + 2.46 cm) (p<0.05) on both the completers analysis and by intent to treat analysis. Cumulative girth loss at treatment 8 (4 weeks of treatment) was 2.15 cm with 15 subjects in the laser group and 16 subjects in the placebo group (Laser -0.78 + 2.82 cm vs. Placebo 1.35 +2.64 cm) in those who maintained their weight within 1.5 kg of their baseline weight (p<0.05). Cumulative girth loss at treatment 8 (4 weeks of treatment) was 1.33 cm with 19 subjects completing in the placebo group and 20 subjects completing in the laser group (Laser -0.87 + 2.65 cm vs. Placebo 0.47 + 3.19 cm) regardless of weight change (p = NS). The standardized pictures of the participants showed a significant 1.21 difference (Laser 1.21 +0.42 vs. Placebo 0 + 0) in appearance on a 0-3 scale favoring the LAPEX 2000 LipoLaser group comparing baseline to week 4 (treatment 8) pictures (p<0.001).
When only those participants that remained within 1.5 kg of their baseline weight (N = 31) were considered, the improvement in appearance increased to 1.25 (Laser 1.25 + 0.45 vs. Placebo 0 + 0) on a 0-3 scale comparing baseline to week 4 (treatment 8) pictures (p<0.001). The girth difference in the laser group compared to the placebo group is illustrated in Figure 1. The differences in appearance from baseline to week 4 (treatment 8) in the whole group and the subjects who remained within 1.5 kg of their baseline weight are illustrated in Figures 2, 3, and 4.
The fat cells that came into contact with plasma or plasma with white blood cells were lysed in both the laser treated and the control plate, but cells in the control wells or in wells with heat-inactivated plasma were not lysed. This indicates that serum complement does lyse fat cells, but that the laser does not activate complement. This is consistent with the mechanism shown by Niera [2] in which the laser created pores through which the fat leaked from the fat cells into the interstitial space.
Experiment 2:
The number of viable cells in the laser treated or untreated group as determined by the propidium Iodide assay were similar, but calcein levels were lower in the laser treated cells (Figure 5). Calcein, a non-fluorescent dye, gets transported through the cell membrane, becomes fluorescent due to cleavage with cellular esterases and gets trapped intracellularly. Normally functioning cells can extrude the entrapped dye. Considering the equal cell viability in the two groups, lower calcein levels in the laser treated group suggests either intact metabolic functioning of cells and/or reduction of cell-trapped calcein, perhaps by leakage. These findings are also consistent with the studies by Niera [2] in which the laser treated cells showed micropores in the membrane, which presumably contributed to the leakage of fat from those cells.
Table 1. Baseline demographic characteristics of study subjects in the LAPEX 2000 LipoLaser study


آدرس مطب : تهران خ ولی عصر روبروی جام جم کوچه خرسند پ 76 طبقه دوم واحد 6
تلفن : 26201037 - 021

نظرات کاربران درباره این مطلب :

مزده ظریفی [ 1393-02-01 ]
سلام خسته نباشید شما که خودتون متخصص پوست ومو هستید چرا کاشت مو نمی کنید؟

farzaneh shafiee [ 1391-12-27 ]
با سلام و سپاس من کارشناس تغذیه هستم با 10 سال تجربه کاری مفید .مایل به همکاری با مرکز شما هستم. در صورت امکان لطفا پاسخ دهید.

مهربون [ 1391-12-14 ]
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