what is liposuction?


“Lipo” (from the Greek “lipos) means fat. And liposuction is a cosmetic surgical procedure by which excess fat is broken down and sucked out from under the skin. ​​Liposuction can be used to target fat under the chin, neck, cheeks, upper arms, breasts, abdomen, buttocks, hips, thighs, knees, calves, and ankle areas.

When performed by our expert plastic surgeons, liposuction can help reshape your contours – body and face. While it is certainly not a shortcut to drastic and instant weight loss, It eliminates those stubborn pockets of fat and restores youthful definition where it matters most: your midsection, thighs, flanks, and arms.

what is liposuction?


“Lipo” (from the Greek “lipos) means fat. And liposuction is a cosmetic surgical procedure by which excess fat is broken down and sucked out from under the skin. ​​Liposuction can be used to target fat under the chin, neck, cheeks, upper arms, breasts, abdomen, buttocks, hips, thighs, knees, calves, and ankle areas.

When performed by our expert plastic surgeons, liposuction can help reshape your contours – body and face. While it is certainly not a shortcut to drastic and instant weight loss, It eliminates those stubborn pockets of fat and restores youthful definition where it matters most: your midsection, thighs, flanks, and arms.

what is liposuction?


“Lipo” (from the Greek “lipos) means fat. And liposuction is a cosmetic surgical procedure by which excess fat is broken down and sucked out from under the skin. ​​Liposuction can be used to target fat under the chin, neck, cheeks, upper arms, breasts, abdomen, buttocks, hips, thighs, knees, calves, and ankle areas.

When performed by our expert plastic surgeons, liposuction can help reshape your contours – body and face. While it is certainly not a shortcut to drastic and instant weight loss, It eliminates those stubborn pockets of fat and restores youthful definition where it matters most: your midsection, thighs, flanks, and arms.

what is liposuction?


“Lipo” (from the Greek “lipos) means fat. And liposuction is a cosmetic surgical procedure by which excess fat is broken down and sucked out from under the skin. ​​Liposuction can be used to target fat under the chin, neck, cheeks, upper arms, breasts, abdomen, buttocks, hips, thighs, knees, calves, and ankle areas.

When performed by our expert plastic surgeons, liposuction can help reshape your contours – body and face. While it is certainly not a shortcut to drastic and instant weight loss, It eliminates those stubborn pockets of fat and restores youthful definition where it matters most: your midsection, thighs, flanks, and arms.

what is liposuction?


“Lipo” (from the Greek “lipos) means fat. And liposuction is a cosmetic surgical procedure by which excess fat is broken down and sucked out from under the skin. ​​Liposuction can be used to target fat under the chin, neck, cheeks, upper arms, breasts, abdomen, buttocks, hips, thighs, knees, calves, and ankle areas.

When performed by our expert plastic surgeons, liposuction can help reshape your contours – body and face. While it is certainly not a shortcut to drastic and instant weight loss, It eliminates those stubborn pockets of fat and restores youthful definition where it matters most: your midsection, thighs, flanks, and arms.

what is liposuction?


“Lipo” (from the Greek “lipos) means fat. And liposuction is a cosmetic surgical procedure by which excess fat is broken down and sucked out from under the skin. ​​Liposuction can be used to target fat under the chin, neck, cheeks, upper arms, breasts, abdomen, buttocks, hips, thighs, knees, calves, and ankle areas.

When performed by our expert plastic surgeons, liposuction can help reshape your contours – body and face. While it is certainly not a shortcut to drastic and instant weight loss, It eliminates those stubborn pockets of fat and restores youthful definition where it matters most: your midsection, thighs, flanks, and arms.


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January 10, 2022

All You Need To Know About Breast Surgery

Are you considering breast surgery? If so, there are some things you need to know. Breast surgery is a big decision, and it’s important to make sure you’re informed about all of your options. This blog post will give you an overview of breast surgery, including the different types of procedures and the risks involved. So if you’re curious about breast surgery, keep reading! You’ll find out everything you need to know.

What is Breast Surgery?

Breast surgery is any procedure where tissue is removed or repositioned for medical reasons, including breast reconstruction following mastectomy. A healthy person doesn’t need to undergo breast surgery unless he or she has a problem with the chest wall, but anybody who needs it should find out more about each of their options before moving forward.

Breast surgery is usually done to remove cancerous tissue, but it can be used for cosmetic or reconstruction purposes as well. Breast surgery doesn’t just involve the breasts themselves; in some cases, the surrounding lymph nodes may also need to be removed.

Types of Breast Surgery

There are three types of breast surgery:

  • Mastectomy
  • Lumpectomy
  • Partial mastectomy

Mastectomy

A mastectomy is a surgery to remove all of the milk-producing glands (mammary glands) in both breasts. It can be done either with or without lumpectomy (surgery that removes only the lump).

Lumpectomy

A lumpectomy is a surgery that removes only the cancerous lump in one breast. It may be done instead of mastectomy if there are no signs of lymph node involvement, or it can take place after mastectomy in cases where cancer remains present in the breast tissue.

Partial Mastectomy

A partial mastectomy is a surgery that removes only part of the breast, along with lymph nodes in the armpit area. The other milk-producing glands are left intact. It’s sometimes done instead of lumpectomy or mastectomy if cancer is found near or around the nipple, to avoid damaging the nipple and areola.

Breast surgery can be used to treat breast cancer, but it can also be used to address cosmetic concerns. If you’re experiencing pain, swelling, or other issues with your breasts for cosmetic reasons (rather than medical), surgery may be able to help. Breast augmentation and breast reduction are the most common types of cosmetic breast surgery; both procedures remove fat tissue from different areas of the body to achieve a certain size and shape.

Surgery to correct inverted nipples is also done for cosmetic purposes; this operation leaves scars around the nipple so it can stick out through clothing and bras.

Breast Reconstruction, Breast Augmentation, and Breast Reduction

If you are considering breast surgery, are you also thinking about getting breast reconstruction or augmentation? Some experts say that the decision to get implants should be made along with the decision to get surgery. There are different types of procedures for breast augmentation and breast reconstruction, so it’s important to know what each entails in order to make your choice! Let’s explore these options more in-depth.

Breast Reconstruction

Breast reconstruction is a breast surgical procedure that restores the breast to its natural breast and nipple appearance and position, with minimal scarring. The breast may be reconstructed after mastectomy (breast removal) or other breast trauma such as breast cancer treatment. Breast reconstruction can involve autologous tissue transfer (sometimes called “flap” surgery), breast implant placement, breast augmentation using breast implants, latissimus muscle flap breast reconstruction, transverse upper gracilis breast flap, or a Pedicle Sternal Flap (PSF), all accomplished by plastic surgeons.

Breast Augmentation Surgery

Breast augmentation is a cosmetic surgery designed to add volume and shape to your upper body using implants. Each breast can be augmented independently, or both at the same time. Some people opt for a more natural-looking augmentation that just increases the fullness and projection of their breasts without going too large, while others choose to have a dramatic size increase in order to fit the proportions they want. It’s important to note that breast augmentation is done through an incision in the breast tissue, unlike reconstruction where the skin is closed over the implant.

Breast augmentation can be done under local or general anesthesia. After being numbed, you will have a small incision in your crease where the surgeon inserts an implant through a pocket he creates for it under your pectoral muscle. The implant may be placed under or over the muscle. If it is going under, your surgeon will make a larger incision and work from there

Breast Implants and Surgery

Breast implants are breast-shaped devices that can be inserted into your breast to increase its size. They’re usually made of silicone, but there’s also a saline implant option. Saline breast implants are filled with a saltwater solution instead of silicone, but they work the same way.

There are three basic types of breast implants: two-piece gel-filled implants; three-piece saline-filled “soft” implants; and three-piece silicone-gel-filled “hard” implants.

Breast implant surgery is usually an outpatient procedure.

You will be given anesthesia, either general or local (similar to putting dental anesthesia), and breast implants are inserted under the breast tissue or placed above the muscle. If you already have breast implants, they can remain in place, but some surgeons prefer to remove them for safety reasons. Your breasts are then wrapped in gauze dressings.

The breast surgery recovery process typically takes about one to two weeks, but recovery is different for every woman. You will most likely experience some pain or discomfort that can be relieved by medication or ice packs. Your breast implants may feel firm and sore, but you should not have any bleeding, skin discoloration, or blood spots under your breast fold.

Since breast implants are composed of a silicone shell filled with either saline solution or silicone gel, they will feel different from breast tissue. But breast implants do not interfere with the function of your breasts and should not affect how often you need to breastfeed or express milk for an adopted baby.

Breast Lifts

Breast lift surgery is a cosmetic procedure that can improve the shape and position of sagging breasts. Women may choose breast lift surgery to make their breasts appear higher, firmer, more youthful, healthier, improving breast symmetry, or because they are asymmetrical due to breastfeeding. Symptoms for breast sag are inability to wear certain clothing without embarrassment or discomfort; difficulty finding bra cup size or style that fits both her current bra size and the desired outcome after planned surgery; the desire to use particular types of bras – including sports bras – simply for reducing pain from breast weight; difficulty with nipple soreness or sanitary conditions due to breast weight; or difficulties with breast cleavage.

Breast Reduction

Breast Reduction Surgery is a surgical procedure that reduces breast size for women, who feel their breasts are too big than desired. It involves the removal of breast fat, glandular tissue, and skin to relieve the discomfort. The weight reduction is achieved by breast repositioning, nipple reshaping, and breast lift.

Benefits of Breast Augmentation Surgery

Standard Benefits:

  • You’ll have breast implants that are natural-looking and feel more comfortable.
  • Your breast size will be proportional to your body type.

Emotional benefits:

  • You’ll feel more confident wearing clothes that show off your chest area.
  • You’ll feel more attractive and desirable.
  • Your breast size will match your body proportionately, so you can gain weight in other areas of your body without having an uneven breast size

There are many reasons why breast augmentation is a good choice for improving your self-image. Breast augmentation can help you feel more confident and attractive, which can boost your self-esteem. Additionally, breast augmentation can make you feel more feminine and confident in your appearance.

Risks Involved with Breast Surgery 

As with all medical procedures, there are risks associated with breast surgery. However, you won’t know exactly what those risks are until you talk to your doctor and ask questions about the procedure. You may be wondering what kind of risks apply to breast surgery. Some of the more common complications include:

Infection

Your incisions will be cleaned regularly during recovery in order to prevent infection from occurring after surgery. The risk for infection is very low, but — as always — it’s important to take care of yourself properly after your operation so that something like this doesn’t happen

Scarring

This is another common side effect of surgery. Your scars will fade with time, but the location of your incisions means that it will take years for them to completely disappear.

Numbness

If you experience numbness around your nipples after breast surgery, this could be due to nerve damage during the procedure. This problem can usually be fixed with surgeries if necessary

Recurrence of cancer

Although doctors do everything they can to prevent a recurrence, some women who undergo lumpectomy or mastectomy may still later develop cancer in their other breast or nearby lymph nodes.

However, most cases of these complications are very rare. The benefits far outweigh the risks when it comes to breast surgery; it’s just important that you talk to your doctor about your situation before making any decisions.

After Breast Surgery

What happens after breast surgery depends on the type of procedure you undergo; some procedures require more recovery time than others. Regardless, you’ll need to take it easy after getting breast surgery in order to prevent further complications and allow your body to heal properly. You can’t drive or lift anything heavy for a few weeks, so hire somebody to help with household chores if necessary! Your doctor will discuss pain management options with you; make sure that you take this information seriously and ask questions if there’s anything that isn’t clear to you.

Breast Surgery Clinic Dubai: How much Does a Breast Lift Cost in Dubai?

The cost of breast surgery varies depending on the type of procedure you choose. However, you can expect to pay between AED 18,650 (USD 5000)  and AED 36,370 (USD 10000) for breast surgery. It’s important to remember that the cost of breast surgery may vary depending on your situation. So if you’re considering breast surgery, be sure to ask your surgeon about the cost involved.

Breast Surgery in Dubai

It is important to understand the risks and benefits of breast surgery before you make a decision on what type of procedure may be best for your situation. Breast augmentation surgery  and breast reconstruction can help people with tissue loss from mastectomy, lumpectomy or previous surgeries get back their breasts after cancer treatments like chemotherapy and radiation therapy. The cost of a breast lift in Dubai varies based on several factors including whether it’s bilateral (both breasts) or unilateral (one).

Understanding all potential consequences will help ensure that any decisions made about surgical procedures are well-informed ones; we hope this article has helped provide some clarity into how surgeons view these issues so they can better inform patients considering them as an option.

Cocoona is the best breast surgery clinic in Dubai – you’ll experience the very best in patient care from beginning to end. Our doctors are at the forefront in providing cosmetic surgery for all your needs. Start your journey to a more confident you today.

Contact us  now so you can schedule your consultation and start your journey!

Dr. Sanjay Parashar

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December 14, 2021

The Difference Between Chemical Peel vs Laser

Do you want to look young again? Skin rejuvenation techniques like chemical peel and laser skin treatment are the best options to consider.

But between chemical peel vs laser treatments, which is better?

Both procedures aim to counter the signs of aging and improve your facial appearance. But determining which one between chemical peel vs laser is better can’t be done easily. The success of either cosmetic procedure heavily depends on your skin type, the frequency of the treatment, and the expertise of the specialist conducting the treatment.

Here’s a breakdown of their similarities and differences to help you assess which treatment to undergo.

Chemical peel vs laser – Treatment description

Here’s a brief description on what the two skin rejuvenation treatments do.

What is chemical peel?

Chemical peel is a cosmetic procedure wherein a chemical solution is applied to target areas to remove their top layers, thus promoting the growth of new skin cells. Chemical peel can be done in different depths, namely light, medium, and deep. Deep chemical peels have a more lasting effect but take longer to recover from.

What is laser treatment?

An alternative to chemical peel is laser treatment, or what’s also called laser resurfacing. Instead of chemicals, a high-precision laser is used to improve skin appearance and texture.

There are two kinds of laser skin resurfacing methods: ablative and non-ablative. Ablative laser skin treatment is designed to deal with wrinkles, warts, and scars. Non-ablative lasers don’t remove skin layers but instead use pulsed light, pulse-dye, or fractional beams to deal with spider veins, rosacea, and acne.

Chemical peel vs laser – Differences and similarities

●    Process

Laser peel uses short, concentrated beams to tighten the skin. Chemical peels utilize acids or chemicals of varying strengths to remove the top layers of the skin. So for sensitive skin, the alternative to chemical peel may be better because it doesn’t use components that may cause adverse reactions when they contact the skin.

●    Purpose

Laser peel can treat sun damage, brown spots, and scars. Some deep wrinkles can be improved with laser treatment like the vertical folds forming on the mouth. Laser peel results in tighter and smoother skin for a generally younger appearance.

On the other hand, chemical peels are effective in reducing wrinkles and pores. Acne scars, sun damage, age spots, discolorations, and pigmentations can be treated with chemical peels.

For best results, several sessions may be required for either procedure.

●    Intensity

Both chemical peels and laser skin treatments have different levels of intensity and penetration depth. The higher the intensity, the more lasting the results are.

The intensity level of the laser can be adjusted to achieve the desired results. Between ablative and non-ablative laser skin treatments, the latter is less invasive.

●   Side effects

So, which is safer between chemical peel vs laser? Both cosmetic treatments pose a risk of infection. Risks can be minimized by following post-operative instructions from your doctor.

Lasers and chemical peels help rejuvenate the healthy, youthful glow of the skin. Additionally, either procedure doesn’t cause harm to the body, which is why they’re very popular with first-time patients and repeat customers who want to experience little discomfort during and after the procedure. Still, there may be some side effects that you should consider before undergoing either of these treatments.

Some pain may be felt during and after the skin treatments. The intensity of pain varies depending on the intensity of the laser and your pain tolerance.

A topical numbing cream may be applied by your doctor an hour before the procedure. This will reduce the discomfort you might feel during the treatment. Stronger numbing treatments may be given for more intense sessions.

You might see changes in the skin tone on treated surfaces. Scabbing, scarring, and reddened skin might persist for weeks after the skin has healed.

Between chemical peel vs laser, which is more susceptible to damage from sun exposure? Both cosmetic treatments require that you avoid direct sunlight exposure to produce the best results.

  • Benefits

Both chemical peel and laser treatment rejuvenate the skin by removing the old layers and promoting collagen production.

Laser peel is superior to chemical peel when it comes to precision and controllability. It’s the better option for diminishing fine lines. It also has better effects on deep collagen remodeling. It can also minimize sagging without damaging the skin. Laser peel results typically last longer than chemical peels because the former penetrates deeper into the skin.

●    Effectiveness of treatment

A light or superficial peel produces results that generally last between 1-2-month. Results of a medium peel typically last up to 6 months. Chemical and laser peel results with the deepest level of penetration can last for years.

●    Cost

When it comes to cost between chemical peel vs laser, the former wins. Chemical peels are cheaper compared to laser resurfacing treatments.

The cost of light chemical peels starts at around USD 100, while deep chemical peels can be as much as USD 4,000.

Ablative laser peel costs around USD 2,000, while it’s half the price for the non-ablative version.

However, for chemical peels to achieve the same effect as laser treatments, extra patience is required because it will take several sessions for the best results.

●    Recovery period

Between chemical peel vs laser treatment, the latter heals faster. But in general, the healing process for laser peel treatments may take around 1 to 3 weeks, depending on the intensity of the procedure. Medium peels take around 10 days on average to recover, but redness may last up to 2 weeks.

Can you combine chemical peel and laser treatments?

Some people have tried undergoing chemical peel a few weeks before doing laser treatments. They said it produced better results than just getting either of the skin rejuvenation procedures.

Before combining skin treatments, consult your doctor first to know whether your body can handle it without producing adverse effects.

Which is the best treatment for your skin?

When choosing between chemical peel vs laser treatment, consider your skin type and goals for undergoing either procedure. Examine the pros and cons of each procedure and see which of them is better in resolving your skincare problems. Next is to review your beauty goals to assess which of the skin treatments will get you the best results.

Last, but not least, get only the best doctor to conduct the procedure. Trust only a clinic that has a solid history of producing great outcomes when it comes to chemical peels and laser skin treatments. In the Middle East, the best institute for cosmetic treatments is Cocoona.

We offer facial skin treatments designed to make you look younger again. The procedures are handled by renowned, board-certified experts like Dr. Sanjay Parashar who is one of the most celebrated plastic surgeons in the world. Here at Cocoona, we’ll improve the look and feel of your skin using only the latest technology and advancements in skin science to deliver the best results.

Contact us today to know more about the wide range of cosmetic treatments we offer or to book an appointment with your preferred doctor.

Dr. Sanjay Parashar

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November 17, 2021

CoolSculpting: Is It Permanent?

From muffin tops and love handles to bra bulges, these stubborn fat pockets are one of the most difficult to get rid of no matter how much you exercise. Because it is composed of fatty deposits, these tissue cells remain in the body for a long time even after we’ve lost weight. Getting rid of these fat pockets for good could only mean undergoing major fat reduction surgeries, but not until CoolSculpting came along!

CoolSculpting treatment can help you get rid of these stubborn fat cells producing similar results as a lipo, but without the surgical process and downtime. It sounds too good to be true, so it is no wonder many would skeptically ask – is CoolSculpting permanent? Read on and find out more about the coolest fat reduction technology there is!

What is CoolSculpting?

Also known as Cryolipolysis, CoolSculpting treatment is an FDA-approved, non-surgical, fat reduction, and body contouring treatment. With the help of cooling panels, the treatment works by freezing fat cells in areas carrying excess fats, thereby breaking down those fat cells that are unable to withstand very low temperatures. These fat cells are gradually eliminated from the body naturally.

CoolSculpting is used to target specific areas that are prone to stubborn fat pockets such as the:

  • abdomen
  • love handles (flanks)
  • under bust/bra line bulges
  • back fats
  • thighs
  • banana rolls (under the buttocks)
  • neck jowls
  • upper arms

How Does CoolSculpting Work?

CoolSculpting is a non-surgical fat reduction technique that involves the use of a cooling panel to generate controlled, constant temperature at the treatment area. It’s typically done as an outpatient procedure.

The first stage of the process is to use cool gel packs over the treatment region to protect the skin’s surface. CoolSculpting applicators are flat plates with vacuum suction that are used to cool down the treatment area using a non-freezing gel. The vacuum-like device is then carefully passed over the targeted fat cells causing them to break down. After which, the process is usually followed by a gentle massage of the treated area to avoid leaving any lumps or bumps behind after the CoolSculpting treatment.

In general, the entire CoolSculpting treatment is not painful at all, even for those with low pain tolerance. Some may feel slight discomfort when being cooled down, which usually lasts about 30 minutes to an hour, depending on how thick the fatty tissues are under your skin.

Benefits of CoolSculpting Treatment

Cryolipolysis has steadily gained popularity since its FDA approval in 2010, with those that have been availing this procedure making up to hundreds of thousands yearly. No wonder since CoolSculpting has many benefits, including:

  • Removes fat without surgery.
  • Targets specific fatty areas that are difficult to eliminate naturally.
  • Results can be seen after the first treatment, while optimal results can be achieved after multiple treatments that can be done within two or three months apart, depending on the body type.
  • Compared to fat reduction surgeries like liposuction, CoolSculpting is much easier on the pocket.
  • There is no need for anesthesia and each treatment only lasts about an hour on average.
  • It has no major side effects and is not painful so it is safe to be done even for those with low pain tolerance.
  • The treatment is non-invasive with no downtime whatsoever so you can go back to work immediately after the procedure.

Is CoolSculpting Safe?

CoolSculpting is a non-invasive form of fat reduction that has been used safely by thousands of people across the world. Because it only targets fatty cells, you can be confident that it will not cause any serious damage or side effects.

During the process, you may experience tugging, pulling, mild pinching, intense cold, tingling, stinging, aching and cramping at the treatment area. This will eventually subside as the area turns numb. Temporary redness, swelling, blanching, bruising, firmness, tingling, stinging, sensitivity in the area of treatment, and feeling of fullness in the back of the throat (after a treatment in the neck region) are all common temporary side effects.

In the rare event that your skin becomes inflamed after treatment, there is no need to be overly concerned since this is usually only a temporary response owing to the sensitivity of the skin.

Who Is A Good Candidate For CoolSculpting?

With its FDA clearance and clinically proven outcomes, you can be sure that the CoolSculpting technology is a safe procedure for individuals who want to get rid of stubborn fat cells without having to go under the knife.

However, not everyone is suited for CoolSculpting treatment so it’s best to consult with a trusted board-certified doctor first before getting the treatment done just to make sure that this is right for you and will produce the results that you want.

It is best to have realistic expectations about getting rid of stubborn fat. CoolSculpting is not intended to produce immediate results which is why it’s usually done in a series of treatments. Your doctor will usually assess how many treatments are necessary to see satisfactory results, depending on your body type and condition.

You should know that even though CoolSculpting is an excellent option for those wishing to have a contoured body but are not ready to go through surgical procedures, it is not a substitute treatment for weight loss.

So Is CoolSculpting Permanent?

All things considered, perhaps the best thing about CoolSculpting is its long-term effect as fat cells will continue dying off after every treatment session, which means you can achieve permanent fat reduction after multiple sessions. This is also why it is important to maintain a healthy lifestyle such as eating right and regularly exercising so that the results can be maintained long term.

The results may be gradual but are permanent as long as you maintain a well-balanced lifestyle. With CoolSculpting treatment and the help of board-certified physicians, you can finally get rid of those pesky fat pockets without any problems at all!

Non-Surgical Body Contouring Solutions at Cocoona Dubai

If you’ve been looking for a straightforward and non-invasive method to get rid of fatty areas on your body, the CoolSculpting technology in Cocoona Dubai may be the solution you’ve been searching for.

At Cocoona Dubai, CoolSculpting is one of the few body contouring treatments that actually has lasting results over time. For more information about CoolSculpting Treatment in Dubai, call us on 800-362636 or +9714 3884589 or complete the appointment form or email: hello@cocoona

Dr. Sanjay Parashar

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September 1, 2021

Dental Health: Tips on Caring for Children’s Teeth

Speaking as a Dubai pediatric dentist, I really cannot emphasize this enough: caring for your children’s teeth is just as important when keeping track of their overall health, and good dental habits should be established from the onset.

More often than not, parents underestimate the importance of good dental hygiene practices starting from infancy. Perhaps there is a thinking that baby teeth are still temporary and it is fine to not maintain them that religiously yet, which is very wrong.

As parents, setting good dental habits at a very early age is a great start to ensure that our children will have healthy teeth and gums as they reach adulthood and that they will carry these habits throughout their lifetime. In principle, there is no such thing as too early when we are talking about kids’ dental hygiene.

Understandably, caring for children’s teeth can be a little taxing especially if you are unsure where or how to start. Read on and learn some fundamental advice and tips from Dubai pediatric dentists on caring for children’s teeth.

Infancy Stage: From 0 to 12 months old

  • Remember, just because there are no teeth yet doesn’t mean you can skip any form of dental cleaning. Babies are typically born with their first teeth already set in their jaws. Although every child is different, the first teeth would usually start to come out by the 6th
  • During the infancy stage, clean your baby’s gums by wiping them with a soft damp cloth or gauze pad. Using an index finger, gently run the cloth all over the gums. Cleaning should be done at least twice a day.
  • Once the first tooth or set of teeth erupts, you can switch the damp cloth with a soft-bristle baby toothbrush, or a finger toothbrush.
  • If your baby feeds during bedtime or naptime, make sure to clean their teeth afterward, even if they have fallen asleep.
  • Avoid introducing any sweets just yet, such as juice or other flavored drinks.
  • If your baby uses a soother or pacifier, never put any kind of sweetener on it.
  • Make sure to sterilize everything that is put in your baby’s mouth such as soothers and bottle nipples to rid them of bacteria that may cause tooth decay.
  • Finally, take your baby to their first pediatric dentist appointment in their 12th month, at the latest. Ideally, a dental checkup should be done within 6 months after their first tooth erupted.

Toddler Stage: From 1 to 3 years old

  • Perhaps there is no better time to teach kids dental hygiene practices than the toddler stage. Anything that you teach them at this stage and repeated over and over again can be carried on in the years to come, teeth brushing habits included!
  • Remember that children imitate adults around them, so parents should be good role models when it comes to brushing their teeth too! Train your child to brush their teeth on their own by showing them the proper way of doing it. Still, supervise them well and finish it off in case there are spots or food particles that they missed.
  • By the time they are 3 years old, children would usually have about 20 teeth on average. The dental floss should then be introduced as soon as any two teeth meet and touch.
  • During this stage, you may start to use fluoride toothpaste. A small smear to not more than a grain-sized amount should suffice. Make sure to teach your child not to swallow the toothpaste.
  • There is no need to rinse off the toothpaste after brushing so the fluoride can remain and work to its best effect.
  • Brushing should be done at least two times a day, and not less than 2 minutes each time. Instill in them the daily habit of brushing their teeth before bedtime.
  • Regularly check for any signs of tooth decay. Look out for chalky spots or brown discoloration, and give your pediatric dentist a visit if you see one.
  • It is best to wane your child off the bottle and pacifier during this age period as well. It is not a good habit to let them fall asleep with a bottle of milk or other drink as this can cause tooth decay.

Preschooler Stage: From 3 to 5 years old

  • The amount of fluoride toothpaste can be increased to not more than a pea-sized amount.
  • Even when they have learned to brush on their own, you should still make sure to check that they are doing it properly and that all surfaces have been covered.
  • Parents should help with flossing as this could still be quite a challenge for toddlers.
  • Aside from brushing at least two times a day, also teach them to rinse their mouth after snacking to make sure there are no food particles stuck in their teeth for long periods.
  • It is during this age period that some kids would feel like brushing their teeth is such a chore for one reason or another. To make sure that they keep up the habit, make dental hygiene a fun activity for your kids so they can actually look forward to doing it! One of the things you can do is to give them the freedom to choose the toothpaste flavor that they like or a toothbrush design and color that they prefer. When brushing their teeth, use a timer or play a song that is timed just right, so they don’t rush it. You can also give them some form of a reward when they keep up their great dental habits.

6 years old and beyond

  • Upgrade your child’s toothpaste to one that contains not more than 1,500ppm of fluoride, or upon your pediatric dentist’s recommendation.
  • At this age, they should be able to independently brush on their own, however, it’s still best to check from time to time if they are doing it properly. Make sure they are flossing diligently too!
  • Typically, the primary or baby teeth will start to fall out at around 6 years of age, and gradually be replaced by their permanent teeth as the years’ progress. On average, one would have a full set of 32 adult teeth by their 20th

Fundamentally, it is the first 6 years or so that are crucial in developing your children’s good dental hygiene. It is this time that they have their primary teeth which are prone to tooth decay due to their thin enamel covering. It is important to take great care of your kids’ primary teeth as they will eventually guide the permanent teeth into their correct positions.

Good Dental Hygiene: Make It A Habit

Indeed, good habits that are formed during childhood make all the difference. It is up to us parents to instill good dental hygiene in our children from the onset so they can have the best and healthiest smiles as they grow.

Here are a few more guidelines to keep in mind to keep your children’s teeth healthy:

  • Avoid letting your child eat too much candy or sugar-laden foods, as well as sugary drinks as these are common causes of cavities
  • Instill healthy eating habits and consuming healthy foods that are rich in calcium which is vital in maintaining your children’s healthy teeth
  • Ensure to choose the right, age-specific toothbrush for your child
  • Replace a toothbrush regularly and do not use it for longer than 4 months
  • Keep the toothbrush squeaky clean by rinsing them thoroughly after use, and storing them upright to dry well
  • It is best to replace a toothbrush after having the flu to make sure there is no virus or bacteria left over
  • Finally and most importantly, take your child to dental visits regularly, usually every 6 months.

Dubai Pediatric Dentists at the Cocoona Center for Aesthetic Transformation

Choosing the right pediatric dentist is an important consideration for your child’s comfort. Children should be able to get to know their dentist and click with them well so they can look forward to every visit, instead of fearing it.

When choosing a Dubai pediatric dentist, look no further than Cocoona, The Center for Aesthetic Transformation. We care for your children’s dental health as much as you do, and we make sure that every child’s visit to our clinic will be met with a welcoming and comfortable environment.

At Cocoona’s Dental Clinic in Dubai, our enthusiastic pediatric dentists are highly experienced and trained in pediatric dentistry, and are passionate about their mission to making every child’s dental visit a fun and engaging one.

With us, make your child’s visit to the dentist as comfortable and worry-free as possible. Book a free consultation now.

Dr. Sanjay Parashar

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August 16, 2021

Getting Braces? Here’s What You Need To Know

Gone are the days when having dental braces is seen as one of the classic symbols of puberty as commonly portrayed on movies and TV shows. That braces-laden middle school graduation photo was probably the ultimate portrayal of the days of awkward past.

Not anymore though! In this day and age, having dental braces is now widely accepted. Getting braces is not just for kids of pre-puberty age anymore. Adults, celebrities, and models even get dental braces at typically any age. It has become so widely popular that some even go as far as considering it a fashion statement.

No matter the evolution in their reputation, dental braces still serve the same purpose as has always been. Aside from the self-image boost of having an aesthetically pleasing smile, aligned teeth also equip you to prevent cavity and tooth and gum diseases. Dental braces also help to fix misaligned jaws or bad bites (underbite, overbite, or crossbite) that could lead to several dental-related impairments such as tooth loss or chipping, and even speech disorders.

If you are considering getting braces or think that your child needs it, read on so you can equip yourself with essential information of what to expect before, during, and after getting dental braces.

Before Getting Braces: The Low-Down

  • Know that there are now different types and makes of dental braces that you can choose from. First is the good old, traditional metal brace. Another is its ceramic version, which serves as a good camouflage due to its appearance and color being the same as teeth. There’s also the lingual brace, which is typically the same make as the traditional metal, only that it is placed on the inner or tongue side of the teeth. If you prefer a removable and trendy option to teeth alignment, then an invisible aligner or Invisalign is the way to go which works as a clear plastic tray custom-shaped to your teeth.
  • Getting dental braces in Dubai starts at 10,000AED (3,000USD). The final cost varies with each person, as it will depend on the severity of misalignment, which also often determines if you will need additional extractions or related procedures, as well as the type of dental braces you choose to have. Investing in dental braces is a hefty cost, however, most clinics offer friendly financing options. In some cases, health insurance plans even cover a portion of the cost.
  • The entire process of getting braces is not as easy as 1-2-3. An orthodontist will have to do a thorough assessment of your case. Before the actual installation of the braces to your teeth, you may have to undergo several procedures first such as an x-ray, extraction of 1 or more teeth to create the ideal space for movement, or a palate expansion to widen the jaw. Again, each case is different so you can expect your orthodontist to walk you through the whole process.
  • It’s understandable to feel scared thinking of how painful it will be, but it is wise not to panic and just manage your expectations from the onset. We have different pain tolerance levels, after all. To some, the pain during the installation of braces is very mild, the sort of pain that you can easily manage with an over-the-counter pain reliever pill. To others, there is no pain at all, but just a feeling of discomfort and pressure while the orthodontist is doing the twists and turns of the installation process.
  • The application of the braces itself takes no longer than 2 hours on average, however, there is no definite answer as to how long you will need to have your braces on. It can go anywhere from 8 months to 2 years, even longer. The treatment duration is dependent on each case’s severity, and there are times when your orthodontist will recommend extending according to how the alignment process is responding.


Life With Dental Braces: From Adjustment Pains to Normalcy

  • As with any new experience, the first few days after getting dental braces will be one heck of an adjustment period. Put simply, it will be uncomfortable. You will talk differently and with a lisp. Your lips will pout. The inner portion of your mouth will suffer from abrasions from the metal before they get trained to toughen up. The list goes on. The silver lining is: it will get better as you eventually adapt and get used to it. Before you know it, you won’t even feel like it’s there at all.
  • Your choices of food and how you eat them will have to adjust as well. Steer away from foods that are too hard, chewy, sticky, and stringy. This does not mean that you’ll have to survive on smoothies alone, but in general, you will have to be mindful before eating anything that might get stuck or cause damage to your brackets.

  • That being said, having braces means taking your brushing and flossing to a whole other level. Food will definitely get stuck in one way or another, so it is wise to bring a handy dental kit with you all the time. Brushing and flossing with braces is basically a skill, with all that nook and cranny you have to get into. However, as with any other skill, you’ll learn to be an expert in no time.
  • In many ways, having dental braces is a commitment. For one, dental braces adjustment is done on a regular schedule, usually every four weeks. During your routine check-up, your alignment progress will be checked and tightening adjustments will be done. This process can be uncomfortable to some in the hours or days after, but nothing that can’t be relieved with ice, cold drinks, or pain relievers.

Life After Braces: It Will Be Worth It

  • Do know that after getting your braces off, you will still have to wear retainers to secure that your newly aligned teeth will stay put. You may also consider having your teeth whitened afterwards as having brackets for a long period of time may cause some uneven discoloration.
  • One thing is for sure, nothing compares to the feeling after you’ve had your braces taken off. The first look in the mirror will feel like looking at a completely different person. Earning a smile that you can be proud of and feel your absolute best is unlike any other. All the pains you went through will be absolutely worth it.

Get Your Dental Braces in Cocoona Dubai

All other things considered, one of the most important things that you have to know before getting braces is to make sure to choose an orthodontist that will be with you every step of the way on your dental braces journey.

When looking for where to get dental braces in Dubai, look no further than Cocoona Center for Aesthetic Transformation. Our dental clinic is fully equipped with modern and advanced facilities, as well as highly experienced orthodontists. Get the best advice and book a consultation with us.

Dr. Sanjay Parashar

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July 29, 2021

Everything About Emerald Laser – Non Surgical Weight Loss

Weight loss treatments often belong to the most sought-after cosmetic procedures worldwide. Even those who undergo a strict diet and exercise regime sometimes need a procedure to help them eliminate stubborn fats that cannot be removed through natural means. For overweight individuals, liposuction is often excluded from the options because the treatment is not meant to help them reduce weight as an alternative to exercise.

But what if there is a way to lose weight through a cosmetic procedure without the need for diet or exercise? What if there is an advanced, non-surgical weight loss treatment that is like a magic wand that can make your waistline, thighs, arms, and hips smaller in one go? 

Through the Emerald Laser technology, it is possible to remove fats even for those who are considered obese.

What Is Emerald Laser?

Emerald Laser is the latest technology for non-surgical weight loss approved by the FDA. It can be done on the whole body, removing even the most stubborn fats. Additionally, it targets multiple regions in the body and not just a single area like other existing fat removal procedures.

The procedure is called Emerald Laser because of the green light it emits during the treatment. Known weight loss cosmetic procedures remove fat in specific areas to create the desired contour. With the Emerald Laser, the goal is to reduce overall body circumference.

Emerald Laser is a low-level laser therapy (LLLT) commonly used for acne treatment. It got FDA clearance in 2010 for whole-body fat reduction services, which means the technology has been tried and tested to work for non-surgical weight loss procedures.

If you have a Body Mass Index (BMI) of more than 30, you can enjoy the benefits of this non-surgical weight loss treatment. It is a practical way to start losing weight because it provides visible results that can encourage you to maintain the achieved figure.

How It Works

The procedure is done by pointing the green, cold laser through the skin, breaking down and shrinking fatty tissues. The fat cells are then moved away naturally from the body through the lymphatic system, several weeks after undergoing the treatment.

When the laser reaches the fat cells, it forces the cells to develop pore-like openings. These openings are where fatty liquid seeps out, causing the cells to shrink. The shrinking fat cells become visible as the targeted area of the laser also gets smaller, resulting in a slimmer waist, arms, or thighs.

The treatment is fast and simple. You will be requested in our office to lie down as we point the lasers to the target areas. Once on, the green laser will pass through your skin, penetrating the fat underneath it to start the breakdown process. The whole process will take only 30 minutes to complete, so you can go back to your normal activities without any side effects.

Advantages Over Other Weight Loss Treatments

  • Zero downtime

Emerald Laser procedure requires zero downtime after the treatment. You can instantly go back to your usual routine without any side effects.

  • Painless

The procedure is non-surgical and uses a cold laser for a completely painless procedure. Traditional liposuction, while minimally invasive, can still cause trauma to the tissue, which is why discomfort or pain is often associated with the treatment during the recovery period.

  • Quick results

The Emerald Laser promises an average of 6% reduction in overall body circumference after the broken down fats have been removed from your body. This can significantly boost your confidence and morale to continue with your weight loss regime because of the noticeable fat loss.

  • Versatile 

Other weight loss treatments can only be done on certain areas of the body. On the other hand, Emerald Laser can be applied to specific fatty areas and also on larger parts of the body. 

Comparison With Existing Fat Removal Procedures

Emerald Laser has a huge advantage over other weight loss aesthetic treatments because it can be done on people diagnosed to be obese, exceeding a BMI of 30. Liposuction and other fat removal procedures cannot be done on those who are overweight. Liposuction is not an alternative to diet but is designed to remove excess and stubborn fats that cannot be burned through exercise.

How about CoolSculpting? CoolSculpting is another popular, non-invasive, and non-surgical weight loss cosmetic treatment. However, it can cause slight discomfort during treatment compared to Emerald Laser. Additionally, results appear later with CoolSculpting, and more sessions may be required to achieve the best results.

Emerald Laser is also different from radiofrequency lipolysis as the latter uses heat to destroy the fat cells. It is also different from ultrasound-assisted liposuction like Vaser Hi-Def treatment since this one uses ultrasonic waves to kill fat cells. 

Frequently Asked Questions

  • How effective is Emerald Laser?

A study was conducted by Harvard on the efficiency of the technology that powers Emerald Laser. Those who received the treatment lost an average of 3.51 inches on their waistline, thighs, and hips, all within 2 weeks. Some clients even lost an average of 5.9 inches over four weeks after the procedure. All the results were observed without any change in lifestyle or diet.

  • Who can undergo Emerald Laser treatment?

Men and women who want to trim down their overall size through a non-invasive, non-surgical weight loss procedure are welcome to try what Emerald Laser has to offer. It is best if your BMI is under 30, although the treatment can also be done on those with a higher BMI ratio. 

  • Where can I apply Emerald Laser?

Emerald Laser is often requested to be done on the abdomen, hips, and thighs since these areas carry the most fats and produce the most significant outcomes when treated. The chest, back, legs, and neck can also be treated with green laser light.

  • How long will it take before I see the results?

Results of the Emerald Laser treatment will start to appear over the next 4 to 12 weeks. This is the time your body needs to carry away the fatty liquid extracted through the treatment. During this period, you will slowly observe your body changing as your waistline gets slimmer, your arms more toned, and your thighs more compact. 

It may take around 6 to 8 treatment sessions to achieve the desired results. So long as you commit to the lifestyle plan we will provide, which includes proper diet and exercise, you will see your body transform without any problem.

  • How much will it cost me?

Regarding costs, Emerald Laser treatment is way cheaper than CoolSculpting. A session of CoolSculpting will cost you around AED 4,700 (USD 1,300), and you will most likely need multiple sessions to achieve the desired results. On the other hand, the cost of Emerald Laser starts at AED 6,200 (USD 1,700), and that is for the whole package.

Note: Prices indicated are only estimates. Exact pricing will depend on your requirements. Contact us for more details on this.

Where To Get Emerald Laser Treatment in Dubai?

Cocoona Clinic Dubai is the leading clinic for cosmetic procedures in the Middle East. We cater to international clients, receiving thousands of requests for our services annually.

Our solutions for cosmetic, dental, orthopedic, weight loss, and wellness are backed by state-of-the-art technologies in the field to make sure the services we provide are safe and effective. Our team is composed of highly qualified doctors, counselors, nurses, and technicians. We provide world-class pre- and post-surgery care, giving you a luxurious, high-end treatment to make you feel comfortable and relaxed throughout the whole treatment process.

During your initial consultation with us, you should tell us about the image you want to attain. If you do not have a specific picture in mind or a reference for your beauty goals, we can provide suggestions on the best way to make you look better. We will give you a personalized treatment plan including lifestyle changes that will help you maintain your new form.

If you are unsure about your eligibility to undergo the treatment, do not be afraid to consult with us. Our cosmetic specialists can evaluate your situation and provide you with the best course of action to make you look better.

Dr. Sanjay Parashar

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March 2, 2021

From autumn to spring we normally see colds, flu, aches and pains and a collection of seasonal nasties in clinical practice; no matter what discipline you practice in. if you have a non-thermal low-level laser, now is the time to put it so good use for you, your family, staff and clients. Have a read of this open literature review and see what conclusions you can draw. Given that this is 2020, this review leads with what’s topical, the evidence however is far reaching

This paper looks at the available research on using Non-thermal Low-Level laser as a therapy (NTLLLT), to improve and maintain a good immune response and is based on evidence, mindful of the current world situation in relation to Covid-19 and suggests that NTLLLT may be a viable intervention at this time for viral related seasonal nasties. This paper is not claiming the NTLLLT is a cure for Covid-19 or any disease, it’s merely based on what the evidence suggests.

Two strains of the new coronavirus that are spreading around the world, according to an analysis of 103 cases. But the World Health Organization insists that “there is no evidence that the virus has been changing”, viruses are intelligent and constant change and evolve.

Viruses are always mutating, especially RNA viruses like coronavirus SARS-CoV-2, and others. When a person is infected with the coronavirus, it replicates in their respiratory tract. Every time it does, around half a dozen genetic mutations occur, says Ian Jones at the University of Reading, UK.

When Xiaolu Tang et al at Peking University in Beijing studied the viral genome taken from 103 cases, they found common mutations at two locations on the genome. They identified two types of the virus based on differences in the genome at these two regions: 72 were considered to be the “L-type”(newer type), and 29 were classed “S-type” (older type).

A later analysis by Xiaolu Tang suggests that the L-type was derived from the older S-type. The first strain is likely to have emerged around the time the virus jumped from animals to humans, (anecdotally, there is a belief among some clinicians and members of the public, that this is not possible). The second type emerged soon after that species jump, according to Xiaolu et al. Both, we know, are involved in the current global outbreak. The fact that the L-type is more prevalent suggests that it is “more aggressive” than the S-type, the team say1.

Oxford Brookes University’s Ravinder Kanda, in the UK. Suggests that,  “The L-type might be more aggressive in transmitting itself, but we have no idea yet how these underlying genetic changes will relate to disease severity,”  Erik Volz at Imperial College London, in the same article says “I think it’s a fact that there are two strains” say “It’s normal for viruses to undergo evolution when they are transmitted to a new host.  The differences between the two identified strains are tiny.”

Coronaviruses are naturally hosted and evolutionarily shaped by bats and have been with us for a very long time. Indeed, it has been postulated that most of the coronaviruses in humans are derived from the bat reservoir. It is vital to know how many strains of the virus exist.

Coronaviruses were discovered in the mid 1960s by Tyrrell and Bynoe. The earliest discovered were an infectious bronchial virus in chickens and two in human pediatric patients who had what it was thought to be a common cold.  This was later named human coronavirus 229E and human coronavirus OC43. Other coronavirus type have been identified, these being, SARS-CoV in 2003, HCoV NL63 in 2004, HKU1 in 2005, MERS-CoV in 2012, and SARS-CoV-2 (formerly known as 2019-nCoV) in 2019. Most of these have involved serious respiratory tract infections.

Coronaviruses are large pleomorphic spherical particles with bulbous surface projections that look like a crown (corona). The diameter of the virus particles is around 120 nm. The envelope of the virus in electron micrographs appears as a distinct pair of electron dense shells.

The viral envelope consists of a lipid bilayer where the membrane, envelope and spike structural proteins are anchored. A subset of coronaviruses, specifically the members of Beta Coronavirus subgroup A, also have a shorter spike-like surface protein called hemagglutinin esterase (HE). Inside the envelope, there is the nucleocapsid, which is formed from multiple copies of the nucleocapsid protein, which are bound to the positive-sense single-stranded RNA genome in a continuous beads-on-a-string type structure or conformation. The lipid bilayer envelope, membrane proteins, and nucleocapsid protect the virus when it is outside the host cell.

Around the world, multiple groups are working on a vaccine for the virus. Any vaccine will need to target features that are found in both strains of the virus in order to be effective. Most promisingly, two drugs given together to treat HIV – called lopinavir and ritonavir – are already approved for human use, and in small trials they seemed to reduce disease severity and fatalities in people infected by the SARS or MERS coronaviruses (by reduction in the viral load). Doctors in Wuhan, the centre of the outbreak, have already started a randomised controlled trial of lopinavir and ritonavir. Covid-19 contains a strange HIV-like mutation that may make it more contagious and give it properties not found in other coronaviruses.

Based on what we know of HIV treatments and the links that have been drawn to it and the COVID-19 virus, it could be argued that the use of Non-thermal Low-Level Laser would have the same effect on coronavirus (by load reduction), as on HIV. Reactive species are frequently formed after viral infections. Antioxidant defences, including enzymatic and nonenzymatic components, protect against reactive species, but sometimes these defences are not completely adequate.

Oxygen radicals and nitric oxide (NO) are generated in excess in a diverse array of microbial infections. Emerging concepts in free radical biology are now shedding light on the pathogenesis of various diseases15, 16. Free‐radical induced pathogenicity in virus infections is of great importance, because evidence suggests that NO and oxygen radicals such as superoxide are key molecules in the pathogenesis of various infectious diseases. Although oxygen radicals and NO have an antimicrobial effect on bacteria and protozoa, they have opposing effects in virus infections such as influenza virus pneumonia and several other neurotropic virus infections.

An imbalance in the production of reactive species and the body’s inability to detoxify these reactive species is referred to as oxidative stress.

There is strong evidence which suggests that HIV-1 infected patients are under chronic oxidative stress, as are most viral infected patients. Thus, ROS has been suggested to be responsible for many aspects of HIV-1 pathogenesis such as increase viral replication, reduced immune cell proliferation, loss of immune function, and sensitivity to drug toxicity and chronic weight loss. Furthermore, excessive production of ROS can result in oxidation of proteins, peroxidation of lipids (seen in COVID-19), and eventually cell death. Non-thermal Low-Level Laser Therapy (NTLLLT), can improve the activity of antioxidant enzymes through a photochemical process that accelerates the elimination of ROS. This can be achieved at a molecular level by altering the conformation of antioxidant enzymes. A study conducted by Yang et al showed that LLLT (532 nm) can enhance the activity of anti-oxidant enzymes and also induce production of more ROS, with the amount produced dependent on the dose of the laser irradiation. Lugongolo et al in their paper on the treatment of HIV-1 suggest the use of 660 nm and also refer to a blue laser.

Non-thermal low-level lasers offer a collection of wavelengths, 400nm (blue violet), 530 nm (green), and 630 nm (red) and above. Lugongolo et al refer to similar frequencies.

Lugongolo et al, demonstrated the effects of laser irradiation in HIV-1 infected and uninfected TZM-bl cells. In addition, they showed that uninfected TZM-bl cells were stimulated by laser irradiation, while the effects of both HIV-1 infection and irradiation had detrimental effects on the cells. The TZM-bl cell line used in this study is a HeLa cell clone containing the CXCR4, CD4 and CCR5, which are host cell molecules the virus uses to gain entry into cells and making TZM-bl cell line permissive to HIV-1 infection. The TZM-bl cell line also contains a Tat-responsive firefly luciferase gene under the control of HIV-LTR, which gets expressed during HIV infection.

Herpes zoster, also known as shingles, produces a painful vesicular rash that results from the reactivation of the varicella zoster virus (VZV) treated with 632 nm responds in a similar way to HIV when irradiated using NTLLLT at 660 -880 nm. Both of these viruses respond to NTLLLT. 405 nm laser has also been investigated in the treatment of viral conditions.

An early study in 1991 by Skobelkin et al; performed preoperative NTLLLT on selected cancer patients undergoing palliative surgery. The levels of T-lymphocytes, T-helpers and Tsuppressors were assayed for the 7 days following the surgery, as were immunoglobulin levels, specifically IgA, IgM and IgG. The levels of blood-borne leukocytes, lymphocytes and monocytes all rose after laser therapy. Significantly increased levels of activated Tlymphocytes and helper T-cells were seen, with a significantly lower number of T-suppressors especially by the fifth post NLLLT day. Increased levels of IgA and IgG were seen by the second day, with a sharp reduction to almost normal levels by the fifth day. IgM levels rose slowly over the first four days, then rose sharply on the fifth day and maintained a high level during the period of the study. Skobelkin et al, proposed that these were all indications of a strong photoactivated immunological response, and boosting the competency of the immunocompetent systems of these long-term cancer patients. The high levels of IgG, especially cytotoxic for tumoural cells, has also been associated with a corresponding rise in killer T-cells. the antigen which would normally trigger these reactions was shown to be absent in all patients, thus the reaction was entirely photoactivated. Skobelkin et al, did not report any activation of tumoural remnants following LLLT, which has been of major concern to many researchers.

It could be concluded that utilising NTLLLT in in a proactive way, as a support to immunity, could be generally beneficial to the population, and in so doing give an immune boost to protect from the seasonal nasties. Consider it as a laser flu shot or an immune infusions. Our bodies have everything we need for a happy healthy life, all we sometime lack is the energy to be well, NTLLLT bring the energy to our cells that they need and can use to boot our immunity.

 

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  3. Goldsmith CS, Tatti KM, Ksiazek TG, Rollin PE, Comer JA, Lee WW, et al. (February 2004). “Ultrastructural characterization of SARS coronavirus”. Emerging Infectious Diseases. 10 (2): 320–6. doi:10.3201/eid1002.030913. PMC 3322934. PMID 15030705.
  4. Fehr AR, Perlman S (2015). Maier HJ, Bickerton E, Britton P (eds.). “An Overview of Their Replication and Pathogenesis; Section 2 Genomic Organization”. Methods in Molecular Biology. Springer. 1282: 1–23. doi:10.1007/978-1-4939-2438-7_1. ISBN 978-1-4939-2438-7. PMC 4369385. PMID 25720466. See section: Virion Structure.
  5. Neuman BW, Adair BD, Yoshioka C, Quispe JD, Orca G, Kuhn P, et al. (August 2006). “Supramolecular architecture of severe acute respiratory syndrome coronavirus revealed by electron cryomicroscopy”. Journal of Virology. 80 (16): 7918–28. doi:10.1128/JVI.00645-06. PMC 1563832. PMID 16873249. Particle diameters ranged from 50 to 150 nm, excluding the spikes, with mean particle diameters of 82 to 94 nm.
  6. Lai MM, Cavanagh D (1997). “The molecular biology of coronaviruses”. Advances in Virus Research. 48: 1–100.

doi:10.1016/S0065-3527(08)60286-9. ISBN 9780120398485. PMID 9233431.

  1. de Groot RJ, Baker SC, Baric R, Enjuanes L, Gorbalenya AE, Holmes KV, Perlman S, Poon L, Rottier PJ, Talbot PJ, Woo PC,

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Dr. Sanjay Parashar

Non-Thermal-635nm-Low-Level-Laser-Therapy-in-Pre-Diabetes-and-Obesity-Management.jpg

March 2, 2021

Background

Pre-Diabetes and pre-obesity often go hand in hand. Diabetes mellitus (DM) is a chronic condition that can alter our carbohydrate, protein, and fat metabolism. It is caused by the absence of insulin secretion due to either the progressive or marked inability of the β-Langerhans islet cells of the pancreas to produce insulin, or due to defects in insulin uptake in the peripheral tissue. DM is broadly classified under two categories, which include type 1 and type 2 diabetes.

Body mass index has a strong relationship to diabetes and insulin resistance. In obese individuals, the amount of non-esterified fatty acids (NEFA), glycerol, hormones, cytokines, proinflammatory markers, and other substances that are involved in the development of insulin resistance, is increased.

The pathogenesis in the development of diabetes is due to the β-islet cells of the pancreas becoming impaired, causing a lack of control of blood glucose. The development of diabetes becomes more inevitable if the failure of β-islet cells of the pancreas is accompanied by insulin resistance. Weight gain and body mass are central to the formation and rising incidence of type 1 and type 2 diabetes.

In conclusion, new approaches in managing and preventing diabetes in obese individuals must be studied and investigated based on the facts. True Non-Thermal Low-Level Laser (TNTLLL)may form part of the solution.

The association between type 1 diabetes and weight gain was first investigated by Baum et al in 1975. The Baum et al study suggested that there was an association related to overfeeding or to hormonal dysregulation.

Overweight and obesity are defined by an excess accumulation of adipose tissue which impairs both physical and psychosocial health and well-being. Obesity is considered a health disaster in both developed and developing countries.

The increased prevalence of obesity in the current climate has drawn attention to the worldwide significance of this problem. In the US, approximately two-thirds of the adult population is overweight or obese and similar trends are being noticed worldwide. Obesity is linked to many medical, psychological, and social conditions, the most devastating of which may be type 2 diabetes. At the start of this century, 171 million people were estimated to have type 2 diabetes, and this figure is expected to increase to 360 million by 2030. The figures from the World Health Organisation show that around 422 million people worldwide have diabetes, with the majority living in low-and middle-income countries, and 1.6 million deaths are directly attributed to diabetes each year. Both the number of cases and the prevalence of diabetes have been steadily increasing over the past few decades. A comparison of the two sets of statistics shows just what a combined problem these two conditions represent. The Pharmacoeconomics, not to mention the associated costs on health services is staggering. In 2016 the estimated burden of diabetes on healthcare infrastructure was 825 Billion USD. There are no published figures for 2020, but it is estimated to be more than a trillion USD.

The Study

The study enrolled 140 men and women between the ages of 18 to 70 with a body mass index (BMI) of 27 to 45. This was a 24 month study including follow up. Participating subjects were randomised in a double-blind fashion to receive non-thermal low-level laser. The study was set up as below.

Non-esterified fatty acids (NEFA) are molecules released from triglycerides by the action of the enzyme lipase and are transported in the blood bound to albumin. They contribute only a small proportion of the body’s fat; however, provide a large part of the body’s energy. Measurement of NEFA is important in diabetes where insulin deficiency results in the metabolism of fat. Levels are also frequently increased in obese patients.

Subject sample

Active Subjects Placebo Subjects Total Subjects
70 70 140

Subject demographics

Gender

Group Male Female Total
Active 35 (50%) 35 (50%) 70 (50%)
Placebo 37 (53%) 33 (47%) 70 (50%)

Age

Group Active Placebo Total
Mean 50.13 49.24 49.69
SD 9.78 9.78 9.76
Range 35 – 65 33 – 70 33 – 70

A t-test for independent samples reported a difference of 0.89 years between randomized subjects to the active and placebo treatment groups to be not statistically significant (t=+0.54, p=0.59; p>0.05).

All subjects involved in this study were recommended and referred by their medical team and had to be pre-diabetic and pre-obese or obese and not taking medication for these conditions.

Treatment device.

The low-level laser energy device is a non-invasive dermatological aesthetic treatment cleared by the FDA for use as a non-invasive aesthetic dermatological treatment for reducing the circumference of hips, waist, and thighs and is manufactured by Erchonia Corporation, USA. The LLLT device consists of four independent diodes that are positioned 120 degrees apart and tilted at a 30-degree angle. A fifth diode is positioned at the centreline.

The 17mW of red 635nm of laser light emitted from each diode is collected and processed through a proprietary lens that redirects the beam with a line refractor. The refracted light from each diode is bent into a random spiralling circle pattern that is independent of the other diodes. These overlapping patterns ensure total coverage of the target treatment area. The total amount of energy delivered to the skin during each treatment as stated in the FDA clearance was 3.94J/cm2. Evidence however suggests that this is not relevant as the laser delivers photonic energy via electromagnetic energy transfer.

Procedure.

Each subject was randomised to receive 20 active or sham treatments 2 per week, equally spaced apart with the low-level energy laser device over a 10 week period. Both the active and sham devices have the same physical appearance and emit light when activated that is indistinguishable to both the subject and the administration investigator. All subjects had moderated exercise sessions after each treatment, and another on a day of their choice. Nutritional plans were also moderated for compliance.

Study assessments.

The circumference of each participant was measured using a flexible tape measure pre- and post- each application at 3 points; the base of the circumference at sternum, the circumference at the umbilicus, and again at the trochanter.  For accuracy at remeasuring post treatment, a skin marker was used under the tape at several points so the measurements were duplicated. These points were recorded at baseline to ensure that subsequent measurements were obtained at the same location. All measurements were performed by a member of the investigative team not involved in performing the actual treatments. All subjects were photographed from front, sides and back with hands on head.

The primary outcome measure was the number of subjects accumulated BMI and the total decrease achieved. Individually the three combined measurement points after each session were recorded. Blood glucose was also measured each week along with weight and other

variables such as sleep quality and energy levels. Secondary outcomes assessed at the completion of the study included changes in BMI, associated diabetes risk, obesity levels and several subjective ratings, which measured subject attitudes about overall satisfaction with their results and improvements in the appearance.

All study assessments were performed at baseline, at the completion of treatment, and two weeks post-treatment. Following the baseline physical examination, a blinded investigator noted any changes in existing skin condition including scars, cellulite, stretch marks, discoloration, stria, dimpling, skin quality and elasticity following treatment. Details about food and drink consumption, physical activity, and adverse events for each subject were recorded daily. Further follow ups were recorded every 12 weeks primarily for the first 18 months from inception, then extended over the 5 year period. The study is now concluded.

Ethics.

The protocol used in this study adhered to the Good Clinical Practice guidelines and was approved by the local ethics committee in April 2015. The study was overseen by colleagues in the diabetes assessment unit at the local university hospital.   Informed written consent was obtained from each subject prior to participation in any study-related activities.

Laser Diode Placement

The diodes are placed over the lateral flanks and around the umbilical area. The treatment was performed for 20 minutes and is repeated for a further 20 minutes, with the participant repositioned. A more comfortable method for a heavier subject is for them to lay on their side and the diodes positioned accordingly to cover half of the midsection, the subject then repositions to the other side.

Rational

To find an alternative to the current interventions for diabetes, obesity and associated conditions, to reduce the overall economic burden, and to improve quality outcomes and quality of life for sufferers.

Baseline variables

BMI

Group Active Placebo Total
Mean 5.09 5.62 5.35
SD 1.65 1.80 1.74
Range 3.1 – 8.8 3.1 – 9.1 3.1 – 9.1

A t-test of independent samples found the 0.53 difference in baseline Total Cholesterol between subjects randomized to the active and placebo treatment groups to be not statistically significant (t=-1.82, p=0.071; p>0.05).

Throughout the study all participants had their blood pressure, cholesterol and blood sugars monitored. Changes in behaviour were also considered as was sleep patterns, changes in energy levels and general skin appearance. A glycated haemoglobin test (HbA1c) was taken every 12 weeks.

Total Cholesterol

Group Active Placebo Total
Mean 5.09 5.62 5.35
SD 1.65 1.80 1.74
Range 3.1 – 8.8 3.1 – 9.1 3.1 – 9.1

A t-test for independent samples found the 0.53 difference in baseline Total Cholesterol between subjects randomized to the active and placebo treatment groups to be not statistically significant (t=-1.82, p=0.071; p>0.05).

HbA1c

Group Active Placebo Total
Mean 6.46 6.46 6.86
SD 0.18 0.16 4.70
Range 5.52 – 6.66 5.2 – 6.61 5.2 – 6.66

There is no difference (0 points) in baseline HbA1c between subjects randomized to the active and placebo treatment groups.

Comparisons across evaluations

The following evaluations of study variables were made:

  1. Baseline (pre-treatment)
  2. End of Treatment
  3. Follow-up

The following analyses evaluate the change in evaluations for each study measure across the three evaluations, as applicable.

BMI

BMI Baseline Treatment End Follow-Up
Active               Mean 33.41 30.54 25.86
                             SD 2.67 2.35 1.39
Placebo            Mean 33.57 31.86 36.40
                             SD 3.16 3.12 1.86

As this is a simple inhouse study, the information shared would benefit from more testing within a full RTC. The lead researcher and his team maintained strict protocols throughout this study (see appendix 1).

A one-way ANOVAs for 3 correlated samples was conducted to evaluate change in BMI across the study duration within each of the active and placebo treatment groups, with results as follows:

Active Group

There is a statistically significant difference in BMI ratings across the study evaluation duration for active group subjects (F=563.65, p<0.001). Subsequent Tukey Analysis revealed the statistically significant differences to have occurred between the following evaluations, at p<0.01:

  • Baseline to Treatment End
  • Baseline to Follow-Up
  • Treatment End to Follow-Up

Placebo Group

There is a statistically significant difference in BMI ratings across study evaluation duration for placebo group subjects (F=93.71, p<0.001). Subsequent Tukey Analysis revealed the statistically significant differences to have occurred between the following evaluations, at p<0.01:

  • Baseline to Treatment End
  • Baseline to Follow-Up
  • Treatment End to Follow-Up

In summary, both active and placebo subject groups evidenced a statistically significant decrease in BMI from pre-treatment to treatment end evaluation. However, while both groups likewise evidenced statistically significant changes in BMI from treatment end to follow-up evaluation, this change was in the direction of a statistically significant mean decrease for active group subjects and a statistically significant mean increase for placebo group subjects. By follow-up evaluation, active group subjects evidenced a mean decrease in BMI of 7.55. In contrast, placebo group subjects evidenced a mean increase in BMI of 2.83 across the same evaluation period.

Furthermore, while a t-test for independent samples found a 0.16 difference in baseline (pre-treatment) BMI between active and placebo subject groups to be not statistically significant (p>0.05), the 10.54 difference in BMI between active and placebo groups at follow-up evaluation was seen as statistically significant (p<0.0001).

HbA1c

HbA1c Baseline Treatment End Follow-Up
Active               Mean 6.46 5.66 4.68
                             SD 0.18 0.20 0.40
Placebo            Mean 6.46 6.10 9.56
                             SD 0.16 0.26 1.67

A one-way ANOVA for 3 correlated samples was conducted to evaluate change in HbA1c across study duration within each of the active and placebo treatment groups, with results as follows:

Active Group: There is a statistically significant difference in HbA1c ratings across study evaluation duration for active group subjects (F=797.77, p<0.0001). Subsequent Tukey Analysis revealed the statistically significant differences to have occurred between the following evaluations, at p<0.01:

  • Baseline to Treatment End
  • Baseline to Follow-Up
  • Treatment End to Follow-Up

Placebo Group: There is a statistically significant difference in HbA1c ratings across study evaluation duration for placebo group subjects (F=274.79, p<0.0001). Subsequent Tukey Analysis revealed the statistically significant differences to have occurred between the following evaluations, at p<0.01:

  • Baseline to Follow-Up
  • Treatment End to Follow-Up

In summary, similarly to the BMI findings, both active and placebo subject groups evidenced a decrease in HbA1c from pre-treatment to treatment end evaluation, although the decrease was only statistically significant for the active treatment group at p<0.01. However, while both groups evidenced statistically significant changes in HbA1c from treatment end to follow-up evaluation, this change was a statistically significant decrease for active group subjects and a statistically significant increase for placebo group subjects. By follow-up evaluation, active group subjects evidenced a statistically significant mean decrease

in HbA1c of 1.78 relative to baseline. In contrast, placebo group subjects evidenced a statistically significant mean increase in HbA1c of 3.10 across the same evaluation period.

Furthermore, while there was no difference in baseline (pre-treatment) HbA1c between active and placebo subject groups (both 6.46), the 4.88 difference in mean HbA1c between active and placebo groups at follow-up evaluation was statistically significant in favor of a significantly lower HbA1c for active group subjects relative to placebo group subjects (p<0.0001).

Total Cholesterol

Total Cholesterol Baseline Follow-Up
Active               Mean 5.09 3.53
                             SD 1.65 0.50
Placebo            Mean 5.62 5.76
                             SD 1.80 1.49

T-tests for correlated samples were conducted to evaluate change in total cholesterol across the study duration for each of the active and placebo treatment groups, with results as follows:

Active Group

T=10.11, p<0.0001. There is a statistically significant 1.56-point decrease in total cholesterol ratings from pre-treatment to treatment follow-up evaluation for active group subjects.

Placebo Group

There is no change in total cholesterol ratings from pre-treatment to follow-up evaluation for placebo group subjects (t=-1.32, p=0.19; p>0.05), with the 0.14-point increase being not statistically significant.

Furthermore, while there was no statistically significant difference in baseline (pre-treatment) total cholesterol between active and placebo subject groups (p>0.05), the 2.23-point difference in mean total cholesterol between active and placebo groups at follow-up evaluation was statistically significant (t=-11.89, p<0.0001).

Blood pressure

Blood pressure was recorded at baseline (pre-treatment), treatment end, and follow-up.

At baseline, blood pressure readings for all subjects in both the active and placebo groups were within the Hypertension Group 1 or Group 2 category.

Across treatment end and follow-up evaluations, all 70 subjects in the active treatment group demonstrated a progressive improvement (lowering) in blood pressure readings, and 12 active group subjects had lowered their blood pressure reading to within the pre-hypertension range by follow-up evaluation.

In contrast, there were no notable improvements in blood pressure readings for any of the 70 placebo group subjects from pre-treatment to follow-up evaluation, and no placebo group subject recorded a blood pressure rating below the Hypertension Stage 1 category at follow-up evaluation.

Sleep quality: P, A, I, G, E.

The P, A, I, G, E sleep quality scale used in this study is provided below.

P = You take more than 30 minutes to fall asleep after you get into bed.

You regularly wake up more than once per night.

You lie awake for more than 20 minutes when you wake up in the middle of the

night.

Feel tired quickly upon wakening.

A = You take less than 30 minutes to fall asleep after you get into bed.

You wake no more than once per night.

Your sleep is restless and your bed is tossed when you awaken.

Feel tired midday.

I = You take less than 20 minutes to fall asleep after you get into bed.

You wake no more than once per night.

You return to sleep quickly but sleep light.

Feel tired in the afternoon.

G = You fall asleep quickly after you get into bed.

You wake occasionally in the night.

You return to sleep quickly if you do awaken.

You seldom feel tired in the day.

E = You fall asleep quickly after you get into bed.

You do not wake in the night.

You awaken naturally and feel refreshed.

You never feel tired in the day.

Therefore, progression from ‘P’ through ‘E’ represents improvement in sleep quality.

Below is a summary of the percentage of subjects in each of the active and placebo groups, respectively, who rated their sleep quality on this scale as ‘P’, ‘A’, ‘I’, ‘G, or ‘E’ at each of the three evaluations.

Active Group Baseline Treatment End Follow-up
P 30 (43%) 1 (1%)
A 29 (41%) 12 (17%)
I 37 (53%) 9 (13%)
G 11 (16%) 12 (17%) 13 (19%)
E 9 (13%) 47 (67%)

At basepoint evaluation, eighty-four per cent (84%) of active group subjects rated their sleep quality as ‘P’ or ‘A’ – the two poorest sleep quality categories. By Follow-Up evaluation, only one active group subject reported poor sleep quality, and each of the remaining active group subjects indicated improved sleep quality, with 86% of active group subjects reporting their sleep quality as ‘G’ or ‘E’ – the two best sleep quality categories.

Placebo Group Baseline Treatment End Follow-up
P 39 (56%) 20 (29%) 21 (31%)
A 24 (34%) 37 (53%) 19 (28%)
I 11 (16%) 13 (19%)
G 7 (10%) 2 (2%) 15 (22%)
E

Similarly to active group subjects, 90% of placebo group subjects rated their sleep quality as ‘P’ or ‘A’ – the two poorest sleep quality categories – at baseline evaluation. However, by Follow-Up evaluation, 59% of placebo group subjects continued to record a ‘P’ or ‘A’ rating compared with the single active group subject, and only 22% of placebo group subjects reported their sleep quality as ‘G’ or ‘E’ – the two best sleep quality categories at follow-up evaluation compared with 86% of active group subject – almost four times fewer.

At the end of the 10 week active phase, all the subjects in the active protocol had undergone 4 weeks of further monitoring in relation to their blood glucose levels, and 69 of them no longer presented as a diabetes risk. The control group however all remained on the diabetes index as being at risk at week 10 +4.  All subjects were encouraged to follow their established exercise routine and to foster their nutritional habits. Follow-ups were taken for 24 months.

In the control group 69 went on to develop diabetes and one died because of complications related to diabetes. Over time their weight increased. The female members of the group maintained reduced weight and cholesterol levels. All of the subjects continued with exercises and a reasonable diet.

Discussion

There is a growing body of research showing the benefits of NTLLL in the management of the human fat cell, pain management and neurological disorders but as yet there is no substantive research into the benefits of this technology in the management of obesity and diabetes. Weight contributed to rheumatoid arthritis, heart disease, osteoarthritis, is now a contributory factor in problems associated with the coronavirus. There are well recorded positive side effects associated with the use of NTLLL[i], and these effects need to be exploited. This is a simple inhouse study exploring the use of NTLLL at 635nm in pre-diabetes/pre-obese patients.  Can we do anything to reduce the potential development of diabetes?

Conclusion

Diabetes is potentially a life limiting condition and fraught with many comorbidities.  Patients may go on to develop issues with blood pressure, kidneys, neuropathies, and amputations. The list is practically endless. This study, though inhouse, has followed best practice in terms of RTC, and though it is not perfect, the evidence presented speaks for itself. NTLLL may have a place in the armament of treatments used to prevent and control what is one of the world’s biggest health issues. 65 out of 70 participants in the study who were pre-diabetic and pre-obese, and in a 10 week period, turned their lives around. Over a 5 year period they continued to improve and maintained the good habits they had formed on the study.  They were no longer a diabetes risk and were not obese, and they all had good cholesterol levels and no blood pressure issues. They are no longer a burden on the healthcare systems. Although further studies are required, NTLLL could have long lasting benefits for diabetes, obesity, and health generally.

 

Reference:

  1. Scheen AJ. Pathophysiology of type 2 diabetes. Acta Clin Belg. 2003;58(6):335–341.
  2. van Belle TL, Coppieters KT, von Herrath MG. Type 1 diabetes: etiology, immunology, and therapeutic strategies. Physiol Rev. 2011;91(1):79–118.
  3. Al-Goblan, A. S., Al-Alfi, M. A., & Khan, M. Z. (2014). Mechanism linking diabetes mellitus and obesity. Diabetes, metabolic syndrome and obesity : targets and therapy, 7, 587–591. https://doi.org/10.2147/DMSO.S67400
  4. Baum JD, Ounsted M, Smith MA. Letter: Weight gain in infancy and subsequent development of diabetes mellitus in childhood. Lancet. 1975;2(7940):866.
  5. Naser KA, Gruber A, Thomson GA. The emerging pandemic of obesity and diabetes: are we doing enough to prevent a disaster? Int J Clin Pract. 2006;60(9):1093–1097.
  6. Gallagher D, Heymsfield SB, Heo M, Jebb SA, Murgatroyd PR, Sakamoto Y. Healthy percentage body fat ranges: an approach for developing guidelines based on body mass index. Am J Clin Nutr. 2000;72(3):694–701.
  7. Arora S. Insulin Resistance. Rijeka, Croatia: InTech Europe; 2012. [Accessed September 26, 2014]. Molecular basis of insulin resistance and its relation to metabolic syndrome.
  8. Tsai AG, Williamson DF, Glick HA. Direct medical cost of overweight and obesity in the USA: a quantitative systematic review. Obes Rev. 2011;12(1):50–61.
  9. McKeigue PM, Shah B, Marmot MG. Relation of central obesity and insulin resistance with high diabetes prevalence and cardiovascular risk in South Asians. Lancet. 1991;337(8738):382–386.
  10. https://www.who.int/health-topics/diabetes#tab=tab_1
  11. https://www.hsph.harvard.edu/news/press-releases/diabetes-cost-825-billion-a-year/
  12. Farivar, S., Malekshahabi, T., & Shiari, R. (2014). Biological effects of low level laser therapy. Journal of lasers in medical sciences, 5(2), 58–62.

Dr. Sanjay Parashar

Understanding-Non-Thermal-Low-Level-Lasers-Its-not-all-about-penetration.jpg

March 2, 2021

Put simply, Non-Thermal Low-Level Laser (NTLLL) delivers energy to the mitochondria of cells. This energy is delivered as photons or light particles, and this process is referred to as electromagnetic energy transfer. The aim of this article is to provide a brief synopsis to help the reader understand electromagnetic waves (EMW) and NTLLL.

Electromagnetic energy is a type of energy that is able to travel at the speed of light, it is characterised as having both electric and magnetic fields.

From humble beginnings more than 100 years ago, EMR has become an important component of modern medicine. There is an urgent need for education and better understanding with respect to its principles and applications.

The application of this energy is not new, Endre Mester at the Semmelweis Medical University in Hungary understood its effect.  In 1998, Wilden showed the importance of low-level laser in the delivery of energy.  Wilden went on to say, “Depending on its wavelength, electromagnetic radiation in the form of light can stimulate macromolecules and can initiate conformation changes in proteins or can transfer energy to electrons. Low level laser from the red and the near infrared region corresponds well with the characteristic energy and absorption levels of the relevant components of the respiratory chain”. What he was talking about is Non-Thermal Electromagnetic Transfer via Light. NTLLL is a collimated, monochromatic, unidirectional beam of light from the visual light spectrum. The visible spectrum is the portion of the electromagnetic spectrum that is visible to the human eye.

When you take visual light from the electromagnetic radiation spectrum, depth of penetration in terms of NTLLL becomes totally irrelevant. It is not about penetration, it’s about the wave. The concept of a wave is very familiar to all of us.  We have all seen waves travel across the beach, some are short and fast, while others are fast and slower, and some are just ripples. Electromagnetic radiation/Visual light, is very much like that.

Electromagnetic radiation is part of our everyday lives.  These waves are penetrating our bodies 24 hours a day, 7 days a week, and they never stop. Life could not function without them. Electromagnet waves have many characteristics, and their two most fundamental are wavelength and frequency. Figure 1.1 shows a sinusoidal electromagnetic wave in general. The direction axis of the wave is marked by z this is sometime called the  k-vector. EM waves have two oscillating parts, one electric the

other magnetic (x and  y in the diagram). The magnetic field is at right angles to the electric field and vice versa.

As can be seen from the above diagram, the wavelength is the distance (nanometres nm) between two adjacent peaks or troughs. This distance is measured along the axis z.  How many times per second the wave oscillates is the frequency. EM waves pass through the body without causing any damage.

When we relate the above information to NTLLL, and the fact that they operate from the visual light part of the electromagnetic spectrum; they use minimal power to generating a stable laser beam, and this beam consists of an electromagnetic wave that passes through the body.  Depth of penetration is irrelevant.

There are hundreds of so called lasers out there, and some are lasers, whilst some are not. A True laser is a device that generates an intense beam of coherent monochromatic light (or electromagnetic radiation) by stimulated emission of radiation (photons) from excited atoms or molecules.  Any device claiming to be a laser must exhibit these qualities.

Our bodies rely on photons to maintain good health. Energy from photons or light particles can be absorbed or released by electrons. When an electron absorbs a photon, the energy can free the electron to move around, or the electron can release the energy as another photo. Biophotons are light particles that are generated within the body and are constantly radiated from the body surface. These spontaneous emissions are thought to be associated with generation of free radicals due to energy metabolic processes.

 

References:

  1. Chung H, Dai T, Sharma SK, Huang YY, Carroll JD, Hamblin MR. The nuts and bolts of low-level laser (light) therapy. Ann Biomed Eng. 2012;40(2):516‐ doi:10.1007/s10439-011-0454-7
  2. https://imagine.gsfc.nasa.gov/science/toolbox/emspectrum1.html
  3. Paweł Sowa, Joanna Rutkowska-Talipska, Urszula Sulkowska, Krzysztof Rutkowski, Ryszard Rutkowski, Electromagnetic radiation in modern medicine: Physical and biophysical properties, Polish Annals of Medicine, Volume 19, Issue 2, 2012,
  4. Hamblin MR. Photobiomodulation or low-level laser therapy. J Biophotonics. 2016;9(11-12):1122‐ doi:10.1002/jbio.201670113
  5. Wilden L, Karthein R. Import of radiation phenomena of electrons and therapeutic low-level laser in regard to the mitochondrial energy transfer. J Clin Laser Med Surg. 1998;16(3):159‐ doi:10.1089/clm.1998.16.159
  6. Sliney DH. What is light? The visible spectrum and beyond. Eye (Lond). 2016;30(2):222‐ doi:10.1038/eye.2015.252
  7. https://www.google.com
  8. Van Wijk R, Van Wijk EP, Wiegant FA, Ives J. Free radicals and low-level photon emission in human pathogenesis: State of the art. Indian J Exp Biol. 2008;46:273–309. [PubMed]
  9. Rastogi A, Pospísil P. Spontaneous ultraweak photon emission imaging of oxidative metabolic processes in human skin: Effect of molecular oxygen and antioxidant defense system. J Biomed Opt. 2011;16:096005.
  10. Srinivasan TM. Biophotons as Subtle Energy Carriers. Int J Yoga. 2017;10(2):57‐58. doi:10.4103/ijoy.IJOY_18_17

Dr. Sanjay Parashar

Botox.jpg

February 11, 2021

One of the earliest signs of aging is appearance of facial lines and wrinkles. While we cannot prevent aging, we can certainly delay the appearance of facial wrinkles and hence the visible signs of aging.

Face is a very dynamic part of our body. The muscles of the face can be divided into two groups: the muscles of facial expression and the muscles of mastication.  Interestingly, unlike other parts of the body, the muscles of the facial expressions are inserted in the skin. Normally, the muscles of facial expression communicate emotional states. Where as muscles of mastication are deeper in location and involved in the movement of jaws.

Fig: 1 Check the Dynamic lines appearing with different facial expressions

A permanent crease on the face can send an inappropriate message. A permanent glabellar crease (skin folds between the eyebrows) communicates anger or worry when the person feels neither.

Fig. 2

Many people in the course of normal activity over utilize certain group of facial muscles: thus the muscle is hyper-functional and over active. In some individuals these muscle gets bulkier.

FACT #1

Botox has been the #1 aesthetic procedure performed since 1999

Fig. 3

Movement or contraction of facial muscles result in development of skin folds that are are called Dynamic wrinkles. With time these dynamic lines become deeper and eventually develop into Static lines, which means the lines /creases remain in the skin even without making any facial expressions. If the dynamic lines are treated at an early stage development of static lines can be delayed. This is where Cosmetic Surgeons and dermatologist use Botox.

FACT #2

The FDA approved the use of BOTOX for Cosmetic in 2002

Fig: 4

What is Botox?

Botox is a neurotoxin derived from clostridial bacteria. It contains an active substance called botulinum toxin type A. It can be injected into the muscles or deep into the skin. It acts by relaxing the muscles by causing temporary paralysis of the muscles in which it is injected. When injected into the skin it works on the sweat glands to reduce the amount of sweat produced.

Botox and anti aging: Scientific evidence

Clinicians have observed a long-term and preventive benefit of botox for patients beyond muscle relaxation particularly in patients who receive repeated treatments over time. These changes include progressive reduction of wrinkles, prevention of dynamic wrinkles, and improvements in skin quality.

Humphrey S. Neurotoxins: Evidence for Prevention. J Drugs Dermatol. 2017;16(6):s87–s90.

Histometry of skin biopsy specimens before and after 3 months of BTX-A, showing significant increase in wrinkle width, rather than decrease in wrinkle depth (b) when compared to baseline biopsies (a) (H&E; Å~ 200).

Dermal collagen and elastin before and after 3 months of BTX-A. Immunoperoxidase staining of skin biopsy specimens for collagen types I (a, b) and III (c, d) and elastin (e, f) showing no significant difference in collagen types I and III and elastin content between baseline (a, c, e) and post-treated biopsies (b, d, f), but with better organization and more compact collagen fibers after BTX-A injection (b, d) (original magnification; Å~ 100).

Fig. 5

Ref : El-Domyati M, Attia SK, El-Sawy AE, et al. The use of Botulinum toxin-a injection for facial wrinkles: a histological and immunohistochemical evaluation. J Cosmet Dermatol. 2015;14(2):140–144.

Areas of the face that can be treated with Botox:  

Most commonly treated areas of the face are glabella/frown lines, the forehead lines and the crows feet. However, patients also request treatment of bunny lines on the nose, elevation of droopy eyebrows, under-eye lines, chin wrinkles, lip lines, drooping corners of the mouth, neck lines and cords and sometimes the definition of jaw lines.

Fig. 6

Fig. 7

Botox for Facial slimming.

Some individuals have heavy lower face due to enlarged jaw muscles and find themselves unattractive. They request for a slimmer and softer appearance of the face.  Botox injection in the masseter muscle (muscle of the jaw) helps in slimming down the lower third of the face. I also help in relieving teeth grinding and clenching known as bruxism. And thereby avoids TMJoint dysfunction. Below is an Asian male who had botox injected in the masseter muscle. The after picture of the patient shows slimming of the lower face with a softer look 10 days following the procedure.

Fig. 8

What is Nefertiti lift?

The procedure is named after the Egyptian queen with the perfect jawline. The technique aims to lift and improve the definition of the border and angles of the jaw, elevate the corners of the mouth and drape the skin of the jawline giving the visual effect of a ‘mini lift. Tiny amounts of Botox are injected into the muscles of the neck – specifically the ones that create a downward pull on the jawline.

Fig. 9

Botox for Gummy smile.

Some individuals have exposed gums when they smile due to overactive lip muscles. They are found in 10.5% to 29% of the population and are more common in females. For these individuals a small dose of botox at strategic locations around the lips can help in achieving their goals. The effect typically lasts for three to six months and must be repeated every six months to one year.

Fig. 10

BROTOX– Botox in men

Fig. 11

There is an increasing trend of Botox among men. Male patients who have tried Botox look better, feel better, and believe it gives them a competitive edge. There are significant differences in the outcome of injectables in women and men. We need to take into account each patient’s muscle mass, muscle fiber pattern and hair distribution. Due to greater muscle mass, men require higher doses of Botox than their female counterparts.

What is “Microbotox”/”Mesobotox” ?

It is a newer technique where smaller droplets of lesser concentrated botox is injected under the skin which acts on the sweat and sebaceous/oil glands along with superficial fibres of the facial muscles. It causes

  • Tightening of skin pores
  • Fresher look
  • Smoothing of fine lines
  • Subtle tightening of the skin
  • Improving texture and tone of the skin
  • Helps with facial flushing and sweating

 

Other indications for BOTOX:
There are other extended indications for Botox in medical management of patients. These are:

  • Upper and lower limb spasticity
  • Cervical dystonia
  • Blepharospasm
  • Strabismus
  • Urinary incontinence
  • Overactive Migraine
  • Axillary and palmar hyperhidrosis
  • Bruxism

 

What does a Botoxtreatment feel like?

Upon consulting the doctor and after the facial assessment, a realistic plan is laid out in tandem with the patients desire. The nurse removes all the makeup and applies numbing cream on the face for 20 minutes. After cleaning the numbing cream, with all aseptic precautions, botox is injected in the areas to be treated. These are tiny injections placed under the skin and in the facial muscle that needs to be relaxed using very thin needles. Pain depends upon individual’s level of threshold. Following which some ice is applied to reduce the swelling

Pre treatment Instructions:

  • Schedule your treatment at least 2 weeks in advance before a special event or vacation.
  • It is recommended to discontinue the use of aspirin, motrin, ginko biloba, garlic, flax oil, cod liver oil, Vitamin A, Vitamin E or any other essential fatty acids at least 3 days to 1 week before and after treatment to minimize bruising or bleeding.
  • Avoid alcohol, caffeine, niacin supplement, high sodium and high sugar containing foods, refined carbohydrates, spicy food and cigarettes 24 – 48 hours before and after your treatment.
  • Discontinue Retin A 2-3 days before treatment.
  • Wait at least 2 weeks to to have botox treatment if you had LASER, Ultrasound, chemical peels or microdermabrasion.

Post treatment instructions:

  • Do not lie down flat for at least 4 hours
  • Do not touch or rub the treated area for 4 hours
  • Avoid wearing hats and headbands immediately after the treatment.
  • Do not use of aspirin, motrin, ginko biloba, garlic, flax oil, cod liver oil, Vitamin A, Vitamin E or any other essential fatty acids at least 3 days to 1 week after treatment to minimize bruising or bleeding.
  • Avoid alcohol, caffeine, niacin supplement, high sodium and high sugar containing foods, refined carbohydrates, spicy food and cigarettes 24 – 48 hours after your treatment.
  • Avoid cosmetic treatment like LASER, Ultrasound, chemical peels or microdermabrasion for 2 weeks after the treatment.
  • Avoid make up until the day after treatment. Earlier use may cause pustules. If you must wear make up we recommend a good quality mineral make up for the face.
  • Should you develop increased pain, swelling, redness, blisters or itching please report to your provider.
  • Effect of botox takes about 2 – 10 days for its full effect. Touch up if needed should be done no longer than 2 weeks after the initial treatment.

 

SIDE EFFECTS:

Although generally safe, botulinum toxin side effects and complications can include:

  • Bruising and pain at the injection site
  • Flu-like symptoms
  • Headache
  • Nausea
  • Redness and swelling
  • Temporary facial weakness or drooping
  • It is very unlikely that the toxin might spread beyond the treatment area, causing botulism-like signs and symptoms such as breathing problems, trouble swallowing, muscle weakness and slurred speech

 

Contra-indications: Botox should be avoided if you suffer from one of the following conditions.

  • Infection at the site of injection
  • Past history of allergy to botulinum toxin/BOTOX
  • If you have had any surgery or injury that may have changed the muscle to be injected in some way
  • If you have had an operation or injured your head, neck or chest.
  • Disease affecting the nervous system: Peripheral motor neuropathy, Lou Gehrig’s disease
  • Muscle disorders: Myasthenia gravis/Lambert Eaton syndrome
  • Progressive muscle weakness with an underlying cancer
  • Double vision: condition where one object appears as two or more object
  • Blurred vision
  • Drooping of the upper eyelid
  • Pneumonia due to accidental inhalation of vomit: especially if you will be treated for persistent muscle spasms in the neck and shoulders
  • Decreased lung function and trouble breathing
  • Difficulty swallowing
  • Involuntary leakage of urine
  • Heart disease
  • Suffer from seizures
  • Closed angle glaucoma

 

How soon are the results visible ?

Effect of botox takes about 2 – 10 days ( 3-5 days on an average) for its full effect. Touch up if needed should be done no longer than 2 weeks after the initial treatment.

How long does the effect of Botoxlast?

individual patient’s genetics and the target muscle (mass, size, thickness, and depth below the skin and structure) determine really how long the effect of botox can last. In general, the effect lasts between 3 – 4months. The results may last longer for some patients, especially after repeated treatment. Studies have shown that in individuals who use their facial muscles a lot the effect of botox wears of faster.

About myself : I am a board certified Plastic surgeon with over 10 years of experience. I love beauty as much as science and research. So when beauty is backed with science it can only get real and that’s what we call as scientific beauty.  You can reach me at [email protected] for any further enquiries on botox. I will be happy to answer them for you.

Dr. Sanjay Parashar


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