Cosmetic surgery to remove unwanted fat, sometimes called "body sculpting," is big business. Almost 350,000 Americans underwent liposuction in 2008, according to the American Society of Plastic Surgery.

Consumers also want good results with quicker recovery and less pain.

This year, the Zerona low-level laser is being advertised as the newest noninvasive way to lose inches from hips, waist and thighs without surgery, anesthesia, pain or side effects. San Diego-area doctors are already using it and touting its benefits. And the cost is about half that of conventional surgical liposuction.

Is it a miracle ---- or too good to be true?

Laser treatment sounds high-tech, said Massachusetts dermatologist Eric Parlette, who has written a review article on laser-assisted liposuction. Lasers used to treat skin and eye diseases produce heat, and can cause skin burns or eye damage. Low power or "cold" lasers have no thermal effect on tissues and involve minimal risk in the hands of competent providers.

Laser-assisted liposuction employs a low-level laser inserted under the skin in a thin catheter to liquefy fat cells for easier removal. Different surgeons, Parlette noted, report everything from "significant enhancement to no difference from liposuction alone."

Approval for adjunct device

In 2004, the Food and Drug Administration approved a noninvasive external laser as an adjunct to liposuction, based on a small trial (70 patients) conducted by Erchonia, one of many companies working on low-intensity lasers. In half the patients, the laser was moved back and forth about 7 inches over the area to be treated for 12 minutes before liposuction. The other half had a bright, non-laser light shined over their skin before fat was removed.

Neither doctor nor patient knew who received the laser, but laser-treated patients reported significantly less pain and swelling, and surgeons often found the liposuction easier to perform.

Erchonia now markets the Zerona laser for "body slimming" using the external laser alone. Specific FDA approval has been sought based on further "research before marketing," according to company spokesman Charlie Shanks.

With the Zerona, five sources of low level laser light rotate over the area to be treated for 40 minutes every other day for two weeks. In Erchonia's study, thirty-five patients treated with the laser lost a combined total of 3.6 inches of circumference from their waist, hips and thighs, without pain or any adverse effects, and the response persisted on evaluation after two weeks. Thirty-two patients treated only with a bright light saw no change.

Be skeptical

This may sound too good to be true, and Shanks agreed that skepticism on the part of the consumer is healthy. "How can a red light that you don't feel do anything?" he asked.

And other doctors agree. Dr. Eric Ross, head of laser and cosmetic dermatology at Scripps Clinic, feels there is not enough data to endorse this treatment. "It's hard to believe that something harmless and without side effects is actually effective," he said. Long-term results are unknown, the number of patients treated is small, and this is only one study, funded by people with a vested interest in the outcome.

Because research is usually sponsored by the company promoting a particular device, studies rarely compare different treatment techniques. The FDA also allows companies to market medical devices substantially similar to already approved devices without additional patient studies.

San Diego dermatologist Julie Doyle noted that several previous noninvasive products proved disappointing, mentioning Velasmoothe, Velashape and Triactive (sold over-the-counter).

However, Doyle, who called herself a "skeptic about body sculpting," is one of the first to offer the Zerona laser in San Diego, and she said she found the results "very impressive." Her first 50 patients have lost, on average, a total of 5 inches in circumference for the areas treated, she said.

"It is safe to assume that you will not get the same results as liposuction," she said, because you are not removing the fat cells. External laser therapy appears to stimulate a pore in the fat cell, allowing the fat molecules to leak out and be absorbed by the body. It could be "a great alternative for someone who wants to avoid surgery," she said.

Coronado cosmetic surgeon Dr. Jeffry Schafer uses several liposuction techniques and also offers the Zerona laser. Of his first 20 patients, some have lost 11 inches or more total circumference, he said. The reduction will vary with the number of areas treated.

Both doctors emphasized that maintaining a healthy lifestyle is the key to long-term success. The initial program includes supplements of niacin or L-carnitine, extra fluids and the recommendation to walk 40 minutes a day. Cost averages $2,000 to $3,000, about half the cost of surgical liposuction.

Since cosmetic procedures are not covered by insurance, it is crucial to research the options. Chiropractors can offer noninvasive treatments but must be properly licensed and trained in the treatments they offer.

Cosmetic procedures such as liposuction are medical procedures, said Parlette. "When you shop around, look for expertise, the best skilled provider, not the cheapest price," he advised. "This is not like buying a purse."

A thorough consultation tailored to your particular needs is essential, said Schafer. Looking at before and after pictures from real patients helps keep expectations realistic. Results from cosmetic procedures cannot be guaranteed, Doyle added, and in the worst case, treatment may not work.

Parlette, who does not use Zerona, feels that while lasers have some effect, the results thus far are "not overwhelming."

"Lasers are not magic," he said, but the technology is constantly evolving. Still, he cautioned, "It's never wrong to be a skeptic."