Laser lipolysis can effectively treat obesity and its associated diseases, such as hypertension, fatty liver, and hyperlipidemia. However, currently available invasive laser lipolysis, which transmits laser to a fiber-optic catheter inserted into the subcutaneous tissue for irradiation through an incision, may cause hematomas, infections, and empyrosis. The current study presents a novel, noninvasive approach for laser lipolysis, which directly irradiates the intact skin surface without an incision and preferentially targets adipose tissue at the near-infrared band. High laser energy is necessary to damage adipocytes; however, this may carbonate and burn the dermis. Therefore, the introduction of skin cooling is essential to avoid unwanted hyperthermal injury and improve the threshold of radiant exposure. In the current study, we investigated a novel noninvasive approach assisted with skin cooling by establishing a homogeneous multi-layer skin model. In this method, light propagation in the skin was simulated by using the Monte Carlo method. Skin cooling was employed before laser irradiation to protect the epidermis from thermal damage, which was treated as a boundary condition based on Newton's law. The numerical results showed that the photons were deposited in the adipose layer more than in the other layers. Laser can effectively destroy adipose tissue at an energy density of >200 J/cm^2 at 1210 nm wavelength, whereas at least 300 J/cm^2 is required at 1064 nm to achieve the same effect. In this experiment, at >5 s pulse width, the selectivity of adipose was not obvious. Moreover, the results indicated that 60 ms R134a or R404a spray can effectively reduce the temperature of the epidermis. R404a exhibited a stronger cooling effect than R134a. Cold air cooling at -10 °C for 10 s could effectively decrease the skin temperature, and deeper cooling could be achieved by cold air cooling compared with cryogen spray cooling.
