Why I Combine Photobiomodulation with Regenerative Orthobiologics
Preparing the Biology of Healing Before and After Every Joint Procedure
One of the biggest misconceptions in regenerative medicine is that healing begins when the injection is performed. In reality, the injection is only one part of the regenerative process. The outcome depends largely on the biological environment into which those regenerative products are placed.
That philosophy is the foundation of the RegeneZone Method™. Rather than viewing regenerative orthobiologic procedures as a single event, I view them as a comprehensive process of preparing the body before treatment and supporting tissue repair long afterward. One of the most valuable tools I use throughout that journey is photobiomodulation (PBM).
Photobiomodulation uses specific wavelengths of red and near-infrared light to stimulate cellular metabolism without generating heat or damaging tissue. The recently published 2025 World Association for Laser Therapy (WALT) Position Paper reviewed more than 200 studies evaluating PBM in regenerative medicine and concluded that it consistently improves cell viability, proliferation, differentiation, angiogenesis, tissue regeneration, wound healing, and cellular communication. Remarkably, only 11 of the 204 studies reviewed failed to demonstrate a measurable benefit.
For me, these findings reinforce something I have believed for years: regenerative procedures work best when we first optimize the biology of healing.
Why Photobiomodulation Works
Every tissue in the body depends on energy to heal. Cells require healthy mitochondria, adequate oxygen delivery, proper circulation, controlled inflammation, and an intact extracellular matrix to repair damaged tissue effectively.
Photobiomodulation improves nearly every one of these variables.
According to the WALT review, PBM has been shown to:
Increase mitochondrial ATP production
Improve cellular metabolism
Enhance cell survival
Stimulate cellular proliferation
Increase migration into injured tissue
Promote angiogenesis
Reduce inflammatory cytokines
Increase secretion of regenerative signaling molecules
Accelerate tissue healing after regenerative procedures
The paper also demonstrated that PBM follows a biphasic dose response. More energy is not necessarily better. Most successful studies used relatively low therapeutic doses, particularly when the goal was enhancing cellular proliferation, highlighting the importance of using the correct wavelengths and treatment parameters rather than simply increasing power.
The Research Protocols
Although no single standardized protocol exists, the WALT review identified several consistent patterns across more than 200 studies.
The strongest evidence supports the use of:
Red Light
630–660 nm
Primarily for:
superficial tissues
collagen production
wound healing
fibroblast activity
cellular proliferation
Near Infrared Light
800–890 nm
Primarily for:
deeper joints
muscles
tendons
ligaments
cartilage
bone
peripheral nerves
Most successful studies delivered relatively low energy densities—generally between 0.5 and 5 J/cm², with 0.5–2 J/cm² commonly used when the goal was enhancing cellular proliferation. Importantly, repeated treatments consistently outperformed single treatments. Many investigators treated tissues daily or several times per week over a period of two to six weeks rather than relying on a single application.
To me, this is one of the most clinically important findings in the paper. Regeneration is not an event—it is a process.
My Clinical Protocol
This research closely mirrors how I have incorporated photobiomodulation into the RegeneZone Method™.
Rather than performing a single laser treatment in the office, I have patients use a cutting-edge handheld home photobiomodulation laser every day as part of their regenerative program.
For most joint procedures using HCT/P orthobiologic products, my protocol is straightforward:
Phase One: Biological Priming
Patients begin daily photobiomodulation four weeks before their procedure.
The objective is to:
reduce chronic inflammation
improve regional circulation
increase mitochondrial ATP production
optimize cellular metabolism
prepare the local tissue environment for regeneration
By improving the biology before the procedure, we are creating a healthier foundation for the regenerative products to perform their job.
Phase Two: Regenerative Procedure
Once the tissue has been biologically optimized, I perform an ultrasound-guided injection using the appropriate HCT/P regenerative product based on the patient's condition and treatment plan.
Phase Three: Recovery and Remodeling
Healing does not stop after the procedure.
Following the injection, patients continue using their handheld home photobiomodulation laser every day for another four weeks.
During this recovery phase, I also incorporate focused acoustic wave therapy, which I begin after the procedure as part of the remodeling process. Acoustic wave therapy improves local blood flow, stimulates angiogenesis, enhances mechanotransduction, and helps organize collagen during tissue repair. When combined with daily photobiomodulation, these therapies create an environment that supports continued healing throughout the critical remodeling phase.
The goal is not simply to perform an injection. The goal is to actively support regeneration every day during the weeks when healing is occurring.
Why This Matters
One of the most exciting findings from the WALT review is that photobiomodulation appears to enhance the release of extracellular vesicles and other regenerative signaling molecules. One study demonstrated more than a six-fold increase in extracellular vesicle secretion following photobiomodulation, suggesting that PBM may significantly amplify the communication pathways responsible for tissue repair.
The review also demonstrated improvements in:
angiogenesis
collagen remodeling
bone regeneration
tendon healing
muscle repair
nerve recovery
wound healing
modulation of inflammation
These findings reinforce my belief that regenerative medicine should focus as much on optimizing the tissue environment as on the biologic product itself.
My Philosophy
For years, I have said that regenerative procedures are only as successful as the biology receiving them.
That is why I spend so much time preparing the tissue before treatment and supporting healing afterward. Daily home photobiomodulation before and after the procedure, combined with focused acoustic wave therapy during recovery, allows regeneration to continue long after patients leave my office.
The procedure may take less than an hour.
Healing takes weeks.
My goal is to support that healing every single day.
That is the philosophy behind the RegeneZone Method™: optimize the biology first, support the regeneration continuously, and allow the body to do what it was designed to do—heal.
Reference
Azarsina M, Arany P, Marques MM, et al. Photobiomodulation for Stem Cell Modulation and Regenerative Medicine: WALT Position Paper 2025. Journal of Dentistry. 2025.
